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Pain Management

We recognize that helping patients manage cancer-related pain is one of the most important aspects of their care. The best management for pain combines aggressive therapy with continual assessments to ensure that patients can maintain their quality of life.

Our physicians conduct comprehensive pain assessments to best determine when the pain started, where it is located, how intense it is and how various cancer treatments have made it better or worse. Then, they will help devise a treatment plan tailored to best increase your comfort. Please ask your health care team what pain management options might be best for you.

Our Harry J. Duffey Family Pain and Palliative Care Program features a team of pharmacists, social workers, nurses and palliative care physicians working to increase your comfort. These are nationally-known pain experts utilizing their knowledge of the most advanced techniques in alleviating pain.

Johns Hopkins' team of experts 

The palliative care team, working with your primary oncologist, provides:

  • Communication with you and your physicians
  • Treatment expertise of pain and other symptoms
  • Navigation through  the health care system
  • Guidance with difficult decisions and complex information
  • Information about your treatment options and assistance in evaluating options for your needs
  • Support, emotionally and spiritually, for you and your family


Pain medications taken round-the-clock rather than on an as-needed basis tend to be more effective and may decrease the total daily amount of pain medication required. Treatments for cancer pain include medicines including:

  • opioids or narcotics – the strongest pain relievers available.
  • acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs).

Pain caused by pancreatic cancer is often treated with long-acting oral opioids, a long-acting morphine..... Patients who cannot take opioids orally may be administered continuous-release medication skin patches or medication suppositories. Some patients also may benefit from an intravenous infusion of opioid medication, in which they can get pain relief as needed through a programmable portable pump. For more severe pain that has not responded to these measures, anesthetics can be delivered through small tubes called catheters placed near the spine.

An alternative option for delivering pain medication is through so-called “pain pumps.” Pain pumps are small reservoirs of pain medication implanted under the patient’s skin. The medication gets delivered on a predetermined timeframe through a thin tube extending from the reservoir to the spinal cord. This eliminates the need to take oral medications, and since the pain drugs are delivered directly to the spinal cord, some side effects may be avoided. Johns Hopkins Medicine clinicians are testing the effectiveness of utilizing pain pumps as compared with care directed by a team of pain experts.

Side effects of pain medications and other pain management therapies may include constipation, diarrhea, nausea and vomiting. These may impair the appetite of the patient, increasing the rate of weight loss, fatigue, and depressed mood.

Surgical procedures and radiation therapy also can relieve pancreatic cancer pain.  

  • Alcohol nerve block
  • Thorascopic splanchnicectomy - a minimally invasive procedure that cuts specific nerve branches.

There are some surgical procedures that may diminish the pain of pancreatic cancer patients, which may be performed in conjunction with surgery or separately. For example, during an alcohol nerve block, surgeons inject a local anesthetic into the roots of nerves that carry pain signals from the diseased pancreas to the brain. This procedure, performed in an outpatient setting, provides pain relief for up to three or four months as it numbs the nerves.

A newer technique called a thorascopic splanchnicectomy is a minimally invasive procedure that cuts specific nerve branches.

Another technique is the endoscopic ultrasound-guided celiac plexus nerve block, which uses a thin, lighted tube called an endoscope to look into the stomach and then place a needle through the stomach to inject anesthetic to nerves from the pancreas to the brain.

Another modality to assist with pain management is external beam radiation therapy, in which a radiation beam is directed at the tumor and may provide fast onset of pain relief.

Non-drug Pain Treatment

Patients may also benefit from some non-drug pain treatments, such as:

  • relaxation
  • guided imagery
  • massage
  • hypnosis
  • acupuncture
  • physical therapy
  • position for comfort training
  • coping skills training
  • support and counseling

These therapies can be used in conjunction with pain medications or traditional treatments. Our center also runs support groups for cancer patients, survivors and their families.


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