Palliation of pain in chronic pancreatitis - Use of neural blocks and neurotomy

The pain of chronic pancreatitis is the most difficult symptom to manage ef fectively, probably in part because the origin of the pain is multifactoria l. Trials of non-narcotic analgesics, often supplemented with psychotropic agents, may prove effective in selected patients, but more aggressive, inva sive measures are often necessary. Percutaneous celiac plexus blocks with d epot steroid preparations and most recently splanchnic nerve transection by way of a minimal access approach (thoracoscopy) have become of interest as nonresectional approaches to palliate pain. Operative splanchnic nerve tra nsection and operative ganglionectomy have not been satisfactory or success ful in long-term studies.