LIVER PAIN

Liver pain is a visceral pain (dull, heavy, deep continuous aching pain). It is due to stretching of the liver capsule. It is usually felt in the epigastrium or right side, but is sometimes presents as “backache” and in 2% of patients as groin pain. Pain can also be referred to the chest wall or right shoulder, and this referred element can be opioid insensitive. In any severe visceral pain there can be an autonomic component (pallor, sweats, tachycardia) but such severe pain is always preventable.

Management options include:

1. Morphine

2. Celiac plexus block

3. High dose steroids

4. Liver embolization

5. (Radiotherapy)

1. Liver pain usually responds well to a correctly titrated dose of morphine. (see Morphine)

2. Celiac plexus block is a good technique which gives complete or partial pain relief in 90% of patients. It should be considered as soon as opioids fail to give complete pain relief or are causing unacceptable side effects. (see Celiac Plexus Block)

3. High dose steroids (dexamethasone 8mg per day) may reduce peri- tumor edema and capsule tension and can sometimes reduce pain. They are an adjuvant treatment and should be used in this way if analgesics and celiac plexus blocks have failed to give complete pain relief.

4. Liver embolization can be performed by an interventional radiologist. The hepatic artery is cannulated (via a percutaneous, transhepatic approach) and the branch supplying the involved segment of liver is embolized (with gelfoam or thrombin). This causes a liver infarction which can be extremely painful for several days (with fever and leucocytosis).

The technique is sometimes used to reduce liver pain in vascular tumors (primary hepatoma, or metastases from some tumors—thyroid, renal or choriocarcinomas—that only rarely spread to the liver).  It has no place in routine pain control of liver metastases.

Liver embolization has also been used in carcinoid tumors (to reduce hormone secretion), and as a method of delivering cytotoxics attached to lipoidol which accumulates in the tumor deposits.

5. Radiotherapy can sometimes shrink liver metastases and reduce liver pain, but radiotherapy to the liver causes nausea and vomiting, and should not be considered for pain control.

The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.