pancreatic pain

Pancreatic cancer pain

Coeliac plexus block

The coeliac plexus is a bundle of nerves in your upper back.  These nerves are a certain type, called sympathetic nerves, which control things like digestion, blood pressure and heart rate without you having to think about them.  Nerves in the coeliac plexus go between the brain and organs like the pancreas, stomach, liver and kidneys.

In certain conditions, like pancreatic cancer, this group of nerves begins sending signals that cause you to feel pain in your upper abdomen.  By injecting the area around the coeliac plexus with local anaesthetic, or sometimes other medicines (such as anti-inflammatory steroids), it may be possible to reduce (or block) this pain for some time.

The pain involves the sympathetic nerves which control the things that we do not need to think about, such as digestion, blood pressure and heart rate. This group of nerves do not normally send pain messages, but they become ‘switched-on’ in certain conditions. It is not known exactly why this happens.

The procedure under x-ray guidance:

The doctor will examine you and then inject the area with a local anaesthetic before inserting one or two needles into your upper back.  Once the doctor has found the correct area, the medications to block the pain will be injected.  The injection may initially cause some discomfort, but this will soon stop.

You will be able to go home a few hours after the procedure.

The procedure under endoscopic ultrasound:

You will be asked to attend the endoscopy unit having fasted for 6 hours beforehand.  Under sedation an endoscope will be passed into the upper stomach.  medications to block the pain will be injected through the endoscope into the coeliac plexus.

You should be able to go home a few hours after the procedure.

Splanchnic block (Radio-frequency)

Pancreatic cancer is an aggressive disease with high mortality that causes severe abdominal and/or back pain. The disease is often resistant to analgesics, opioids, and adjuvant medications. The quality of life is seriously affected in these patients, and pain management in the context of palliative care should be an early part of the overall therapeutic plan. The blockade or ablation of thoracic splanchnic nerves and celiac ganglia plays a major role in the pain management of most upper abdominal disorders, particularly chronic pancreatitis and pancreatic malignancies. Thoracic splanchnic nerves carry the majority of the nociceptive stimuli from the upper abdominal viscera, and they are composed of preganglionic fibers, arising from the anterolateral horn of the spinal cord bilaterally, together with the T5-T12 ventral spinal roots. Radiofrequency thermocoagulation is a minimally invasive technique that is performed under local anesthesia and fluoroscopic guidance. It is a target-selective technique, mostly indicated for the management of nociceptive chronic pain that is resistant to conservative therapy, but it can also be used for the management of certain neuropathic pain conditions characterized by limited distribution. However, it is not indicated in centralized pain conditions in cases of co-existing pathology inside the spinal canal or if there are serious co-existing diseases, including severe psychopathology. Radiofrequency thermocoagulation is reported to be a more predictable and safe technique compared to chemical neurolysis of splanchnic nerves or celiac plexus blockade for the management of abdominal pain, but the evidence is still limited and more studies are needed to prove its efficacy in treating various pain states. In particular, only a few studies examined the actual efficacy of radiofrequency thermocoagulation alone or against other methods of interventional pain management in pancreatic cancer cases.