Pain in the upper abdomen or
mid-back may be caused by the tumor involving or invading nerves or organs
that lie near the pancreas. Pain can also be caused if the tumor causes
a blockage in the digestive tract. Treatment, including pain medications
and procedures such as a celiac plexus nerve-block (see below), can be
important in managing pancreatic cancer pain. Since most pain medications
lead to constipation which can make the pain much worse, a doctor can
prescribe medications to avoid constipation.
What is a celiac plexus
A celiac plexus block is a procedure that damages the celiac
nerves with the intent to ease pain. It is sometimes used to treat abdominal
pain in pancreatic cancer. The celiac plexus block procedure damages these
nerves for 3-6 months until they repair themselves.
Why use a celiac plexus
Patients with advanced pancreatic cancer often experience severe
abdominal pain. They often require strong pain medications, such as opioids,
to manage this pain. However, pain medications can cause uncomfortable
side effects, such as constipation. A celiac plexus block may be considered
- pain medication produces unmanageable side effects, or
- pain is uncontrollable with pain medication.
Often, patients with advanced pancreatic cancer experience breakthrough
pain. Breakthrough pain is an intense period of pain experienced even
when medication to control more constant pain is in use. Medications are
available to treat breakthrough pain, but this method of treatment is
not always effective. A celiac plexus block can help a patient avoid breakthrough
pain, but generally does not eliminate all pain. A celiac plexus block
may reduce the need to use pain medications and may alleviate many of
the unwanted side effects that may accompany opioid use.
The block may not help patients
whose pain is not radiating from the bundle of nerves in the upper abdomen.
A doctor or nurse would help make this determination.
What happens during
a celiac plexus block and who performs the procedure?
A celiac plexus block can be performed during surgery, during an endoscopic
ultrasound (EUS) or by going through the skin, called a percutaneous approach.
In all cases, a doctor will first inject a painkiller (anesthetic) to
numb the celiac nerves followed by a substance to damage the nerves. The
effects of the anesthetic are almost instantaneous, but are not long-lasting.
The nerve killing, or neurolytic, substance is usually an alcohol or a
steroid and may take up to one week to be fully effective. In many cases,
a few minutes pass between the two injections. Sometimes, the doctor will
perform a trial block with the anesthetic medication 8-72 hours prior
to the actual block using the neurolytic substance.
If a patient is able to undergo surgery for pancreatic cancer, the pancreatic
or gastrointestinal surgeon will operate with the intent to remove the
pancreatic tumor. If, after opening the abdomen, the surgeon determines
that the tumor is cannot be surgically removed, a nerve block may be performed
to help manage pain that may be caused by the tumor.
Endoscopic ultrasound (EUS) is a procedure used to image the digestive
tract, including the pancreas. An endoscope is passed through the patient’s
mouth into the stomach and the top part of the small intestine. Then,
ultrasound is used to create images of the pancreas. Just before an EUS,
the patient will receive sedative medication through a vein in the arm
and local anesthetic spray to the throat, in order to be comfortable during
the procedure. Since sedative medications are used, the patient should
prepare in advance to have someone else drive him/her home after the procedure.
A patient may have an EUS specifically so the doctor can perform a celiac
plexus block or the patient may already be scheduled for an EUS for other
reasons. A patient who is scheduled to have an EUS procedure and who experiences
uncontrolled pain should discuss the celiac plexus block option with the
gastroenterologist prior to the procedure.
During a percutaneous celiac plexus block, the celiac nerves are accessed
by inserting a needle through the skin. In this case, an anesthesiologist
who specializes in pain management typically inserts the needle through
First, an IV is inserted into
the arm to provide the patient with pain relief and hydration throughout
the procedure. Then, the patient lies face down on an x-ray table. An
area of the patient’s back is cleansed and numbed with a local anesthetic.
A dye is injected and an x-ray or computed tomography (CT) scan image
helps the doctor guide the needle to the correct location. Then, the anesthetic
is injected into the celiac nerve bundle followed by the neurolytic substance.
How long does the celiac plexus block procedure take?
The celiac plexus block itself takes 30-60 minutes. However, the actual
time required depends on which method is used to access the celiac nerve
What happens when the celiac plexus block is finished?
When the celiac plexus block is completed, the celiac nerves are unable
to send pain messages to the brain. Most patients feel some, though not
total, relief from pain after the procedure. Since the nerve block typically
lasts 6-9 months, the procedure may need to be repeated.
What are the possible
Complications related to a celiac
plexus block can be serious and severe. A celiac plexus block is not recommended
for patients taking blood-thinning medication or who have an infection
or bowel obstruction. Talk at length with your healthcare team about the
benefits and risks of a celiac plexus block to determine if it is the
right procedure to manage your pain.
- Low blood pressure (hypotension) along with a feeling of warmth in
the legs immediately following the procedure
- Pain in the area of the injection (tenderness, swelling, bruising)
- Muscle spasm at the area of injection
Less Common Side Effects:
- Delayed gastric emptying and diarrhea if the anesthetic or neurolytic
substances spread and affect the nerves that assist in bowel function
- Damage to kidneys
- Paralysis if the fluid used to destroy the celiac nerve spreads into
the spinal or epidural space
- Accidental injection into the blood vessels causing a seizure or reduced
blood supply to the spinal cord
- Seizure caused by accidental injection into the blood vessels
- Allergic reaction to the dye or medications injected
- Accidental puncture of an organ
- Infection (increased redness or swelling) at the injection or IV site
Cancer Pain Resources
Association of Cancer Online Resources
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