Mesothelioma Pain Management

Mesothelioma is a type of cancer where tumors grow in the lining surrounding some organs – usually the lungs or digestive system. Mesothelioma discomfort comes from bone and neuropathic pain (i.e., aching from nerve damage). Also, pain can be a side effect of treatment (like chemotherapy).

Usually, mesothelioma pain management relies on several types of palliative treatment.

Tumors in the mesothelium tend to spread rapidly. People may feel a “body pain” or overall aching with no exact source. As the cancer progresses, this feeling may become more severe. Severe pain can drastically disrupt life and affect a person’s mood.

If tumors press on bones, nerves, or other organs, the pain can be sharp. Blood clots can also cause sharp, stabbing pains. Consequently, any new pain should be reported to your primary care provider as soon as possible.

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Ways to Control Mesothelioma Pain

Most patients undergo multiple treatments to relieve pain and make the person more comfortable. Commonly called “palliative treatment,” pain relief is a part of every patient’s cancer care plan. Each person is given a few methods to manage their long and short-term mesothelioma pain.

Keep reading for ways to control mesothelioma pain.

Pain Medications

View of elderly woman putting pills into a weekly medication dispenser for mesothelioma pain

Pain medicine is a common part of palliative treatment. Oral medication (usually pills or liquid capsules) allows people to manage pain as needed and on a consistent schedule.

Typically, opioids like morphine and oxycodone are prescribed to treat cancer-related pain. Doctors are careful to consider potential drug interactions when writing a prescription. As a result, some prescriptions are unavailable to patients undergoing certain anti-cancer therapies.

Level of Pain
Potential Prescription Pain Medications
Mild Acetaminophen
Moderate Codeine; low doses of hydrocodone, morphine, oxycodone, or tramadol
Severe Fentanyl, hydrocodone, morphine, oxycodone, tapentadol, tramadol

Other medicines that are often used in combination with opioid pain treatments include:

  • Antiepileptics like gabapentin
  • Non-steroidal anti-inflammatory (NSAID) drugs like acetaminophen, ibuprofen, naproxen
  • Tricyclic antidepressants like doxepin and amitriptyline

Removing Fluid Buildup

Fluid buildup is a symptom of pleural and peritoneal mesotheliomas. Normally, tissues that line the lungs produce a lubricant. This fluid protects the lungs from rubbing against the chest wall. Mesothelioma can cause tissues to produce too much fluid or stop recycling old fluid (known as a “pleural effusion”).

Shortness of breath and pain are symptoms of fluid buildup in the chest or abdominal cavities.

Methods to remove fluid buildup include:

  • Indwelling pleural catheter (IPC) – For patients who are not healthy enough to endure other types of surgery, IPC can provide relief from fluid buildup. A tube is placed into the chest allowing fluid to continually drain from the body.
  • Pleural tap – Also called pleurocentesis and thoracentesis, depending on the location of the procedure. A pleural tap uses a hollow needle to drain fluid from the chest cavity.
  • Talc pleurodesis – Pleurodesis is a procedure that seals the space between the lungs and chest wall using talcum powder.
  • Thoracotomy – Open chest surgery that can be used to remove part of the chest lining or part of or a whole lung.
  • VATS with pleurectomy decortication – Video-assisted thoracoscopic surgery (VATS) with pleurectomy decortication uses a camera to look inside the chest cavity. Part of the lining of the chest wall is removed.

Radiation Therapy

The growth of tumors in the lining surrounding major organs makes them harder to treat with radiotherapy. Accordingly, radiation therapy is generally not used as a primary treatment for mesothelioma.

Typically, radiation is used as adjuvant therapy following other types of treatment (like surgery) to kill or shrink remaining mesotheliomas. To treat pain, radiation beams are aimed at tumors pressing against nerves, bones, and airways to shrink them.

Chemotherapy

Chemotherapy may be used to treat cancer pain by shrinking and killing tumors throughout the body. The combination of pemetrexed and cisplatin is commonly prescribed to patients whose tumors cannot be removed with surgery.

However, rounds of chemotherapy treatment can also cause pain. Subsequently, doctors consider the toxicity of chemo before adding it to your mesothelioma treatment plan.

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Surgery

There are a variety of surgery options to treat mesothelioma pain. Some methods, like pneumonectomy, remove diseased tissues that are causing pain. Other, less-invasive types of surgery can block nerves from sending pain signals to the brain.

Depending on your prognosis, you may have multiple palliative operations.

  • Cordotomy – A procedure that turns off certain pain signals from the spinal cord. Usually used in severe cancer pain cases.
  • Debulking surgery – Surgery to remove pain-causing mesotheliomas. Debulking is considered purely palliative and isn’t used to cure the disease.
  • Extrapleural pneumonectomy (EPP) – A major surgery that removes damaged parts of the lung, the lining of the heart and chest, and diaphragm.
  • Nerve block – A procedure that causes the loss of feeling around a nerve. Nerve blocks may be used to diagnose the source of pain or treat it.
  • Pleurectomy and decortication (P/D) – A two-part surgery that removes diseased tissue from the pleura and tumors from the lungs and chest cavity.

Complementary Ways to Manage Pain

Some patients with poor health or a history of addiction must rely on additional, complementary ways to cope with pain from mesothelioma. Acupuncture, medical massage, and yoga are types of complementary pain management techniques. These therapies are not intended to replace treatment prescribed by your doctor.

As with any treatment, complementary and alternative therapies should be discussed with your doctor before you start.

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