Efficacy of Celiac Plexus Blocks for Pain Control in Pediatric Patients with Visceral Hyperalgesia

Objective: Visceral hyperalgesia (VH) is a condition characterized by increased sensitivity to painful stimuli, which often results in chronic abdominal pain. Irritation of the abdominal organs (associated with gastrointestinal disorders or an idiopathic etiology) modifies efferent neural transmission, resulting in hypersensitization of the viscera and a modified pain response. Symptoms classically include nausea, vomiting, bloating, and altered bowel habits. There are currently no diagnostic tests or standard treatments available. Present therapy for VH utilizes a multidisciplinary approach involving anti-neuropathic medications, behavioral therapy, and dietary modifications. There is some evidence that celiac plexus blocks (CPBs), typically employed for abdominal pain relief in adults and pediatric cancer patients, are effective for control of refractory visceral pain. In this study, we examined the effect of CPBs for control of chronic abdominal pain. To the best of our knowledge, this is the first report examining pain management in pediatric patients with VH. Materials and Methods: Three patients underwent CPBs at Cook Children’s Medical Center to treat VH: 1 case was associated with Crohn’s disease and 2 with hereditary pancreatitis. The subjects (2 females and 1 male) were all Caucasian and between the ages of 14- and 19-years old. A retrospective chart analysis was conducted to assess pain scores for the 2 days surrounding the CPB and to document the duration of pain relief. Results: All 3 patients experienced significant reduction in abdominal pain after the CPB. Follow-ups were conducted via telephone calls and office visits. Duration of pain relief varied from 4 to 19 weeks, before the patient experienced a relapse, which we defined as the recurrence of severe abdominal pain that necessitated a hospital admission. Conclusions: Due to the significant degree of pain relief, we suggest that CPBs be considered for pain management in pediatric patients with VH, as an addition to their multidisciplinary therapy. However, clinical follow-ups must be maintained as the duration of pain relief can vary widely. As this case study examined only three patients, further research is needed to corroborate these findings.