***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective The classic posterior approach of superior hypogastric block has several technical difficulties . The transdiscal approach is a novel and easier approach for superior hypogastric which overcome these technical difficulties . Methods Thirty patients were r and omly allocated to two groups :  The transdiscal group and the classic group  ; visual analog scale pain scores , daily morphine consumption , duration of the procedure and side effects were recorded . Results The duration of the procedure was significantly decreased in the transdiscal group ( 24.4±5.6 min ) compared to the classic group ( 57.9±9.8 min ) . There were no significant differences between the 2 groups in daily morphine consumption and VAS pain scores . There was no discitis , disc rupture , or herniation in the transdiscal group . Conclusion The transdiscal approach for superior hypogastric plexus block in pelvic cancer pain is easier , safer , and more effective with less side effects than the classic approach The optimal assessment of cancer pain includes a detailed description of pain characteristics and classification by both syndrome and likely mechanisms . In the clinical setting , the interpretation of this information is aided by knowledge of the available clinical experiences on these aspects of the pain . Unfortunately , existing data are limited . There have been few large surveys of cancer pain characteristics and syndromes , and comparative data from patients in different parts of the world are entirely lacking . To better define the characteristics of cancer pain syndromes the Task Force on Cancer Pain of the International Association for the Study of Pain ( IASP ) conducted a prospect i ve , cross-sectional , international , multicenter survey of pain specialists and their patients . From a total of 100 clinicians who described themselves as cancer pain practitioners in the IASP membership directory , 51 agreed to participate in the survey and a total of 58 provided data . These clinicians resided in 24 countries and evaluated a total of 1095 patients with severe cancer pain mostly requiring opioid medication  , using a combination of patient-rated and observer-rated measures . The patient-rated scales comprised a  pain intensity measure  chosen from the brief pain inventory . The observer-rated information included demographic and tumor-related data , and responses on checklists of pain syndromes and pathophysiologies . Patients were heterogeneous in terms of demographics and tumor-related information . More than 76 % had a Kamofsky performance status score < or = 70 . Almost one-quarter of the patients experienced two or more pains . A large majority of the patients ( 92.5 % ) had one or more pains caused directly by the cancer ; 20.8 % of patients had one or more pains caused by cancer therapies . The average ( SD ) duration of pain was 5.9 ( 10.5 ) months . Approximately two-thirds of patients ( 66.7 % ) reported that the worst pain intensity during the day prior to the survey was > or = 7 on a 10-point numeric scale . The factors that were univariately associated with higher pain intensity included the presence of breakthrough pain , somatic pain or neuropathic pain , age younger than 60 years , and lower performance status score . A multivariate model suggested that the presence of breakthrough pain , somatic pain , and lower performance status were the most important predictors of intense pain . Pains that were inferred by the treating clinician to be nociceptive and due to somatic injury occurred in 71.6 % of the patients . Pains labeled nociceptive visceral were noted in 34.7 % and pains inferred to have neuropathic mechanisms occurred in 39.7 % . In a broad classification , the major pain syndromes comprised bone or joint lesions ( 41.7 % of patients ) , visceral lesions ( 28.1 % ) , soft tissue infiltration ( 28.3 % ) , and peripheral nerve injuries ( 27.8 % ) . Twenty-two types of pain syndromes were most prevalent . Large differences in the diagnosis of breakthrough pain by clinicians of different countries suggest that this phenomenon is either defined or recognized differently across countries . These data confirm , in segment of the cancer population experiencing severe pain , in different parts of the world , that cancer pain characteristics , syndromes and pathophysiologies are very heterogeneous . Predictors of worsening pain can be identified . The data provide a useful context for the interpretation of pain-related information acquired in both clinical and research setting s. They suggest the need for future studies and the potential usefulness of a written checklist for cancer pain syndromes and pathophysiologies OBJECTIVE This additional analysis of data from a previously reported prospect i ve trial comparing the effect of intraoperative alcohol or saline placebo neurolytic block in patients with pancreatic cancer was conducted in response to the development of a new theory , which explores the relationship of negative mood states to pain , pain-related behavior , and ultimately , longevity . METHODS The original study used a double-blind procedure to r and omly assign 139 patients with histologically proven , unresectable pancreatic cancer to receive either an alcohol or a saline block . Data on visual analog pain , mood , and interference with activity were collected preoperatively and every 2 months postoperatively until death . The current analysis was conducted on the complete data sets received from 130 patients . Demographic data were su bmi tted to chi-square analysis and to univariate and multivariate analysis of variance . Univariate and multivariate analyses of variance also compared 1 ) the effect of alcohol versus saline on pain , mood , interference of pain with activities , and longevity and 2 ) the impact of mood on pain with longevity as the dependent variable . Correlation and regression analyses examined the impact of mood on life expectancy . RESULTS The alcohol intervention had a significant positive effect on life duration and mood scores . High negative mood states correlated significantly with an increase in visual analog pain , the rating of pain intensity at its worse , and pain interference with patients ' activities . CONCLUSION In these subjects , the neurolytic block , as compared with medical management alone , improved pain , elevated mood , reduced pain interference with activity , and was associated with an increase in life expectancy Aims and Background There is controversy about the role of neurolytic sympathetic blocks in advanced cancer , when pain syndromes may assume other characteristics , with a possible involvement of structures other than visceral . The aim of the present study was to assess the pain characteristics and the analgesic response of a consecutive sample of home care patients with pancreatic and pelvic pain , which would have possible indications for a celiac plexus block and a superior hypogastric block , respectively . Methods From January 1999 to December 1999 , 400 consecutive advanced cancer patients were surveyed for a prospect i ve longitudinal survey . We considered only patients who had pancreatic cancer or pelvic cancer with pain . Results Thirty-six patients were surveyed : 22 patients had pelvic cancers and 14 had pancreatic cancer . Patients with pelvic cancers showed a longer survival  than those with pancreatic cancer ( P = 0.019 ) . Patients with pelvic cancers more frequently showed a neuropathic component associated with a visceral or somatic mechanism than patients with pain due to pancreatic cancer ( P = 0.019 ) . When the pain mechanism was taken into consideration , patients with pelvic cancers with a neuropathic component showed worse pain relief than patients with pain due to pancreatic cancer ( P = 0.040 ) . Conclusions Sympathetic procedures for pain conditions due to pancreatic and pelvic cancers should be intended as adjuvant techniques to reduce the analgesic consumption , and not as a panacea , given that multiple pain mechanisms are often involved because progression of disease is able to change the underlying pain mechanisms . Pancreatic pain seems to maintain visceral characteristics amenable to sympathetic block more than pain due to pelvic cancer Twenty-one patients with pancreatic cancer pain were studied to evaluate the effectiveness of celiac plexus block ( CPB ) on pain relief and quality of life ( QOL ) , compared to the traditional NSAID-morphine treatment . The criteria were morphine consumption , visual analogue pain scale ( VAS ) , performance status ( PS ) determined by medical and nursing staffs , and answers to QOL question naires .  Morphine consumption , VAS , PS , and self-assessed QOL scores were taken when the administration of morphine was necessary for pain relief and those scores were used as control .  Morphine consumption and the VAS score were recorded at regular weekly intervals and the PS and QOL scores were measured every 2 weeks thereafter . CPB was performed within 2 - 3 days after the control measurement . The VAS scores of the patients receiving CPB ( n = 10 ) were statistically lower for the first 4 weeks after the procedure than those of the patients receiving the st and ard NSAID-morphine treatment ( n = 11 ) during the same time period after the control measurement .  Morphine consumption was significantly lower in weeks 4 - 7 ( inclusive ) following the procedure in the CPB group and continued to be lower thereafter , though not significantly so . Although the PS score slightly improved at the 2nd week after CPB , it was not improved by the start of the NSAID-morphine treatment .  Self-assessed QOL scores did not ameliorate statistically after CPB ; however , they did deteriorate remarkably in the patients treated only with morphine-NSAID during their survival periods , while they deteriorated only slightly in the CPB group . There were fewer side effects after CPB . These results indicate CPB does not directly improve QOL in patients with pancreatic cancer pain , but it may prevent deterioration in QOL by the long-lasting analgesic effect , limitation of side effects and the reduction of morphine consumption , compared to treatment only with NSAID-morphine PURPOSE Implantable intrathecal drug delivery systems ( IDDSs ) have been used to manage refractory cancer pain , but there are no r and omized clinical trial ( RCT ) data comparing them with comprehensive medical management ( CMM ) . PATIENTS AND METHODS We enrolled 202 patients on an RCT of CMM versus IDDS plus CMM . Entry criteria included unrelieved pain ( visual analog scale [ VAS ] pain scores > /= 5 on a 0 to 10 scale ) . Clinical success was defined as > /= 20 % reduction in VAS scores , or equal scores with > /= 20 % reduction in toxicity . The main outcome measure was pain control combined with change of toxicity , as measured by the National Cancer Institute Common Toxicity Criteria , 4 weeks after r and omization . RESULTS Sixty of 71 IDDS patients ( 84.5 % ) achieved clinical success compared with 51 of 72 CMM patients ( 70.8 % , P = .05 ) . IDDS patients more often achieved > /= 20 % reduction in both pain VAS and toxicity ( 57.7 % [ 41 of 71 ] v 37.5 % [ 27 of 72 ] , P = .02 ) . The mean CMM VAS score fell from 7.81 to 4.76 ( 39 % reduction ) ; for the IDDS group , the scores fell from 7.57 to 3.67 ( 52 % reduction , P = .055 ) . The mean CMM toxicity scores fell from 6.36 to 5.27 ( 17 % reduction ) ; for the IDDS group , the toxicity scores fell from 7.22 to 3.59 ( 50 % reduction , P = .004 ) . The IDDS group had significant reductions in fatigue and depressed level of consciousness ( P < .05 ) . IDDS patients had improved survival , with 53.9 % alive at 6 months compared with 37.2 % of the CMM group ( P = .06 ) . CONCLUSION IDDSs improved clinical success in pain control , reduced pain , significantly relieved common drug toxicities , and improved survival in patients with refractory cancer pain CONTEXT Pancreatic cancer is an aggressive tumor associated with high mortality . Optimal pain control may improve quality of life ( QOL ) for these patients . OBJECTIVE To test the hypothesis that neurolytic celiac plexus block ( NCPB ) vs opioids alone improves pain relief , QOL , and survival in patients with unresectable pancreatic cancer . DESIGN , SETTING , AND PATIENTS Double-blind , r and omized clinical trial conducted at Mayo Clinic , Rochester , Minn. Enrolled ( October 1997 and January 2001 ) were 100 eligible patients with unresectable pancreatic cancer experiencing pain . Patients were followed up for at least 1 year or until death . INTERVENTION Patients were r and omly assigned to receive either NCPB or systemic analgesic therapy alone with a sham injection . All patients could receive additional opioids managed by a clinician blinded to the treatment assignment . MAIN OUTCOME MEASURES Pain intensity ( 0 - 10 numerical rating scale ) , QOL , opioid consumption and related adverse effects , and survival time were assessed weekly by a blinded observer . RESULTS Mean ( SD ) baseline pain was 4.4 ( 1.7 ) for NCPB vs 4.1 ( 1.8 ) for opioids alone . The first week after r and omization , pain intensity and QOL scores were improved ( pain intensity , P < or = .01 for both groups ; QOL , P<.001 for both groups ) , with a larger decrease in pain for the NCPB group ( P = .005 ) . From repeated measures analysis , pain was also lower for NCPB over time ( P = .01 ) . However , opioid consumption ( P = .93 ) , frequency of opioid adverse effects ( all P>.10 ) , and QOL ( P = .46 ) were not significantly different between groups . In the first 6 weeks , fewer NCPB patients reported moderate or severe pain ( pain intensity rating of > or = 5/10 ) vs opioid-only patients ( 14 % vs 40 % , P = .005 ) . At 1 year , 16 % of NCPB patients and 6 % of opioid-only patients were alive . However , survival did not differ significantly between groups ( P = .26 , proportional hazards regression ) . CONCLUSION Although NCPB improves pain relief in patients with pancreatic cancer vs optimized systemic analgesic therapy alone , 
    Output:
    
CPB , regardless of the technique used , improved analgesia and /or decrease opioid consumption , and decreased opioid-induced adverse effects in comparison with a conventional analgesic treatment .
On the basis of existing evidence , CPB has a strong recommendation in patients with pancreatic cancer pain .