Chronic abdominal pain, particularly intractable pain that resists conventional treatments, can devastate quality of life. For patients with conditions like pancreatic cancer, chronic pancreatitis, or abdominal visceral neuropathy, pain often becomes a relentless companion.
Opioid medication may offer temporary relief but can come with risks of dependency, tolerance, and side effects like constipation or sedation. Even high doses sometimes fail to control severe pain, leaving patients trapped in a cycle of suffering.
The frustration of unmanaged pain extends beyond physical agony. It erodes mental health, strains relationships, and limits the ability to work or engage in daily activities. Many patients undergo endless tests, surgeries, or medication adjustments with minimal improvement.
For those with intractable pain – defined as pain persisting beyond 12 weeks despite treatment – the lack of options can feel hopeless. A celiac plexus block procedure for chronic abdominal pain offers a targeted, drug-free solution. This minimally invasive procedure interrupts pain signals from the celiac plexus, a network of nerves serving organs like the pancreas, liver, and stomach.
The procedure itself is simple: a needle is guided towards the celiac plexus with the help of imaging, and an anesthetic is delivered to temporarily numb and shut down the area’s ability to send out pain signals. By blocking these signals, patients often experience significant, lasting relief.
What is a Celiac Plexus Block?
The celiac plexus is a cluster of nerves located near the aorta in the upper abdomen, responsible for transmitting pain signals from abdominal organs. It’s often also called the solar plexus.
A celiac plexus block for chronic abdominal pain involves injecting a local anesthetic (e.g., lidocaine) and/or anti-inflammatory agents (e.g., corticosteroids) directly into or near this nerve bundle. The celiac plexus nerves are responsible for transmitting pain signals from the abdominal organs to the brain.
Nowadays, a celiac plexus block is largely performed through endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN). Two approaches exist: a bilateral one, during which both sides of the celiac axis are injected, and a central one, with only one injection. A neurolytic celiac plexus block involves using chemicals like alcohol or phenol to destroy the celiac plexus nerves for longer-term pain relief.
The procedure typically takes 30–60 minutes and is done under sedation or local anesthesia. It’s virtually painless, non-invasive, and hassle-free.
Who Benefits from a Celiac Plexus Block?
A celiac plexus block for chronic abdominal pain is most effective for conditions involving chronic pain and intense pain originating from abdominal organs. Visceral pain refers to pain felt internally, more specifically around your internal organs, such as the pancreas, stomach, spleen, kidneys, and liver. Most pain from the midgut and foregut can be shut down through a celiac plexus block.
As such, key candidates include:
- Pancreatic Cancer Patients: Up to 80% of patients with pancreatic cancer experience severe abdominal pain as tumors press on nerves.
- Chronic Pancreatitis: Inflammation and scarring of the pancreas often cause debilitating, opioid-resistant pain.
- Abdominal Visceral Neuropathy: Nerve damage due to surgery, diabetes, or autoimmune disorders can trigger immense gut pain.
- Intractable Pain Post-Surgery: Pain persists after abdominal procedures like gastrectomy or splenectomy.
A celiac plexus block is not going to be effective for gut pain caused by gastrointestinal tract issues, or motility problems. It’s also ineffective for somatic pain (muscle and skin).
How a Celiac Plexus Block Works
Like other nerve blocks, the celiac plexus block for chronic abdominal pain disrupts pain signaling through three mechanisms:
- Local Anesthetic Effect: Pain medicine is injected to temporarily numb the nerves (hours to days of relief).
- Neurolytic Agents (e.g., Alcohol or Phenol): For longer-term relief, these chemicals deliberately damage pain-transmitting nerves (weeks to months), leaving them unable to send pain signals.
- Anti-Inflammatory Action: Corticosteroid injections reduce inflammation around irritated nerves and may also be used if applicable/appropriate to reduce swelling.
Benefits Over Traditional Pain Management
A celiac plexus block can reduce your reliance on opioids and other pain medications for pain relief, provide longer-lasting relief (through neurolytic blocks), remain minimally invasive compared to major surgery, and drastically improve your quality of life by helping you regain mobility, appetite, and even emotional wellbeing.
Risks and Side Effects
There are some risks to be aware of. For example, the injection may induce temporary hypotension (low blood pressure) or diarrhea, due to sympathetic nerve actions.
There may also be mild soreness at the injection site, and as with all injections, there is a minor risk of bleeding, infection, or an accidental puncture of an unrelated body part. These risks are all minimized when the procedure is performed by an experienced pain specialist, so there’s no need to worry.
What to Expect During the Procedure
Let’s walk through the step-by-step of a celiac plexus block procedure. It’s quite simple:
- Preparation: Fasting for 6–8 hours; discontinuation of blood thinners, and other relevant medication. Follow the doctor’s orders closely here, or the procedure can’t continue.
- Imaging Guidance: CT or ultrasound ensures precise needle placement, often together with an endoscopy.
- Injection: A test dose of local anesthetic confirms proper positioning before administering the full block.
- Recovery: Most patients go home the same day. Pain relief may begin immediately or within 48 hours.
Please organize a ride home after the appointment, and refrain from operating any heavy machinery for at least 24 hours. Rest and recuperation are also important. Give the nerve block time to work.
Effectiveness for Intractable Pain
For patients with intractable chronic abdominal pain, the celiac plexus block can be transformative in treating abdominal pain. A 2017 study on the use of celiac plexus blocks for the management of chronic abdominal pain found them to be safe and effective for reducing opiate dependence and improving quality of life in the management of pain, including palliative pancreatic cancer pain.
Conclusion
If chronic or intractable abdominal pain has derailed your life, the celiac plexus block for chronic abdominal pain could offer the respite you need.
While not a cure, nerve blocks can provide a critical and minimally invasive bridge to improved function and reduced suffering. Give us a call at PMIR today, to discuss whether this procedure aligns with your diagnosis and goals.
Take the First Step Towards Pain-Free Living Today
