Pain Management for Mesothelioma

Mesothelioma is a rare type of cancer that develops in the mesothelium, a thin membrane that creates a protective sac covering most of the body’s internal organs. There are three types of mesothelioma:

 

Mesothelioma is primarily caused by exposure to asbestos and develops decades after time of exposure. Asbestos is a mineral that was commonly used in insulating and fire retardant materials. It is no longer mined, manufactured or used in the United States because of its toxicity and risk to public health. 

 

Symptoms of mesothelioma can include:

 

 

Most patients diagnosed with cancer experience pain, and even more so for mesothelioma patients because it is often not diagnosed until the cancer is advanced. Late stage cancer always causes more pain for the patient as the tumors have progressed and interfere more with healthy bodily functions. 

 

Because the majority of mesothelioma cases are diagnosed in advanced stages of the disease, pain relief and palliative care is a realistic and necessary part of treatment. The World Health Organization defines palliative care as: “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.” 

 

Palliative care for mesothelioma patients is often the only option as there is no known cure. Therefore any treatment will have a strong component of pain management and symptom relief to increase quality of life from diagnosis to end of life. 

 

Palliative care can be used for treating symptoms as well as to decrease the difficult side effects of chemotherapy and radiation. 

 

There are two major types of pain management: pharmacological and non-pharmacological. In this article we will discuss palliative chemotherapy, palliative radiation, and pharmacological therapies, which primarily rely upon medication to control pain.

 

Palliative chemotherapy and radiation therapy, as well as surgical procedures, are standard first line treatment options used to reduce tumor size, thereby reducing symptoms and pain caused by mesothelioma.   Local surgical procedures to control pleural effusion, such as parietal pleurectomies or talc pleurodesis, are used to relieve patients of dyspnea and pain. Combination therapies, such as surgery along with chemotherapy and/or radiotherapy, are often recommended for mesothelioma patients.

 

Pharmacological palliative therapies use different drugs to relieve painful symptoms of the disease. Medications can include nonopioid pain relievers (such as aspirin and paracetamol), opioid pain relievers (such as codeine and morphine), and topical treatments. Two common indices used to determine the best drug treatment plan is the pain management index (PMI) and the WHO Analgesic Ladder. The analgesic ladder outlines the use of nonopioid and opioid analgesics and adjuvant medications for severe pain. The three steps of the ladder are:

 

Adjuvant medications are pain-relieving drugs that were originally designed to treat medical conditions other than cancer. Adjuvant means something that helps or assists. These drugs may be used along with first-line cancer medications typically used in primary treatment to help treat pain. Some of the more commonly used adjuvant medications are:

 

Some common medications used for relief of shortness of breath are lorazepan, diazepam, midazolam, and methotrimeprazine. Benzodiazepines are anxiolytic drugs that have a sedative effect, helping muscles to relax, relieve pain and breathlessness.  Other medications to consider are NSAIDs and neurolytic blocks.

 

Pain management for mesothelioma patients is vital for improved quality of life. Treatment options can change and must be suited to the individual and designed to minimize side effects. The amount, type and location of pain are taken into consideration when determining the choice of medications to use. Drug regimens will need to be reviewed on a regular basis by a healthcare team. The dosage and types of drugs may need to be changed depending on pain levels. It is recommended to talk with a pain specialist to gain the best information, discuss any concerns, and make the best choice. Many hospitals have palliative care teams available to consult with you and offer advice, options, and suggestions. 

 

Apart from pharmacological treatment options, there are other proven methods of pain relief. Please check back to this site, Helping Mesothelioma Patients, to read more about pain relief without drugs.

 

The information in this article is intended to be informative and support you through your care. Consult with your doctor, health care professional, or mesothelioma specialist for finding the right treatment for you. Always consult with a physician before starting any new drug regimen.