Pancreatic and other upper abdominal organ malignancies can produce intense visceral pain
syndromes that are frequently treated with splanchnic nerve neurolysis (SNN) or celiac plexus
neurolysis (CPN). Although commonly performed with either alcohol or phenol, there is scant
literature on the comparative effectiveness, duration of benefit, and complication profile
comparing the 2 agents. This study presents a retrospective chart review of 93 patients who
underwent SNN for cancer-related abdominal pain in order to describe patient characteristics,
examine comparative efficacy, duration of benefit, and incidence of complications with alcohol
vs. those of phenol. Consistent with previous studies, SNN reduced reported pain scores while not
significantly reducing opioid consumption. No difference in pain outcomes was found comparing
alcohol versus phenol based neurolytic techniques. Celiac axis tumor infiltration and pre-procedural
local radiation therapy did not change the effectiveness of the procedure. Our data demonstrated
that 44.57% of patients had ≥ 30% pain reduction while 43.54% did not have pain reduction.
Interestingly, the procedure produced significant improvements in anxiety, depression, difficulty
thinking clearly, and feeling of well-being. In addition, no difference in complications was seen
between the agents either. SNN was an effective and relatively safe procedure for the treatment
of pain associated with pancreatic and other upper abdominal organ malignancies in our sample
of patients. Choice of neurolytic agent can appropriately be left to the clinical judgment and local
availability of the treating physician. The change in ancillary symptoms has a theoretical basis that
supports a biopsychosocial model of pain since changes in one target area (pain) impact other
related ones (depression and anxiety).
Key words: Celiac plexus, splanchnic nerves, neurolysis, nerve block, alcohol, ethanol, phenol,
pain, cancer pain, abdominal pain, visceral pain, symptom assessment
Assessment of abdominal organ motion using cine magnetic resonance imaging in different gastric motilities: a comparison between fasting and postprandial states