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Treating Pain

Significant pain often accompanies mesothelioma, particularly during the later stages of the disease. It is considered one of the major challenges facing patients and their doctors because of the impact pain has on the patient's quality of life and treatment of mesothelioma.

Fortunately, today more than ever, health-care workers who specialize in part control are employing state-of-the art techniques to successfully fight pain. One expert anesthesiologist recently pointed out that "our experience suggests a greater than 90 percent effectiveness rate... with the fewest side effects" in controlling pain caused by mesothelioma.

Progressive Symptoms

Pain associated with mesothelioma changes from mild, episodic, and localized, to severe and chronic as the disease progresses. The first symptoms of pain depend on the type of mesothelioma. For pleural mesothelioma, the initial symptoms are a nagging discomfort or mild pain in the chest area or in the back. For peritoneal mesothelioma, the first symptoms are abdominal or pelvic discomfort, and, in some cases, bowel obstruction and its resultant pain.

During the initial stages of mesothelioma, pain can be relieved with over-the-counter analgesics, such as aspirin, Tylenol or ibuprofen (Advil, Motrin). As mesothelioma progresses and destroys surrounding soft tissue and nearby nerve endings, the pain increases considerably. If the mesothelioma spreads into the chest wall, muscles or ribs, patients may experience severe pain.

Pain Management Techniques

Doctors have several options for treating mesothelioma pain. Initially, with the assistance of the patient, the doctor assesses the pain and develops a treatment plan.

a) Drug Therapy
Drug therapy is the primary method for treating mesothelioma pain. There are 3 types of medicines used for pain relief.

Non-Opoids are pain-relieving medicines such as acetaminophen (Tylenol) and NSAIDs, such as ibuprofin, which can be purchases over-the-counter and taken orally. These are usually the first choice for mild pain. Because of certain side-effects, however, doctors do not recommend anything greater than the maximum daily dosage.

Opoids are the strongest medicines available to treat pain. Opoids, such as codeine, morphine, oxcodone, fentany, and hydromorphone, are very effective in relieving mesothelioma pain. These drugs also have side effects, and managing these side effects is an important part of pain management. Opoids are administered orally or intravenously.

Adjuvant analgesics are medicines intended for purposes other than pain relief. A number of these are used to alleviate pain associated with mesothelioma, such as antidepressants, anticonvulsants, and steroids.

b) Epidural Implants
If orally or intravenously administered drugs are not effective in easing pain, mesothelioma doctors may prescribe a solution containing local anesthetics and opioid analgesics that is delivered epidurally, that is outside of the dural membrane of the spinal cord, but still within the spinal canal.

The pain-management team surgically implants a thin catheter beneath the skin. Precise doses of the pain-killing mixture are programmed to flow through this tubing into the epidural area of the spinal canal at preset amounts and times. The drugs bind to receptors in the central nervous system at the level of the nerve roots, blocking pain signals.

In addition to controlling pain, the epidural implant reduces the need for in-hospital pain care, permitting maximum mobility for patients. Doctors, in conjunction with trained technicians of a private home-health care agency, provide the medication and monitor the ongoing operation of the device.

For additional information on pain management, and to obtain a copy of "Cancer Pain: Treatment Guidelines for Patients," which was released in January of this year by the American Cancer Society and the Comprehensive Cancer Network, call us at 1-800-362-1479.

Emotional Support to Help Relieve Pain

As with all aspects of mesothelioma, emotional support from family or professional counseling can play a key role in pain management. Improving a patient's mental health helps minimize the fear, anxiety and depression that can make the physical pain feel worse.