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Pancreatic cancer visceral pain — FRCA Final MCQ

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HardPain MedicinePancreatic cancer visceral painFRCA Final

A 66-year-old man with pancreatic cancer has severe upper abdominal pain radiating to the back despite oral morphine, antiemetics and laxatives. He is losing weight and wants to reduce opioid adverse effects if possible. What is the most appropriate pain management?

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Correct answer: A — Discuss coeliac plexus block or neurolysis with the pain team

Coeliac plexus block or neurolysis can reduce visceral upper abdominal cancer pain and opioid requirements in selected pancreatic cancer patients. Simple opioid escalation may be necessary but does not address intolerable adverse effects. Lumbar epidural steroid injection treats radicular pain rather than pancreatic visceral pain. Interventional decisions should be integrated with oncology and palliative care planning.

Reference: Faculty of Pain Medicine cancer pain guidance; NICE palliative care guidance