Managing mesothelioma pain during treatment is a challenge because pain is often caused by multiple factors. However, the more experts understand the pathology of pain—how and why pain develops—the more effectively they can treat it and improve patient quality of life.

A new oncology nurses’ report looked at the challenges doctors face when trying to treat the pain mesothelioma patients experience. It’s essential for caregivers and medical teams to better understand how to manage pain symptoms because to improve a patient’s quality of life.

Usually, caregivers and medical staff struggle with mesothelioma pain management for many reasons. Pain is often not caused by one particular factor. Patients also experience pain differently and in different levels of severity, since pain is subjective.

For example, metastasizing (spreading) tumors and aggressive treatments can both cause pain. This pain could be a sharp stabbing pain in one spot of their body, or it could be a deep, dull ache that stretches across their chest and back.

Mesothelioma Pain Management

Effectively treating pain is as vital in mesothelioma treatment as controlling the disease is because alleviating painful symptoms gives patients a better quality of life during their remaining time after diagnosis. To effectively treat pain, doctors need to understand what causes it.

One reason for mesothelioma pain is that as cancer spreads, the tumors press against the patient’s bones, lungs or nerves. Other times the pain is caused by the treatment itself, such as when radiotherapy causes radiation dermatitis—when the patient’s skin is irritated.

Current Mesothelioma Pain Management Approaches

Currently, there are two general options for mesothelioma pain management: medication and surgery. For medicine, the World Health Organization recommends a ladder approach—administering drugs from the mildest to the most potent. This approach is effective for relieving up to 80% of a patient’s pain.

Medication for Pain Management

The first step of the ladder is acetaminophen and anti-inflammatories. As the patient’s pain levels increase, they move onto weaker opioids like codeine and tramadol. The third and final step is stronger opioids. If these medicines aren’t covering all of the pain, patients can take some other painkillers as well.

While WHO advises the use of the ladder system, they do not recommend any dosages because each patient’s needs are unique. However, they do suggest that medicine should be oral to give the patients more control over their pain management.

Therapies for Pain Management

In addition to medications, doctors also perform medical procedures such as radiation and surgeries to control patient pain. But, one problem with radiation for pain management is that while doctors know it works to relieve cancer pain, they do not know what dosage or fraction will make it most useful.

Another medical procedure that researchers are investigating as a form of pain relief is a cordotomy. When mesothelioma metastasizes (spreads), it can affect the nerves in the patient’s back and chest and cause pain. A cordotomy is a surgery that disables these nerve connections and effectively prevents the transmission of pain signals.

Studies have shown that patients will still experience some pain in those locations after the cordotomy surgery. However, the post-operative pain is more manageable than the pain the patients experienced before the procedure.

Unfortunately, in many cases, these multimodal approaches don’t sufficiently address the broad range of symptoms that patients experience. This is why the cancer nurses’ report is calling for more research into pain management for mesothelioma patients.

Further Research Needed to Understand Mesothelioma Pain

Due to the multifactorial aspect of cancer pain, it is difficult for doctors to control it, which is why it’s vital for researchers to learn more about mesothelioma pain management. Not feeling pain, or only experiencing a low level of pain, is imperative for patients because it dramatically improves their quality of life and ability to fight the disease.

There is a lot of room for improvement. For example, while WHO recommends patients continue to take acetaminophen when they are on opioids, there is not enough evidence available to say whether or not it’s beneficial.

Furthermore, researchers are not sure if the second step on WHO’s ladder is necessary at all. Not everyone responds to codeine, and there isn’t enough proof to show whether or not receiving lower dosages of stronger opioids helps alleviate pain.

This report is crucial for doctors, patients and the mesothelioma research community, as it calls for further research to better understand the pathology of pain and find the most effective pharmaceutical and radiation doses possible.

To ensure the best chance of improving quality of life, mesothelioma patients should work with a mesothelioma doctor. Specialists have better knowledge and insight into current understandings of mesothelioma, including pain management. For more information on mesothelioma specialists in your area, contact a Patient Advocate today at (800) 584-4151.

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Sources
  1. "Pain Management in Mesothelioma," Journal of Palliative Care & Medicine. Retrieved from: https://www.omicsonline.org/open-access/pain-management-in-mesothelioma-2165-7386-1000223.php?aid=55868. Accessed May 30, 2019.
  2. "Causes and Types of Cancer Pain," Cancer Research UK. Retrieved from: https://www.cancerresearchuk.org/about-cancer/coping/physically/cancer-and-pain-control/causes-and-types. Accessed May 29, 2019.
  3. "Pain Management in Patients with Malignant Mesothelioma: Challenges and Solutions," Lung Cancer: Targets and Therapy. Retrieved from: https://www.dovepress.com/pain-management-in-patients-with-malignant-mesothelioma-challenges-and-peer-reviewed-fulltext-article-LCTT. Accessed May 29, 2019.
  4. "Pain Management in Patients with Malignant Mesothelioma: Challenges and Solutions," Lung Cancer: Targets and Therapy. Retrieved from: https://www.dovepress.com/pain-management-in-patients-with-malignant-mesothelioma-challenges-and-peer-reviewed-fulltext-article-LCTT. Accessed May 29, 2019.

Last modified: June 13, 2019