The celiac ganglia are the target of neurolysis in patients with refractory abdominal pain. This is performed transthoracically, transabdominally, transgastrically, or intraoperatively. The other structures listed do not directly innervate the pancreas. Obstruction of pancreatic or biliary ducts may also be a source of significant pain. These patients may benefit from endoscopic or surgical decompression.
Palliative pain management generally focuses on the use of narcotic medications. Other medications, such as tricyclic antidepressants and antiemetics, may potentiate the analgesic effect of narcotics. ESMO recommends morphine as the drug of choice for pain management. If this is inadequate or poorly tolerated, however, a percutaneous celiac plexus blockade is suggested.
Radiotherapy may be used to palliate pain in the setting of metastatic pancreatic cancer.
Biliary or pancreatic duct stenting may relieve pain secondary to obstruction of these structures.
To learn more about the palliative treatment of pain in pancreatic cancer, read here.
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Cite this: Michael J. Pishvaian. Fast Five Quiz: Test Your Knowledge of Metastatic Pancreatic Cancer Pathophysiology, Diagnosis, and Treatment - Medscape - Sep 26, 2018.