Pain from the upper abdominal organs travels through a single identifiable structure: the celiac plexus, an autonomic nerve plexus sitting in the retroperitoneum at the root of the celiac trunk.1 Because the pain funnels through one place, it can be interrupted at that place. That is what a celiac plexus block does, and it is why the procedure exists for pain that oral medication handles badly.
Who this is for
Chronic upper abdominal pain occurs as a complication of various malignant and benign diseases, including pancreatic cancer and chronic pancreatitis, and when present it may contribute to lower quality of life and higher mortality.1 A majority of patients with abdominal cancer report intractable abdominal pain as the disease progresses.2
Note that this is not solely a cancer procedure. Chronic pancreatitis is a benign disease that produces the same kind of visceral pain through the same pathway, and the practice’s pancreatitis page covers that use.
Block or neurolysis
Direct intervention at the level of the plexus is called a celiac plexus block or a neurolysis depending on what is injected.1 The distinction matters when consenting: a block using local anesthetic is diagnostic and temporary, while neurolysis is intended to be longer lasting. Which is appropriate depends on the diagnosis and the goal.
What it achieves
This minimally invasive intervention has been demonstrated to decrease pain, improve function and reduce opiate dependence.1 The main benefit may in fact be the reduction in opiate dependence and the side effects that come with it, which in turn improves quality of life.1
That is worth stating plainly for anyone weighing it up. The point is not only a lower pain score — it is needing less medication to reach that score, and getting back the alertness, appetite and bowel function that heavy opioid use costs. How the practice approaches reducing medication burden generally is described under opioid stewardship.
Safety and timing
Various percutaneous techniques have been described. With appropriate preprocedural planning, use of image guidance — usually computed tomography — and postprocedural care, the frequency and severity of complications is low and the success rate high regardless of the approach taken.1
The reviewers concluded that celiac plexus block and neurolysis are safe and effective treatments for chronic upper abdominal pain and should be considered early in patients experiencing such symptoms.1 “Early” is the operative word. It is frequently offered only after oral medication has failed and side effects have accumulated, which is later than the evidence suggests it should be raised.
Frequently asked questions
Do I have to have cancer to be considered for a celiac plexus block?
No. Chronic upper abdominal pain arises from both malignant and benign disease, including chronic pancreatitis, and the pain travels the same pathway either way. See the pancreatitis page.
What is the difference between a block and a neurolysis?
The injectate. A block is generally temporary and can serve a diagnostic purpose; neurolysis is intended to last longer. Which one suits your situation is a clinical decision — see celiac plexus block.
Will it let me take less pain medication?
That is one of its main documented benefits. The intervention has been shown to decrease pain, improve function and reduce opiate dependence, and reducing opioid-associated side effects is a large part of the quality-of-life gain. See opioid stewardship.
How risky is it?
With appropriate planning, image guidance and aftercare, the frequency and severity of complications is low and the success rate high across the described techniques. Image-guided technique is described under ultrasound-guided and fluoroscopic procedures.
Should I wait until the pain is worse?
The published recommendation is the opposite — that it be considered early in patients with these symptoms rather than held back as a last resort. To discuss timing, use the appointment request form.
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
