Gulia A, Dhamija E, Kumar M, et al. Impact of Early Intervention in Pain Management in Cancer Patients: A Randomized Controlled Study in a Tertiary Care Cancer Hospital. Clin J Pain. 2021 Apr 1;37(4):259-264. doi: 10.1097/AJP.0000000000000919. (Original study)

OBJECTIVES: The present study aimed to assess the role of early intervention of nerve blocks in the management of cancer pain. We also aimed to study its effect on the quality of life and the opioid requirement.

MATERIALS AND METHODS: Sixty patients with cancer having pain, 18 to 75 years were randomised and divided into an intervention group and analgesic titration with opioids group. Patients in the intervention group received nerve block and residual pain managed with opioids. Control group patients were managed with opioids alone.

RESULTS: The mean visual analog scale score showed statistically significant improvement in both the groups (8.56±1.07 to 2.5±0.63 in the intervention group, 9.3±0.74 to 3.3±0.75 in the control group at 1 month (P=0.000). This was associated with a decrease in the opioid requirement in the intervention group at 1 week (P=0.014) with only 4 patients receiving morphine at the end of 1 month.The change in the Karnofsky scale was statistically significant from baseline to 1 month in both groups.

DISCUSSION: Interventional pain management has a definitive role in palliative setup for pain management. Pain relief was obtained in both groups, but the quality of pain relief was better in the intervention group with an associated reduction in the opioid requirement.

Discipline Area Score
Physician 6 / 7
Comments from MORE raters

Physician rater

A very interesting, very early study. There is not enough data to know whether it should be practiced. Information about the patient's cancer or function, the fact that ALL patients in the intervention group were felt acceptable for a nerve block (very different from my experience), and the fact that so many patients in the intervention group were not using any opiates a month later (again, I worry as it does not fit my patients). Also, while there was a statistical difference, there was no discussion of clinical difference. Still, this points out, as have others, that multi-modal therapy for pain is best.

Physician rater

This article highlights the significant role of nerve blocks but is novel in using them as front line therapy.
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