Quadratus Lumborum Block for Back Pain Related to PancreaticCancer – A Report of Two Cases
Bibliographic record
Abstract
Pancreatic cancer is often accompanied by severe pain. Patients typically experience upper abdominal and/or thoracolumbar back pain. For those cases failing to respond to standard medical management, as suggested by the World Health Organization, interventions designated at interruption of the sympathetic axis (such as neurolysis of the celiac plexus or splanchnic nerves) have been shown to be efficacious. Other than axial drug delivery, there are few interventional alternatives in patients with pancreatic cancerrelated pain. There is little knowledge regarding the therapeutic effects of treating peripheral somatic soft tissue among oncological patients. Here we report on 2 such patients, whose back pain improved following a quadratus lumborum block. Two patients diagnosed with pancreatic cancer presented with severe back pain. The pain pattern and patients’ physical exams were compatible with myofascial pain arising from the quadratus lumborum muscle, possibly irritated by the abdominal tumor. Advanced pain management, including long- and short-acting opioids and adjuvants, as well as celiac plexus neurolytic block, failed to provide satisfactory pain relief. Given the apparent muscular origin of the pain, a bilateral ultrasound-guided quadratus lumborum block was performed. Four weeks post procedure, the 2 patients reported substantial pain relief supported by reduced consumption of pain medication and improved functional status. No adverse events or complications were observed in either case. In the patients described here, quadratus lumborum block proved to be safe and efficacious in alleviating back pain related to pancreatic cancer. In our opinion, clinicians should be aware of the possible contribution of a myofascial component to pain in pancreatic cancer and in cancer-related pain in general. Key words: Quadratus lumborum block, cancer pain, pancreatic cancer, pain control, myofascial pain syndrome, interventional pain management
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.006 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".