Pancreatic cancer is a common malignant tumor of the digestive system, and many patients are already at an advanced stage when they are seen. Therefore, the surgical resection rate is low and the prognosis is poor. Pain is the most common and serious clinical symptom of advanced pancreatic cancer. Most of the patients’ pain is caused by the cancer invading the abdominal plexus including the visceral nerves, which causes severe pain in the abdomen and back and lumbar region, causing unbearable pain, seriously affecting the patients’ diet and sleep, accelerating physical exertion and causing a series of poor prognosis. The study of the mechanism of severe neuropathic pain caused by pancreatic cancer invading the abdominal plexus and the search for effective methods to treat this serious symptom is a very urgent requirement in the treatment of advanced pancreatic cancer. The mechanism of neuropathic pain caused by pancreatic cancer is not clear at present.1 It is generally believed that back pain in pancreatic cancer patients before surgery is an undesirable late symptom, often suggesting that the tumor exceeds the limits of the pancreas and directly infiltrates into the retroperitoneum or compresses visceral nerves, stimulating peripheral pain receptors or damaging nearby nerve fibers; or the cancerous tissue in the pancreas infiltrates the perineural space, resulting in The peripheral nerve edema caused by the infiltration of intrapancreatic cancer tissue into the perineural space, resulting in burning sensation and certain sensory dullness and abnormal sensation. The mechanism of neuropathic pain due to advanced pancreatic cancer has been reported to be related to the following three factors: (1) Transthyretin chemotaxis studies have shown that when nerve growth factor (NGF) is overexpressed, animals have reduced prevalence of nociceptive hypersensitivity and nociceptive hypersensitivity to injurious stimuli, and anti-NGF antiserum and TrKA2IgGg fusion protein can reduce inflammatory pain and neuropathic pain. (2) Tumor necrosis factor 2α induces apoptosis Tumor necrosis factor 2α (TNF2α) and other cytokines can cause neuronal cell injury and mediate neuronal cell death. Based on TNF2α is associated with inflammation and neurogenic pain production. (3) Abnormal sodium channel discharge Sodium channel is the 1st ion channel identified at the molecular level. Pain transmission, relies on voltage-gated sodium channels on neurons to generate action potentials. In nerve injury and inflammation, upregulation of the TTX-insensitive Na+ channel mR2NA expression is increased at the end of neuromas and in cell bodies formed in peripheral nerves, ectopic accumulation of sodium channels in axonal injury areas, and abnormal increases in sodium channels can lead to abnormal, repeated electrical activity and enhanced sodium currents. Prostaglandin E2, nerve growth factor, and 52HT can increase TTX-insensitive Na+ currents, and bradykinin acts on Na+ channels to increase the sensitivity of injurious afferents. In recent years, with the rapid development of interventional radiology, the use of CT or endoscopic-guided abdominal plexus block for the treatment of intractable pain in mid- to late-stage tumors in the upper abdomen has become more and more common at home and abroad, with remarkable efficacy, durability and safety, and few complications. However, the key to the success or failure of block therapy is whether the location, size and morphology of the celiac plexus can be correctly identified and clearly displayed. It is the largest autonomic plexus in the body, located at the level of T12 to L1, anterior or anterolateral to the superior abdominal aorta, surrounding the roots of the celiac artery and superior mesenteric artery. The plexus contains mainly the celiac ganglion, the superior mesenteric ganglion, and the aortic renal ganglion. The celiac ganglion is the main ganglion within the celiac plexus and is lamellar, nodal, long, and semilunar in shape. These plexuses are accompanied by blood vessels that innervate the functions of the corresponding organs, such as liver, pancreas, stomach, kidney and mesentery, etc. The nerve fibers emitted from them not only regulate the endocrine and exocrine functions of the pancreas, but also are related to the pain sensation in the abdomen. The study of the mechanism of neuropathic pain caused by pancreatic cancer and the adoption of targeted therapeutic measures according to the pathological mechanism is the fundamental treatment of neuropathic pain in pancreatic cancer. The role of various sodium channel blockers, mainly including local anesthetics, antidepressants, anticonvulsants and antiarrhythmics in the treatment of pain. Studies have shown that the application of drugs including 2 ,222 fluorodeoxycytidine nucleoside, September 2007 pyrimethamine, or appropriate palliative treatment such as radiochemotherapy and radiation alone can improve the quality of survival of some patients with advanced pancreatic cancer. (1) Blocking sodium channel analgesia (2) Drug analgesia Drug analgesia is by acting on the nervous system, causing loss of pain perception, which can only serve to temporarily relieve pain, but cannot remove the cause of pain. In the early stage of unresectable pancreatic cancer, oral or injectable narcotic analgesics can be used as non-steroidal anti-inflammatory drugs (NSAIDs). Opioid analgesics are administered in stages, from weak to strong, according to the WHO recommended 3-step ladder protocol. However, as the disease progresses, opioid analgesics alone are not sufficient. Antidepressants, anticonvulsants, steroid hormones, calcitonin, ketamine, and anticholinergics. (3) Epidural spinal canal injection Epidural spinal canal injection is used when pain is not adequately analgesic by WHO 3-step method and opioid analgesic method has serious side effects.1 Generally, nerve disruption, visceral nerve block and submesenteric plexus block are used for visceral pain. Before epidural injection of ethanol, local anesthetic is injected to confirm its analgesic effect. In the choice of anesthetic drugs, opioid analgesics should be chosen and colistin (clonidin) ,ketamine should be injected to enhance the analgesic effect and reduce the side effects. (4) Tumor destruction to avoid NGF chemotaxis High-energy focused ultrasound (HIFU) is a non-invasive local treatment, which uses the characteristics of focusability and soft tissue penetration of ultrasound to gather low-energy ultrasound in vitro at the tumor lesion in vivo, thus producing high temperature effect, cavitation effect and mechanical effect, causing tumor cell coagulation and necrosis. Both in vitro and ex vivo experiments show that focused ultrasound can kill tumor cells, destroy tumor tissues and inhibit tumor tissue proliferation. Since high-energy focused ultrasound can generate high temperature of 70 ℃ to 100 ℃ at the target site of treatment, it can cause degeneration and necrosis of pancreatic cancer cells and the involved abdominal nerve plexus and its branches, block the transmission of pain stimuli to the brain and make the pain disappear, thus playing a role in complete pain relief. (5) External radiation therapy The study on the efficacy of different modes of radiation shows that patients who receive multiple low-dose treatments to achieve the same cumulative radiation dose not only achieve the required high dose in the tumor part, but also the surrounding normal tissues are exposed to less radiation, thus achieving better efficacy and fewer side effects. The majority of patients can get pain relief or reduce their dependence on pain medication. (6) Chemical visceral nerve debridement Chemical visceral nerve debridement, also known as anesthetic block of the abdominal plexus, is commonly performed with nerve-disrupting agents such as alcohol and carbolic acid. Endoscopic ultrasound-guided abdominal nerve (N) plexus block (CPN) is a technique developed in recent years to chemically block the abdominal N plexus under endoscopic ultrasound guidance, injecting drugs (such as anhydrous ethanol, corticosteroids or lidocaine) into the abdominal N plexus to cause chronic necrosis of the abdominal N ganglion, thus achieving the purpose of severing the visceral sensory nerves. Clinically, ordinary ultrasound and CT-guided nerve block can be used to relieve pain, but the efficacy is greatly affected by the long injection path, which is not easy to avoid deep important organs in the abdominal cavity and difficult to locate accurately. Under the guidance of ultrasound gastroscopy, anhydrous alcohol was injected into the abdominal nerve plexus adjacent to the posterior wall of the cardia with a very fine puncture needle to block the nociceptive nerves of the abdominal organs, thus achieving pain relief. Because the ultrasound endoscopic puncture is closer to the abdominal plexus, accurate judgment, short injection path, less damage to the adjacent tissues and fewer complications, it becomes an effective way to relieve the problem of intractable abdominal pain in patients with advanced pancreatic cancer. Endoscopic ultrasound refers to placing a miniature ultrasound probe on the tip of the endoscope. When the endoscope is inserted into the digestive tract, it can not only directly observe the morphology of lesions on the mucosal surface through the endoscope, but also perform ultrasound scanning to obtain histological features of the walls of the digestive tract at various levels and ultrasound images of the surrounding important organs, thus increasing the diagnostic scope of endoscopy and improving its diagnostic ability. In addition, the distance between the ultrasound probe and the target organ is significantly shortened, thus enabling clearer visualization of lesions located deep in the abdominal cavity. EUS can also clarify the depth of invasion of the gastrointestinal wall, the presence of regional lymph nodes and adjacent tissues and organs, and the metastasis, and the imaging of soft tissue structures around the gastrointestinal tract and pancreas is not comparable to ex vivo BUS, CT and MRI. With the maturity of radiological interventional techniques, the use of subguided blockade of the abdominal plexus with anhydrous ethanol can achieve effective analgesia. At present, the pain department in China mainly adopts CT-guided abdominal plexus disruption, which has high resolution and can clearly show the anatomical structures of the retroperitoneal space, such as the pancreas, abdominal aorta, celiac trunk and superior mesenteric artery, as well as the size, location and number of tumor and retroperitoneal lymph node metastases, which are very important for selecting the puncture point, needle route and depth. During the puncture process, CT can accurately show the precise location of the needle tip and its adjacent relationship with the surrounding structures, which can avoid damaging important organs and anatomical structures. It can also accurately observe the diffusion of contrast agent in the body. Therefore, it is increasingly used in clinical practice. Choosing the correct approach can make the puncture more accurate, improve the efficiency of pain relief and reduce complications. Commonly used approaches are: anterior approach, transvertebral disc approach, transaortic approach, and large visceral nerve block above the foot of the diaphragm. The disadvantages of abdominal plexus destruction are that the patient must remain in an uncomfortable position for a long time without being able to move, the efficacy does not cover all pain symptoms, the effect cannot be maintained for a long time, severe pain may reappear after a certain period of time, and chemical visceral nerve removal or abdominal nerve block is performed twice under various guidance techniques (e.g., CT-guided, MRI-guided, endoscopic ultrasound-guided, or laparoscopic-guided). During pancreatic cancer surgery in some hospitals in Europe and the United States, intraoperative injection of anhydrous ethanol on both sides of the abdominal trunk under direct vision is safe and effective for destruction of the abdominal plexus, but this method cannot be used repeatedly.