A celiac plexus block for pancreatic cancer pain is a nerve block in which a doctor places medicine next to the bundle of nerves deep in the upper abdomen (the celiac plexus) that carries pain signals from the pancreas. It is used when pain in the upper abdomen and middle of the back persists despite pain medicines, and many patients notice relief within a day. Because it often lets patients lower their opioid dose, constipation and drowsiness can ease as well.
The Japan Society of Pain Clinicians gives this procedure its highest grade (A) for pancreatic cancer pain. This guide explains how the block works, who it is for, what happens on the day, recovery time, study results and how side effects are managed, based on US and Japanese sources.
Treatment status · An established, widely used procedure. The Japan Society of Pain Clinicians guideline gives grade A to the block compared with drug therapy alone and grade B to performing it early. MD Anderson Cancer Center and Memorial Sloan Kettering Cancer Center (MSK) in the US offer it with patient guides. This article is general information, not a recommendation for any treatment.
What is a celiac plexus block?
Behind the pancreas and in front of the aorta lies a network of nerves that collects sensation from the stomach, liver, pancreas and other upper abdominal organs. This is the celiac plexus. When pancreatic cancer grows into or presses on these nerves, it causes deep, constant pain under the breastbone and in the middle of the back.
In a celiac plexus block, a thin needle is guided to these nerves and medicine is injected to stop pain signals travelling upward. Doctors usually inject a local anesthetic first to confirm the effect, then a longer-acting agent such as alcohol. Switching the nerves off for a long time this way is called neurolysis. There are two main routes for the needle.
| Item | Percutaneous approach | Endoscopic ultrasound (EUS) approach |
|---|---|---|
| Needle route | Through the skin of the back, beside the spine | Through the stomach wall from an endoscope passed via the mouth |
| Image guidance | X-ray fluoroscopy or CT | Ultrasound at the tip of the endoscope |
| Usually performed by | Interventional radiology, anesthesiology and pain medicine | Gastroenterology |
| Strength | Wide imaging view of the nerve area | Close view of nerves just behind the stomach |
Based on MSK and MD Anderson patient guides and a Japanese multicenter randomized trial (Doi et al., 2013).
Both approaches are image-guided needle procedures without a surgical incision. Other image-guided treatments are described in our IVR (interventional radiology) guide.
Who is it for?
The MSK guide explains that the block may be recommended when common pain medicines do not relieve pain enough or cause troublesome side effects. Besides pancreatic cancer, it is used for pain from other upper abdominal cancers such as stomach and bile duct cancer.
- Persistent pain in the upper abdomen or middle back that does not settle with higher doses of pain medicine
- Constipation, drowsiness or nausea from opioids, with a wish to lower the dose
- A wish to manage pain alongside chemotherapy (the block can be planned around chemotherapy)
In a study cited by the Japanese guideline, the block worked particularly well for cancer in the head of the pancreas, relieving pain in 92% of patients. When a tumor spreads widely around the nerves, the medicine may not spread evenly and the effect can be smaller. That is why doctors review a CT scan of the tumor's position and check blood clotting before the procedure.
What studies show
Randomized trials in several countries have confirmed the benefit. Key results are below; figures are as reported, with the comparison group stated.
| Study | Patients | Main result |
|---|---|---|
| Cochrane systematic review (2011) | 6 randomized trials, 358 patients | Lower pain scores at 4 weeks than drug therapy alone, clearly lower opioid use and less constipation |
| Canadian randomized double-blind trial (Wyse et al., 2011) | Patients newly diagnosed with pancreatic cancer | Pain fell 28.9% more at 1 month and 60.7% more at 3 months with EUS neurolysis than in the control group, with lower morphine use |
| Japanese multicenter randomized trial (Doi et al., 2013) | 68 patients with upper abdominal cancer pain | Pain score of 3 or less at day 7 in 73.5% with direct injection into the nerve ganglia vs 45.5% with the standard method |
| Chinese CT-guided study (Lu et al., 2023) | 56 patients with advanced pancreatic cancer | Daily opioid dose at 2 months (morphine equivalent) 41.82 mg with early block vs 74.12 mg with delayed block |
Based on figures cited in the Japan Society of Pain Clinicians guideline and the study abstracts.
The Cochrane authors highlighted that the block causes fewer adverse effects than opioids, an important advantage for patients. The Japanese guideline recommends it over drug therapy alone on the same evidence. In the Chinese study, patients treated early had lower pain scores from months 3 to 5 and better scores for sleep, appetite and mood.
The block treats pain rather than the tumor itself. Treatments aimed at the tumor are covered in our articles on NanoKnife (IRE) for pancreatic cancer and radiofrequency ablation (RFA) for pancreatic cancer.
The procedure takes about an hour
According to MD Anderson, the procedure usually takes less than an hour. MSK allows about 90 minutes including sedation. Most patients go home the same day.
| Step | What happens |
|---|---|
| Before | Blood tests including platelets, review of blood thinners, no food from midnight (some hospitals allow clear liquids until 2 hours before arrival) |
| Position and anesthesia | Lying face down with a pillow under the hips, local anesthetic to the skin of the back, IV sedation if needed |
| Needle placement | Needles placed on one or both sides of the spine under X-ray or CT guidance |
| Injection | Local anesthetic to confirm the effect, then the neurolytic agent |
| After | IV fluids and monitoring of blood pressure and pulse, then discharge once stable |
Combined from the MSK patient guide and MD Anderson information. Actual steps and timing follow each hospital's protocol.
If you receive sedation, you cannot drive that day, so bring a companion. Handing over a list of your medicines in advance helps the team decide quickly which ones to pause.
Recovery and managing side effects
MD Anderson notes that many patients feel a difference within 24 hours and some can reduce or stop pain medicines. The full effect may take a few days, and MSK says the block can last several weeks to several months. The Chinese researchers describe relief from neurolysis as typically lasting 3 to 6 months.
| Common reaction | Why it happens and how it is managed |
|---|---|
| Diarrhea, gas | Nerve signals that slowed the bowel are reduced. MSK says it may last 3 to 5 days; drink plenty of fluids |
| Dizziness, low blood pressure | Blood vessels in the abdomen widen. IV fluids and getting up slowly usually help |
| Back soreness | Soreness at the needle site for a few days, managed with prescribed pain relief |
| Temporary pain increase | Pain may rise briefly in the first 24 hours; extra pain medicine for 1 to 2 days may be needed |
The UW Medicine guide says you may shower the next day and should avoid lifting more than 10 pounds (4.5 kg) and soaking in baths or pools for 48 hours. Blood thinners are usually restarted after 24 hours. Contact the hospital promptly for a fever of 38°C or higher, worsening dizziness, swelling or drainage at the needle site, or a major change in bowel habits. Nerve complications such as leg weakness are rare, but because the injection is near the spine, the team checks for them after the procedure.
Where is it available?
Celiac plexus block is widely performed at cancer centers and university hospitals in the US, Europe and Japan. In Japan, pain clinics and palliative care teams usually perform it, while the EUS approach is done by gastroenterologists. As the Japanese multicenter trial above shows, Japanese hospitals have also worked to refine the technique.
When contacting a hospital abroad, prepare a recent CT scan, the names and daily doses of your pain medicines, and a record of your pain scores. If the pain comes from cancer that has spread to bone, a different IVR procedure may fit, as described in ablation for bone metastasis pain.
Questions to ask your doctor
- Is my pain the type that a celiac plexus block can relieve?
- Will you use the percutaneous or the EUS approach?
- When should I stop eating, and which medicines should I pause and for how long?
- Can the block be repeated if the effect fades?
- How will it fit with my chemotherapy schedule?
Frequently asked questions
How long does a celiac plexus block for pancreatic cancer pain last?
It varies, but relief usually lasts weeks to months. With a neurolytic agent, many reports describe relief for 3 to 6 months. If the effect fades, your team will discuss the next step.
Can I stop pain medicines after the block?
Some patients reduce or stop them. In the Cochrane analysis, patients who had the block used clearly less opioid medicine than those on drug therapy alone. Always adjust pain medicines together with your doctor.
Is the procedure painful?
The skin of the back is numbed and sedation is used if needed to keep you comfortable. The needle site may be sore for a few days, which is managed with prescribed pain relief.
When is the best time to have it?
The Japanese guideline gives a grade B recommendation to performing it early. In the Chinese study, patients treated early used less opioid medicine and had better daily-life scores. Discuss timing with your doctor once pain begins.
This article summarizes overseas official sources and studies as general information and is not medical advice. Please discuss treatment choices with the medical team who examines you.
Sources (checked November 3, 2026)
- Arcidiacono PG, Calori G, Carrara S, et al. Celiac plexus block for pancreatic cancer pain in adults. Cochrane Database of Systematic Reviews. 2011;(3):CD007519.
- Japan Society of Pain Clinicians. Interventional pain management guideline: celiac plexus block, CQ27–28 (Japanese).
- Doi S, Yasuda I, Kawakami H, et al. Endoscopic ultrasound-guided celiac ganglia neurolysis vs celiac plexus neurolysis: a randomized multicenter trial. Endoscopy. 2013;45(5):362–369.
- Wyse JM, Carone M, Paquin SC, et al. Randomized, double-blind, controlled trial of early endoscopic ultrasound-guided celiac plexus neurolysis to prevent pain progression in patients with newly diagnosed, painful, inoperable pancreatic cancer. J Clin Oncol. 2011;29(26):3541–3546.
- Lu F, Wang X, Tian J, Li X. Early versus delayed computed tomography-guided celiac plexus neurolysis for palliative pain management in patients with advanced pancreatic cancer: a retrospective cohort study. Front Neurol. 2023;14:1292758.
- Memorial Sloan Kettering Cancer Center. About your celiac plexus block. Patient education.
- MD Anderson Cancer Center. Celiac plexus block: 5 things to know about the procedure. Cancerwise, 2024.
- UW Medicine. After your celiac plexus injection block: important instructions. 2025.