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Pain Management for Mesothelioma

Most patients with cancer experience pain, and even more so for patients diagnosed with mesothelioma 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

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 Pain Management

Pharmocological 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:

  1. Use of nonopioid analgesic, with or without an adjuvant agent
  2. If pain persists or increases, use of opioid plus nonopioid agent, with or without adjuvant medication is tried
  3. If pain continues or increases still, stronger doses of opioid analgesic prescribed, with or without a nonopioid or adjuvant agent.

Adjuvant Medications

Adjuvant medicine consists of 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:

  • antidepressants
  • anticonvulsants
  • analgesics
  • local anesthetics
  • steroids
  • corticosteroids
  • bishposhonates
  • radiopharmaceuticals
  • octreotide
  • topical drugs (applied directly to skin as patch, gel or cream)

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.

Improved Quality of Life for Mesothelioma Patients

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.

The information presented here 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.