Background Pancreatic cancer can have a high burden of pain, and, for many people, management of this pain is complex. Interventional approaches to pain management are well established, but timely identification of those who may benefit and access these pain interventions is variable. The National Pancreatic Cancer Roadmap was developed by Cancer Australia to support improved outcomes for people affected by pancreatic cancer and includes the development of pathways for timely access to pain management and early referral to palliative care. Alongside these pathways was the need to develop guidance for clinicians to support patient access to interventional pain management when required. The aim of this project was to develop clinical guidance to support referral for interventional pain management in the setting of pain due to pancreatic cancer.

Methods Throughout the development of the pathways, literature reviews were conducted alongside extensive stakeholder and expert consultation with individuals across all states and territories in Australia. A wide variety wide range of groups were represented including clinicians, consumers, peak body organisations, culturally and linguistically diverse groups and Aboriginal and Torres Strait Islander communities. The development of clinical guidance was informed by the National Clinical Effectiveness Committee Standards for Clinical Practice Guidance, with specific attention was given to: a) Ensuring multidisciplinary input in the development of guidance.

b) Considering geography and coverage.

c) Understanding implementation implications.

Draft Clinical Guidance documents were iteratively re-presented to the stakeholders with feedback incorporated into subsequent refined drafts.

Results Clinical Guidance which has levels of evidence and practical information for clinicians were established to be linked to the pathways to pain management and palliative care. A set of overarching principles to inform the Clinical Guidance were developed including the importance of patient-centred care and supported decision-making; care coordination; timely access to pain management and palliative care, and cultural factors that may influence the expression and assessment of pain.

The Clinical Guidance recommends that for people with refractory pain (defined as pain not adequately controlled with pharmacological management or intolerable side effects after 2–4 weeks), coeliac plexus or splanchnic plexus neurolysis should be considered, with evidence of effect, outcomes and other considerations for clinicians outlined. Early identification of those who may benefit from coeliac plexus or splanchnic plexus neurolysis should be considered including discussion of those with refractory pain at multidisciplinary cancer meetings. Evidence and guidance on the role of radiotherapy and intrathecal analgesia are also presented.

Conclusion The National Pancreatic Cancer Roadmap developed by Cancer Australia set out the need to establish pathways to timely pain management, including interventional pain management and palliative care, with supporting Clinical Guidance linked to key points in these pathways. Implementation into national systems of care is the next step towards these pathways and accompanying Guidance improving outcomes for people with pancreatic cancer and their families.

This project is funded by Cancer Australia, National Pancreatic Cancer Roadmap – Delivery of early implementation priorities.