Pain from the upper abdominal organs travels through a single structure you can point to: the celiac plexus. It is a web of automatic (autonomic) nerves that sits deep in the back of the belly, at the root of the celiac trunk artery.1 Because the pain funnels through one place, it can be blocked at that place. That is what a celiac plexus block does. It is why the procedure exists for pain that pills handle badly.
Who is a candidate for a celiac plexus block?
Chronic upper belly pain can come from many cancers and from non-cancer diseases, including pancreatic cancer and chronic pancreatitis. When present, it may lower quality of life and raise the risk of death.1 Most patients with cancer in the belly report pain that won’t let up as the disease gets worse.2
Note that this is not just a cancer procedure. Chronic pancreatitis is not cancer, but it causes the same kind of visceral (deep organ) pain through the same path. The practice’s pancreatitis page covers that use.
Block or neurolysis
Treating the plexus directly is called a celiac plexus block or a neurolysis, depending on what is injected.1 The difference matters when you give consent. A block uses numbing medicine. It is a test, and it wears off. Neurolysis is meant to last longer. Which one fits depends on the diagnosis and the goal.
How effective is a celiac plexus block?
This minimally invasive procedure has been shown to lower pain, improve function and cut reliance on opioids.1 In fact, the main benefit may be needing fewer opioids and having fewer of their side effects. That, in turn, improves quality of life.1
That is worth saying plainly if you are weighing it. The point is not just a lower pain score. It is needing less medication to reach that score. And it is getting back the alertness, appetite and bowel function that heavy opioid use takes away. How the practice cuts medication load in general is described under opioid stewardship.
Is a celiac plexus block safe, and when should it be done?
Several percutaneous (through-the-skin) methods have been described. With good planning beforehand, image guidance (usually a CT scan) and good aftercare, problems are rare and mild. The success rate is high, no matter which method is used.1
The reviewers concluded that celiac plexus block and neurolysis are safe and effective treatments for chronic upper belly pain. They said it should be considered early in patients with these symptoms.1 “Early” is the key word. It is often offered only after pills have failed and side effects have piled up. That is later than the evidence suggests it should come up.
Frequently asked questions
Do I have to have cancer to be considered for a celiac plexus block?
No. Chronic upper belly pain comes from both cancer and non-cancer disease, including chronic pancreatitis. The pain travels the same path either way. See the pancreatitis page.
What is the difference between a block and a neurolysis?
What is injected. A block usually wears off and can work as a test. Neurolysis is meant to last longer. Which one suits you is a clinical decision. See celiac plexus block.
Will it let me take less pain medication?
That is one of its main proven benefits. The procedure has been shown to lower pain, improve function and cut reliance on opioids. Fewer opioid side effects is a big part of the gain in quality of life. See opioid stewardship.
How risky is it?
With good planning, image guidance and aftercare, problems are rare and mild, and the success rate is high across the methods described. Image-guided technique is described under ultrasound-guided and fluoroscopic procedures.
Should I wait until the pain is worse?
The published advice is the opposite. It says to consider it early in patients with these symptoms, not to hold it back as a last resort. To talk about timing, use the appointment request form.
What is the celiac plexus?
It is a web of autonomic nerves deep in the belly, behind the organs, at the root of the celiac trunk artery. Pain from the upper belly organs, including the pancreas, funnels through this one structure on its way to the brain. Because it all passes through one place, a celiac plexus block can stop it at that place.
How is a celiac plexus block done?
It is a minimally invasive, percutaneous procedure. The needle goes in through the skin, not through a surgical cut. Several methods exist. What keeps problems low and success high with any of them is careful planning, image guidance during the procedure (usually a CT scan), and good care afterward.
To discuss upper abdominal pain, request an appointment, call (314) 481-5000, or text (314) 886-5902.
Sources
- Cornman-Homonoff J, Holzwanger DJ, Lee KS, Madoff DC, Li D. Celiac Plexus Block and Neurolysis in the Management of Chronic Upper Abdominal Pain. Seminars in Interventional Radiology. 2017;34(4):376–386. doi:10.1055/s-0037-1608861. Retrieved via PubMed. DOI
- Ashlock K. Celiac Plexus Block: Management of Abdominal Pain in Patients With Late-Stage Cancer. Clinical Journal of Oncology Nursing. 2018;22(6):663–665. doi:10.1188/18.CJON.663-665. Retrieved via PubMed. DOI
Dr. Gurpreet Singh Padda, MD, MBA, MHP
