Pain is one of the symptoms of mesothelioma. Managing pain associated with mesothelioma is essential for more than just the patient’s comfort. Chronic, uncontrolled pain adversely affects treatment because it:
- Affects the patient’s ability to sleep and eat, leading to fatigue and worsening health
- Interferes with being able to schedule treatments
- Contributes to a negative mental outlook
- Makes it more difficult for the family to help the patient cope
Avoiding these negative effects by successfully managing pain is essential to improving treatment outcomes and lengthening survival.
Initially, the pain and discomfort of the disease is mild and controllable with over-the-counter medications. In the end stages, the pain progresses to severe and chronic but is treatable with strong narcotics. Throughout the course of the disease, the patient also has other options for keeping pain under control.
Pain Causes
Initially, discomfort and pain is normally caused by the build-up of fluid between the two layers of the mesothelium. In pleural (lung) and pericardial (heart) mesothelioma, fluid build-up in the chest area results in pain in the chest or back. In peritoneal mesothelioma, the pain occurs in the abdomen.
As the tumor grows, it begins pressing against nerves and other organs causing an increase in pain sharpness and longer-lasting episodes. It can also cause a burning or tingling feeling. Surgical treatment, radiation, and chemotherapy can also contribute to short-term pain issues.
In the later stages of the disease, as the cancer spreads farther into adjacent tissue, it begins to have a greater effect on nerves and organs. This greater involvement leads to increasingly severe and chronic pain symptoms.
Medications
Pain Relievers
In the early stages of the disease, pain is controllable with over-the-counter medications such as acetaminophen or ibuprofen. When pain advances to the point that these are no longer effective, the doctor will prescribe a narcotic medication such as:
- Codeine
- Hydrocodone
- Oxycodone
- Hydromorphone
- Fentanyl
- Morphine
The choice of medication is usually determined after considering the patient’s condition and the drug’s potential side affects or interactions with other medications. These drugs – whether delivered orally or using a patch – are usually slow-release to help maintain a constant amount of pain-reliever in the bloodstream. Note that narcotics do not stop pain. In the right dose, they simply reduce the perception of pain to a tolerable level.
Occasionally, however, the patient on narcotic pain relievers experiences breakthrough pain, which is an intense episode lasting a short while. If breakthrough pain becomes a problem, the doctor can prescribe a fast-acting narcotic such as oral immediate-release morphine to be taken when breakthrough pain occurs.
Other Medications
Anti-depressants can actually be effective for some types of pain, and anti-convulsants can control burning and tingling pain. When pain results from swelling, steroids can reduce the swelling and thus the pain.
Because there is such an array of choices, it’s important to discuss with your doctor exactly what type of pain you’re experiencing, when and where it occurs, how intense it is and how long it lasts. When one medication is not working, he or she will be able to adjust the dosage or choice of medication to be more effective.
Medical Treatments
Paracentesis
When pain is being caused by fluid build-up on the lungs (pleural effusion) or in the abdomen (peritoneal effusion), the doctor can relieve the pain by draining the fluid in a procedure generally called paracentesis, or more specifically:
- Thoracentesis when fluid is removed from the membrane lining the lungs (pleura)
- Peritoneocentesis when fluid is removed from the membrane lining the abdomen (peritoneum)
- Pericardiocentesis when fluid is removed from the membrane lining the heart (pericardium)
To accomplish this, the doctor applies a local anesthetic and uses a fine needle to locate and withdraw the fluid from the chest or abdomen.
Pleurodesis
If fluid build-up in the mesothelium is a recurring problem, the doctor can perform pleurodesis. In this procedure, an irritant such as Bleomycin, Tetracycline, or talc powder is injected into the space between the layers of the mesothelium. This causes the membranes to stick together and eliminates the space where fluid would otherwise collect. Preventing further fluid build-up effectively eliminates this as a source of pain.
Surgery
Although surgery involves inevitable short-term pain, removing the tumor that is invading adjacent organs, tissues, and nerves can remove some of the source of a patient’s more chronic pain. After recovering from surgery, the resulting pain relief should last for some time until the cancer begins to recur.
Radiation
Radiation has the effect of killing cancer cells and can reduce the size of a tumor. Studies have shown that this can reduce pain symptoms for up to several months following treatment. Sometimes no more than a single treatment is necessary to have an effect on pain. A long course of radiation therapy may itself become a source of pain, however, if extensive treatments begin to damage healthy tissues.
Spinal Catheter with Infusion Pump Implant
When pain is no longer controlled satisfactorily with standard medications and delivery methods, the doctor may change the pain management strategy to a spinal catheter with an infusion pump implant.
This approach places a catheter below the skin and directly into the fluid at the base of the spine and attaches it via tubing to an infusion pump. The programmable pump delivers precise doses of narcotic into the spinal fluid where pain signals are then blocked. This direct drug delivery method requires much smaller doses and therefore reduces side effects.
Even better for the patient, the pump – about the size of a hockey puck – can be implanted just under the skin of the abdomen providing the patient with a highly effective and portable pain relief system. Batteries last up to five years and the doctor can refill the pump’s drug reservoir with a simple injection.
Other Pain Relief Strategies
Some patients may be interested in alternative pain relief techniques that don’t involve drugs and narcotics. Though many of these approaches will not completely alleviate pain – especially severe pain – many people find that they can reduce their reliance on pain medications by using one or more of these techniques. If any of these techniques appear interesting, you may want to do further research to learn more.
- Relaxation
- Biofeedback
- Imagery
- Distraction
- Hypnosis
- Transcutaneous Electric Nerve Stimulation
- Acupuncture
- Massage
- Acupressure
- Vibration
- Cold or Heat
- Menthol
- Skin Stimulation
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