Treatment Plan Includes Pain Management for Mesothelioma Patient

• Nancy Meredith
• Nurse's Corner

Pain management is an important part of the medical management of mesothelioma. Over fifty percent of mesothelioma patients report they suffer from pain at some time during their battle with the disease. The most common pain-related symptoms reported by patients with malignant pleural mesothelioma are general pain, back pain, and chest pain. Patients can get pain from several different sources, which is why the assessment of pain needs to be thorough and extensive.

Pain can be managed if it is included as part of the mesothelioma treatment plan. Pain and palliative care specialists are experts in pain control. Palliative care specialists treat the symptoms, side effects, and emotional problems of both cancer and its treatment.

There are different types of pain from malignant mesothelioma – tumors can infiltrate the intercostal nerves (nerves which arise from the thoracic nerves, and run between the ribs) causing a painful syndrome known as neuropathic pain syndrome. If a patient has chemotherapy, they might develop a peripheral neuropathy. If they receive the chemotherapy through an abdominal port, they can experience pain at the port site and diffuse abdominal pain.

Some patients who undergo surgery, either a pleurectomy or an extrapleural pneumonectomy can develop post-thoracotomy pain, neuropathic pain localized to the region of the thoracotomy scar. This can be experienced months post-surgery. The pain is often described as an aching or burning. A small percent of surgical patients can also develop post-operative frozen shoulder which is limited shoulder range of motion usually caused by untreated thoracotomy pain and inadequate rehabilitation.

Treatment for mesothelioma pain depends on the source of the pain. For pain caused by the chemo agent cisplatinum, which can cause peripheral neuropathy, corticosteroids, tricyclic antidepressants, and alpha-2 agonist may be used. Specific medicines that may be used are Gabapentin, Pregabalin, Phenytoin, Carbamazepine, Dexamethasone, Prednisone, and Amitriptyline. For patients with thoracotomy syndrome, lidocaine patches—worn for 12 hours per day—have been found to help. Other treatments shown to be effective are trigger-point injections, nerve blockers, and neurolytic procedures.

According to an article in Cancer Investigation, “It is estimated that chronic pain in patients undergoing cancer treatments range from 33 to 50 percent, it is considerably higher (over 70 percent) in patients with advanced disease.” If someone is having continuous pain, opioids (narcotics) will be ordered. Opioids consist of Morphine, Codeine, Oxycodone, Hydromorphone, Oxymorphone, Fentanyl, and Meperidine. They can be taken by mouth, injection, intravenously, rectally, transmucosal- lollipops, or by spinal infusion.

The most important thing to remember is that pain can be managed effectively with help from your medical team. However, you play a critical role by describing the pain, keeping records of when the pain happens, communicating with your team, and being honest about the effectiveness or lack of relief from the treatment.