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Karen Ritter, RN BSN
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Important Facts About Mesothelioma Pain Management
- There are various types of pain caused by mesothelioma, mostly due to mesothelioma symptoms and side effects from other treatments.
- Mesothelioma pain management may involve medications, surgical procedures, therapies and supportive care.
- Alternative treatment options are often available to patients seeking palliative care, such as physical therapy, massage therapy, acupuncture and more.
Types of Mesothelioma Pain
There are several types of pain associated with mesothelioma:
- Acute pain – Sudden and sharp pain that lasts for a short time
- Chronic pain – Persistent and lasting pain but easy to control
- Breakthrough pain – Sudden, intense pain occurring despite taking pain medication
- Neuropathic pain – Nerve damage, which can lead to tingling, burning, or shooting pain
Pain related to mesothelioma requires pain management techniques that include a combination of medications, treatments and complementary care to control pain.
Causes of Mesothelioma Pain
Symptoms of mesothelioma may be a cause of the pain associated with this rare cancer, but side effects from treatment can also lead to pain and suffering.
Mesothelioma pain is often caused by the growth of tumors and from fluid buildup in the chest or abdominal cavities. These are primary mesothelioma symptoms. Mesothelioma forms in the pleura (lining of the lungs) or peritoneum (lining of the abdomen). The pleura and peritoneum have two tissue linings that contain fluid.
The mesothelioma tumors develop in these linings, which can impact the normal flow of fluid in and out of these spaces. This can cause fluid buildup, which can lead to further pain and other troubling symptoms.
Fluid buildup presses against the patient’s chest or abdominal wall, causing pressure and pain. The excess fluid and tumors can also leave less room for nearby organs to move and function properly. For instance, the lungs need space to fully expand against the chest wall. With less free space, the lungs cannot expand, which causes patients to have difficulty breathing and chest pain. This is a primary symptom of pleural mesothelioma.
In the abdomen, the fluid can cause abdominal distention, abdominal pain, decreased appetite and other digestion issues, like constipation or bowel blockages. These are symptoms of peritoneal mesothelioma.
Mesothelioma Pain Management Medications
Options for pain management for mesothelioma can involve a combination of different medications. Pharmacological management of cancer pain includes opioids (narcotic pain medication), nonsteroidal anti-inflammatory drugs (NSAIDS), and antidepressants.
The addition of drug-free or alternative treatments, including physical therapy, massage therapy and acupuncture, can provide a more comprehensive relief of symptoms and ways to cope with pain.
Opioid pain relievers, or narcotic pain medications, are commonly prescribed for moderate to severe pain. However, they can cause side effects such as constipation, nausea, drowsiness, and respiratory depression. Patients taking opioids should be closely monitored by their healthcare provider.
NSAID pain relievers work by reducing inflammation and provide pain relief. They are often used for mild to moderate pain and can be taken with or without opioids. However, NSAIDS can cause stomach ulcers, bleeding, and kidney damage – especially with long-term use.
Antidepressants are an alternative to narcotic pain medicine but can also be effective in pain control associated with malignant mesothelioma. According to the Mayo Clinic, they work by increasing the neurotransmitters in the spinal cord resulting in reduced pain signals to the brain. However, they may take a few weeks to become effective and can cause side effects, such as dry mouth, dizziness and weight gain.
Many mesothelioma patients are aware of opioid drugs and their addictive nature. We recommend discussing the risks and your concerns with your physician or pain management specialist.
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Mesothelioma Pain Management Procedures
Pain management is a way to help mesothelioma patients maintain their quality of life throughout their cancer journey. This treatment option should be offered at every stage of the disease and be part of a comprehensive treatment plan.
Methods of pain management for mesothelioma patients may include medications, treatments and supportive care. Fluid buildup is a primary mesothelioma symptom and a common source of pain. Removing the fluid around the lungs, in the abdomen or around the heart is one way doctors can help decrease pain and symptoms.
Pleurodesis is a surgical procedure that can help to alleviate pain for patients with malignant pleural mesothelioma. During pleurodesis, fluid is drained from the thoracic cavity, and the pleural space is permanently closed, eliminating future fluid buildup in the pleura (pleural effusions). Doctors use a talc-like substance to cause the two linings of the pleura to scar together. A thoracoscopy, which is a thoracic scope with a camera attached, is used to perform the pleurodesis.
Pleurodesis Procedure Details:
- The thoracoscopy with pleurodesis can take 1-2 hours to perform, according to the St. Vincent’s Hospital website.
- The recovery time for pleurodesis is typically 2-3 weeks, with the first 3-5 days spent in the hospital for monitoring and recovery.
- Doctors may leave a chest tube drain in for a few days following the procedure to allow for excess fluid to drain out.
A thoracentesis, also called pleurocentesis, is a procedure to drain fluid from the pleural space and the chest cavity. It is similar to a pleurodesis but does not permanently close the pleural space. The procedure will temporarily resolve pleural effusions, but fluid accumulation may recur.
Thoracentesis Procedure Details:
- Doctors will numb the skin at the procedure site.
- A hollow needle is inserted into the chest cavity with the assistance of an ultrasound. The ultrasound will help the doctor identify the structures of the lung and the location of the fluid.
- According to the National Heart, Lung and Blood Institute, a thoracentesis for pleural mesothelioma patients can take approximately 15 minutes. It may take longer, depending on the volume of fluid in the pleura.
A thoracentesis can be used in the mesothelioma diagnosis process if cancerous cells are found in the removed fluid. Most patients can recover fully from the thoracentesis within one week and are typically able to leave the hospital on the same day of the procedure.
A paracentesis is a procedure to drain fluid from the peritoneum and within the abdominal cavity. This procedure is performed for peritoneal mesothelioma, which forms in the peritoneum. Fluid buildup in the peritoneum and abdominal cavity is called ascites.
Paracentesis Procedure Details:
- Doctors will numb the skin at the procedure site.
- An ultrasound machine is used to verify the location of the fluid and ensure proper placement of the needle.
- This is a temporary solution for ascites, and doctors may need to repeat this procedure to manage fluid accumulations and relieve pain.
- The procedure takes approximately 30 minutes to perform.
A paracentesis may play a part in diagnosing peritoneal mesothelioma. Surgeons may be able to remove small amounts of diseased tissue during this procedure, which are sent to pathology to identify any evidence of mesothelioma cancer cells.
According to Memorial Sloan Kettering Cancer Center, patients can recover from a paracentesis within a few days and are typically discharged from the hospital within a few hours after the procedure.
A pericardiocentesis is a procedure to drain fluid from the pericardium, the lining around the heart and where pericardial mesothelioma forms. Fluid buildup around the heart can cause pressure and prevent the heart from pumping blood at full function.
Pericardiocentesis Procedure Details:
- The doctor will use an echocardiogram (ultrasound of the heart) or live X-ray imaging (fluoroscopy) to visualize the structures of the heart and identify the location of the fluid buildup.
- With imaging assistance, the doctor will determine the best place to insert the hollow needle.
- Doctors will numb the skin at the procedure site.
- Since a pericardiocentesis involves the heart and surrounding tissues, doctors will carefully monitor the blood pressure, pulse and cardiac function of the patient before, during and after the procedure.
Pain Management Treatments for Mesothelioma
- Drug-free alternatives can be a helpful addition to managing pain symptoms and side effects associated with mesothelioma.
- Physical therapy can help to improve mobility, reduce stiffness, and strengthen muscles, which can provide a reduction in pain.
- Massage therapy can help relax muscles and reduce tension, which can also help alleviate pain.
- Acupuncture stimulates points that stimulate nerves, muscles and connective tissue. This stimulation can boost the body’s natural painkillers and endorphins.
Managing mesothelioma pain is an essential part of mesothelioma treatment plans. Pain management should be used with every type and stage of mesothelioma. Effective pain management is crucial in improving the quality of life and coping with mesothelioma symptoms and the disease process.
A combination of medications and drug-free treatments provide the best results. Patients should work closely with their healthcare providers to determine the best treatment plan for their individual needs.
Frequently Asked Questions About Mesothelioma Pain Management
What are the Signs of Mesothelioma Pain?
Mesothelioma pain may be a symptom of pressure against the chest wall, lungs, abdominal wall or abdominal organs. This occurs due to tumor growth within the linings inside the chest and abdomen. The tumors can cause fluid buildup in the linings — the pleura and peritoneum — where mesothelioma tumors originate.
What Procedures Treat Fluid Buildup and Mesothelioma Pain?
Fluid buildup is a primary cause of pain from mesothelioma. Fluid builds up in the pleura or peritoneum due to tumor growth and inflammation. Doctors may choose to perform a procedure to remove the fluid, such as pleurodesis, thoracentesis, paracentesis or pericardiocentesis.
What are Some Mesothelioma Pain Treatments?
Opioids, NSAIDS and antidepressants are medications doctors use to help manage mesothelioma pain. Patients may also find relief from drug-free options that can be used alone or as complementary therapies with medications. Physical therapy, massage therapy and acupuncture are just a few alternative treatments available to help relieve symptoms associated with mesothelioma pain.
Sources & Author
- Guidelines for Pathologic Diagnosis of Malignant Mesothelioma. International Mesothelioma Interest Group. Retrieved from: https://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2017-0124-RA. Accessed: 10/04/19.
- Immunohistochemistry. National Cancer Institute. Retrieved from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/immunohistochemistry. Accessed: 10/04/19.
- The mesothelial cell. U.S. National Library of Medicine. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/14592528. Accessed: 04/17/19.
- Epithelioid Cell. ScienceDirect. Retrieved from: https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/epithelioid-cell. Accessed: 10/04/19.
- Malignant Mesothelioma Stages. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/types/malignant-mesothelioma/detection-diagnosis-staging/staging.html. Accessed: 05/04/2023.