Outcomes of Fluoroscopy-Guided Transdiscal Splanchnic Nerve Neurolysis for Upper Abdominal Cancer Pain.

The goal of this prospective study is to learn whether fluoroscopy-guided transdiscal splanchnic nerve neurolysis can safely reduce severe upper abdominal cancer pain in adults with pancreatic, gastric, or hepatobiliary cancer. The study will also assess whether this procedure can reduce the need for opioid pain medicines and improve patients' functional status and quality of life. The main questions it aims to answer are: Does the procedure reduce patients' pain one month after treatment? Does it reduce the amount of opioid pain medication patients need? Does it improve functional status and quality of life? What complications or side effects occur after the procedure? How long does pain relief last, and how often is repeat treatment needed? Participants will: First receive a diagnostic splanchnic nerve block with local anesthetic. If the diagnostic block provides at least 50% pain relief, undergo transdiscal splanchnic nerve neurolysis using fluoroscopy guidance. Receive a neurolytic agent (absolute alcohol or phenol) through a needle placed at the T11-T12 or T12-L1 level. Have their pain, opioid medication use, functional status, complications, and satisfaction assessed before treatment and during follow-up. Complete follow-up assessments at 1 week, 1 month, 3 months, and 6 months after the procedure. Complete a quality-of-life questionnaire before treatment and at 1 month. The primary outcome will be the change in pain score on the 0-10 Numeric Rating Scale at 1 month after the procedure.

Inclusion Criteria: * Age ≥ 18 years. Confirmed diagnosis of pancreatic, gastric, or hepatobiliary malignancy with epigastric/upper abdominal pain. Baseline NRS ≥ 7 despite optimized pharmacotherapy, or intolerable opioid side effects. ≥ 50% pain relief on diagnostic splanchnic nerve block. Able to provide informed consent. Exclusion Criteria: * Coagulopathy (INR \> 1.5, platelets \< 50,000/µL). Local or systemic infection. Uncontrolled hypotension or severe cardiopulmonary compromise precluding prone positioning. Intestinal obstruction. Known allergy to contrast, local anesthetic, or the neurolytic agent. Patient refusal.