Mesothelioma Info

Mesothelioma Pain Management

Pain from mesothelioma is one of the major challenges facing patients and their doctors, and it can have a significant impact on their quality of life. Cancer pain is a chronic, progressive pain that increases in severity over time. Many mesothelioma patients have pain that is unresponsive to conventional medical management.

Symptoms of early stage disease may be experienced by a nagging discomfort or mild pain in the chest area or in the back. As the disease progresses, it destroys soft tissue and nearby nerves, and the patient experiences the most discomfort. Eventually, as the tumor spreads, it grows into the chest, the chest muscles and ribs, causing tissue destruction and severe pain. Surgery, radiation and chemotherapy are aimed at stopping the spread of the disease and thus easing the pain; however, these treatments are not pain-free.

Palliative care is not always the best option for mesothelioma pain sufferers. Also, many patients are not at a stage of being only concerned with palliative care and simply need relief from the pain and discomfort associated with many stages of the disease. This can be modified through several different means. Such help may come through any of the following:

• Acupuncture
  
  Although still not a very common practice in western cultures on the whole, findings reveal that this type of therapy can have a beneficial effect on the well-being of cancer sufferers. One study even reports average pain reduction of 36% for those who undergo regular treatments.
• Meditation
  
  This form of pain reduction is obviously cost effective and allows great freedom for the patient in the times it is used and the means, since it can be done at any given location once techniques are learned. The stress reduction that is also a bi-product of this therapy is of great benefit to the patient.
• Massage
  
  This is a means of pain management through which the touch of another brings relief by relaxing muscles and joints and bringing a greater overall sense of peace in the midst of a trying time. An increase of circulation is also a benefit and even if only for a short time, the effects of this therapy can give a much needed respite from chronic pain.
• Transcutaneous Electrical Nerve Stimulation (TENS) Therapy
  
  TENS therapy is administered with the use of electrodes placed at particular points on the patient's body. The electrodes send a small battery-powered electric shock to the nervous system of the patient that initiates the release of a natural pain-reliever. Although some patients have anxiety about the use of any kind of "shock therapy," the safety of the therapy is proven and the lack of side effects make it a welcome pain reliever for those who have aversions to medicinal forms of pain relief.

The Brigham and Women’s Hospital Pain Management team is a multidisciplinary team whose goal is to bring maximum physical comfort and quality of life to all patients. Treatment is tailored to the needs of the individual patient. The goal is to provide the greatest amount of pain relief with the fewest number of side effects and with the greatest ease of administration.

Today, pain management specialists are providing more relief than ever before, thanks to superior pain management techniques. Some of these techniques include implanting devices, which deliver pain-fighting drugs directly to the central nervous system. Patients no longer responsive to the strongest oral or intravenous pain medications may have a special pain-killing mixture delivered intraspinally (inside of the dural membrane of the spinal cord, but still within the spinal canal). This intrathecal implant reduces the need for in-hospital pain care, allowing the pain to be controlled at home

At the Brigham and Women’s Hospital, eligible patients will have the opportunity to participate in a protocol studying the effectiveness of a three-drug intrathecal (administered into the spine) therapy in the management of pain due mesothelioma.

Medications are the cornerstone of mesothelioma pain management, and their use is aimed at providing the greatest pain relief possible with the fewest number of side effects and the most ease of administration. What medications should be used for each person, and for each kind of cancer pain that should be treated with medications, forms the art of effective mesothlioma pain management.


Medications used for cancer pain are selected by health care professionals to meet the pain needs of the patient. For some kinds of pain related to cancer, non-prescription medications may be sufficient. For other degrees and kinds of pain, prescription medications are used.
The following medications may be used, based on the severity of the pain caused by mesothelioma:


Mesothlioma pain management for mild pain - For mild mesothelioma pain, acetaminophen or nonsteroidal anti-inflammatory medications (NSAIDs), such as ibruprofen, are often used. Mild to Moderate Pain – For mild to moderate mesothelioma pain, when pain relief is not achieved with acetaminophen or NSAID medications, opioid medications are often used, usually as combination tablets with NSAIDs or acetaminophen. Some of the opioid medications used as combination products are hydrocodone, codeine, or oxycodone. Adjuvant medications may also be used for pain that is difficult to manage. Adjuvants are medications that were originally designed to treat conditions other than pain, such as tricyclic antidepressants.


Mesothlioma pain management for moderate to severe pain – Moderate to severe pain is usually best treated with higher doses of opioid medications often not given as combination products. Adjuvant medications, NSAIDs, and acetaminophen may also be used. The opioid medications used to treat moderate to severe pain include morphine, fentanyl, oxycodone, and hydromorphone.


Additionally, breakthrough pain medications are often provided, intended to deliver quick relief for flares of pain that occur despite the use of other pain medications. These medications are used only when breakthrough pain occurs and are intented to provide quick relief. See the section on breakthrough pain medications.


When you begin taking medications for cancer pain, it's very important to tell your health care providers what other medications (prescription and over-the-counter) you may be taking to treat other health-related conditions. You should also discuss any vitamin or mineral supplements or herbs that you take on a regular basis. Medications can and do interact, sometimes harmfully -- and this process of full disclosure will reduce the chances of problems occurring in your pain treatment.


It's useful to understand some basic facts about each kind of medication used for mesothlioma pain management, and its side effects. Remember, side effects should not prevent you from using medications for your cancer pain. Discuss side effects with your health care provider, and get assistance in managing these.
1. NSAIDs (ibuprofen, aspirin, naproxen, acetaminophen)

These medications, available over-the-counter as well as by prescription, do their work by reducing swelling and inflammation. Some NSAIDs, notably ibuprofen, aspirin and naproxen, have a greater impact on inflammation than does acetaminophen. As mentioned above, sometimes NSAIDs are combined with opioids to fight pain.


Side Effects. Some NSAID medications can cause gastrointestinal problems, especially ibuprofen and aspirin. Acetaminophen does not cause this side effect, and the newest NSAIDs, the COX-2 inhibitors Celebrex and Vioxx, reportedly have a minimal impact on the gastrointestinal tract. However, it's important to know that the COX-2 inhibitors have not been tested for cancer pain relief, and are presently used only to treat arthritis pain. Acetaminophen should not be taken by people who have three or more alcoholic drinks in the course of 24 hours, as damage to the liver can result.


If you are taking cancer pain medications that contain NSAIDs, don't take additional over-the-counter pain medications without discussing this with your physician or nurse who handles your mesothlioma pain management.
2. Opioids

These medications are most often used to treat moderate to severe cancer pain, and they are always prescription medications. Opioids are sometimes combined with acetaminopen (Percocet) or aspirin (Percodan), for example. These medications can be taken in a wide variety of ways orally, by patch, rectally, by injection, transmucosally and are formulated to be long- and short-acting. Almost always, opioid treatment for mesothelioma pain management begins with a low dose, and the dosage is increased until pain relief is satisfactory to the person in pain.


For many people experiencing cancer pain that is expected to continue, opioids should be administered on an around-the-clock basis, rather than given only when pain becomes intense. The around-the-clock approach provides a consistent level of the medication in the blood, and this helps to provide a fairly consistent level of pain relief, preventing abrupt peaks and valleys of pain. Additionally opioid formulations for breakthrough pain probably should be provided.


Side Effects. Opioid medications can produce a variety of side effects. The most important to know about are:


Constipation. Almost without exception, every person using opioid medications on a regular for mesothelioma pain management experiences constipation, unless he or she is given information about a special bowel regimen designed to head off this problem, which can be very painful. Many mesothelioma pain experts recommend that a bowel regimen be started immediately when opioid medications are prescribed. People taking these medications should also drink 8- 10 glasses of water each day, and increase fiber in their diet, if possible.


Nausea and vomiting. Some people experience nausea and sometimes vomiting when they begin using opioids. There are excellent anti-emetic (anti-nausea) prescriptions medications available today, such as Zofran and Kytirl; ask your health care provider about using them to combat nausea. For most people, the nausea fades away after taking the medication for a short period of time.


Sleepiness. It is not unusual for some people beginning opioids to experience sleepiness for several days during mesothlioma pain management. For most people, this is a temporary side effect, and it is worthwhile to stay on the medications for a few days to see if the drowsiness fades away. If the sleepiness is severe, contact your health care provider.


Respiratory depression. A serious side effect of opioids is slow, shallow breathing. This side effect rarely occurs when opioids are taken as prescribed. If you have concerns about this side effect, be sure to discuss them with your health care provider.