Korean J Gastrointest Endosc.  2011 May;42(5):323-326.

A Case of Pancreatic Cancer and Opioid Withdrawal after Endoscopic Ultrasound-guided Celiac Plexus Neurolysis

• Seol SH
• Kim HS
• Hwang BS
• Oh DM
• Baek IY
• Park MK
• Ryu HU
• Kwon JK

Abstract

Pancreatic cancer is usually unresectable upon diagnosis, and treatment aims to optimize the quality of the patient's life by managing symptoms, and, particularly, by providing adequate pain control. When the pain is refractory to opioids, interventions such as celiac plexus neurolysis (CPN) can be considered. Endoscopic ultrasound (EUS)-guided CPN has been introduced for pancreatic cancer. Reported herein is a case of a 75 year-old man with pancreatic cancer who was treated with opioids due to severe abdominal pain. EUS-guided CPN was performed for pain control, and the opioid administration was discontinued as the pain improved dramatically. However, the patient experienced opioid withdrawal symptoms, including anxiety, insomnia, nausea, and vomiting. Thus, although EUS-guided CPN successfully reduced pain in a patient undergoing such treatment and to whom opioid was administered, opioid administration should not be abruptly discontinued. Rather, the opioid dose should be reduced gradually to avoid drug withdrawal.

Keyword

Endoscopic-ultrasound-guided celiac plexus neurolysis; Pancreatic cancer; Opioid withdrawal

MeSH Terms

Abdominal Pain
Analgesics, Opioid
Anxiety
Celiac Plexus
Humans
Nausea
Pancreatic Neoplasms
Sleep Initiation and Maintenance Disorders
Substance Withdrawal Syndrome
Vomiting
Analgesics, Opioid