Symptom: Pain

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 Block?
A celiac plexus block is a surgical procedure that can be used to help manage abdominal pain in pancreatic cancer. If the tumor presses on the nerves at the back of the abdomen or against the spine, the patient may experience pain. A celiac plexus block can stop the pain coming from the bundle of nerves (the celiac plexus) in the upper abdomen. This plexus of nerves, which extends from the pancreas, gall bladder, intestines, liver, and stomach, transmits pain signals to the brain.

Why Use a Celiac Plexus Block?
If pain is uncontrollable with pain medication or a patient experiences unmanageable side effects to pain medication, a celiac plexus block may be considered. The procedure may reduce the need to use pain medications and may alleviate many of the unwanted side effects that may accompany opioid use, such as constipation.

Who Performs a Celiac Plexus Block?
An anesthesiologist who specializes in pain management typically performs this procedure. Consideration of this procedure should be discussed with a physician. The block may not help patients whose pain is not radiating from the plexus in the upper abdomen. A doctor or nurse would help make this determination.

What Happens During a Celiac Plexus Block?
There are two parts to the celiac plexus block. First, a trial block is performed using a local anesthetic. This block can last from 8 to 72 hours, depending on the type of local anesthetic used. If this procedure is effective, then the celiac plexus block is performed with a neurolytic substance, such as phenol or alcohol. This is called a neurolytic block because the nerve is actually destroyed in the process. The nerves are disabled from sending pain messages to the brain. The neurolytic block typically lasts 3 to 6 months, so the procedure may need to be repeated.

The actual procedure takes thirty minutes to an hour. However, many facilities or doctors may use sedation, so the procedure time may be longer. First, an IV is inserted into the arm. Then, the patient will be placed face down on an X-ray table. After the back area is cleansed and numbed with a local anesthetic, a dye will be injected and an X-ray or CT scan image will be used to guide the needle into the correct location. A local anesthetic will then be injected into the celiac nerve plexus. If this procedure helps to alleviate or manage the pain, the patient will have the procedure repeated with a neurolytic substance, such as alcohol, within a few days.

What are the Possible Side Effects?

• Hypotension (low blood pressure) may result, along with a feeling of warmth in the legs immediately following the procedure
• Loose bowel movements (diarrhea)
• Pain in the area of the injection (tenderness, swelling, bruising)
• Muscle spasm at the area of injection

Less Common Side Effects:

• Damage to kidneys
• Paralysis due to the neurolytic agent spreading into the spinal or epidural space
• 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

Pain.com

Cancer-Pain.org

Association of Cancer Online Resources

Partners Against Pain

The information and services provided by the Pancreatic Cancer Action Network, Inc. are for informational purposes only. The information and services are not intended to be substitutes for professional medical advice, diagnosis or treatment. If you are ill, or suspect that you are ill, see a doctor immediately! The Pancreatic Cancer Action Network does not recommend nor endorse any specific physicians, products or treatments even though they may be mentioned on this site. 080925