Road map for pain management in pancreatic cancer: A review

Table 1 Potential molecules that were under investigation

Molecule	Mechanisms	Ref.
Capsaicin/resiniferatoxin	Activation of vanilloid receptors on cancer cells, inducing apoptosis	Hartel et al[17]
MEN 11467	NK-1R antagonists, inhibiting cell growth and neuronal invasion	Friess et al[18]
HSV-Enk viral vector	Increased met-enkephalin production in the peripheral nerve terminal endings and in dorsal root ganglion, reducing pain	Lu et al[45] Yang et al[46]
Phentolamine	Alpha-adrenergic blockade of sympathetic induced pain	Yasukawa[47]

NK-1R: Neurokinin-1 receptors; HSV-enk: Herpes simplex virus carrying the human preproenkephalin.

Table 2 Summarizing all treatment approaches, administration route or techniques and indications

Treatment approaches	Medications and modalities	Administration route/techniques	Indications
Medical treatment	Opioids and derivates	Per os	Moderate to severe pain
		S/C	Impossible oral intake (occlusion)
		Patch (fentanyl)	Breakthrough pain
		Nasal	Breakthrough pain
	Antiepileptics	Per os	Neuropathic pain
	corticosteroids	Per os or IV	Adjuvant, especially in metastatic bone pain
Interventional treatment	Celiac plexus block (LA) or neuolysis	Transcutaneous guidance1 or endoscopic ultrasonography	Refractory pain
	Splanchnicectomy	Thoracotomy, thoracoscopy	Intractable pain in non resectable tumor
	Intrathecal therapy	Implantable intrathecal drug delivery systems	End-of-life stage
Alternative medicine	Acupuncture	Jiaji points	adjuvant to drug therapy and/or interventional techniques
	Hypnosis	Sessions with an expertise	Any stage of pain
Chemotherapy and radiation therapy	FOLFIRINOX	IV	Locally advanced tumor
	Gemcitabine

¹Ultrasound, X-ray fluoroscopy or computed tomography. S/C: Subcutaneous; IV: Intravenous; LA: Local anesthetics.