The thoracic splanchnic nerves carry pain signals from your upper abdominal organs (stomach, pancreas, liver, gallbladder). Targeting them aims to reduce upper abdominal pain, though individual results vary. Depending on your pain pattern, this may be done on one or both sides. There are several treatment options, used only as far as needed:

• Local anaesthetic: numbs the area immediately, helping confirm the response.
• Pulsed radiofrequency (pulsed RF): short bursts of energy applied to the same nerves without destroying them, aiming for longer-lasting effect.
• Thermal radiofrequency or neurolytic agent: used in some cases, particularly for cancer-related pain, to provide longer-lasting relief.

This procedure may help if you have:

• Chronic upper abdominal (visceral) pain not explained by other causes
• Upper abdominal pain related to pancreatic or other upper gastrointestinal cancer
• Chronic pancreatitis pain in selected cases

It isn't possible to guarantee how any individual will respond. As a general guide:

• Local anaesthetic: works within minutes and wears off after a few hours — a good early sign of response.
• Pulsed RF: effect usually begins after a couple of weeks and may last for a few months.

This procedure is generally considered safe when performed under X-ray guidance, though as with any medical procedure the degree of benefit varies and cannot be guaranteed.

Common, minor effects:

• Temporary soreness at the injection site
• Temporary low blood pressure, which can cause light-headedness or dizziness on standing
• Temporary loose stools or diarrhoea for a day or two, as the nerve supply to the bowel is affected

Rare, more serious risks:

• Infection or bleeding at the injection site
• Pneumothorax (partial lung collapse), which is rare given the proximity to the lung and may require monitoring or a chest drain
• Temporary or, rarely, persistent nerve pain (neuralgia) along a rib if a nerve is irritated during the procedure
• Nerve injury, or injury to nearby blood vessels or organs
• Allergic reaction to the local anaesthetic or contrast dye
• Small increased lifetime risk from the X-ray exposure used to guide the procedure
• Serious sedation or anaesthetic complications, very rarely including stroke or death
• Minimal or no improvement in pain

• Tell us about any blood-thinning medication (e.g. warfarin, Xarelto, Plavix) well in advance — special arrangements may be needed and you may be asked to pause these under guidance
• Tell us if you are, or might be, pregnant — this procedure uses X-ray guidance
• Tell us about any allergies, including to contrast dye, local anaesthetics, or reactions to previous injections or anaesthesia
• You will usually be asked to fast for 6 hours beforehand if sedation is planned
• Bring a list of your current medications
• Arrange for someone to drive you home afterwards

• You will lie face-down (prone) on the procedure table
• The skin over the treatment area is cleaned with antiseptic
• Local anaesthetic numbs the skin before the main needle is placed
• Live X-ray (fluoroscopy) guides the needle precisely to each target
• The procedure usually takes 30-45 minutes

• You will be monitored briefly in recovery before going home
• Some soreness at the injection sites is common for 1-3 days — simple pain relief (e.g. paracetamol) usually helps
• You may remove the small dressing after 24 hours, keeping the area clean and dry
• You may feel light-headed on standing for a day or two — stand up slowly and ask for help if needed
• Avoid strenuous activity or heavy lifting for 24-48 hours
• If you were sedated, avoid driving, operating machinery, or making important legal or financial decisions for 24 hours
• Continue your regular medications unless specifically advised otherwise

Contact your GP, Total Pain Clinic, or your nearest Emergency Department if you notice:

• Increasing redness, swelling, or discharge at the injection site
• Fever or feeling generally unwell
• New shortness of breath or chest pain
• Severe pain not settling with simple pain relief

A review appointment is usually arranged 2-4 weeks after your procedure to discuss how you responded and plan next steps — please call Total Pain Clinic reception to schedule this if it hasn't already been arranged. Please ask your doctor any questions before you proceed; you will be asked to sign a consent form if you agree to go ahead.