Managing The Pain From Mesothelioma
By Warren Miller. 20th April 2020
Most victims of Mesothelioma will be in pain. There are no nerves in the Mesothelium tissue where the cancer usually starts, so the pain is not normally felt until the tumours start to grow and press on vital organs. This is one of the reasons why people are not diagnosed with the disease until the Mesothelioma is more advanced.
A build-up of fluid in the pleura may also increase the pressure in the chest.
As the mesothelioma tumours grow, the cancer may start to invade the chest wall and patients may then require mesothelioma pain management.
Chest pain has been reported in excess of 60% of pleural mesothelioma patients and between 30% and 50% of peritoneal patients report pain in the abdomen.
Traditional treatments to manage this mesothelioma pain include medication and medical procedures. In the early stages of the cancer there may be some minor pain which may be treated with over the counter products such as Ibuprofen. As the pain worsens, doctors may recommend weak opioids such as codeine, supplied with other medications such as antidepressants, anti-inflammatories and Ketamine. For more severe pain, consultants may decide to replace weak opioids with strong opioids such as Morphine to control the pain.
Medical Cannabis may also be prescribed to reduce pain from mesothelioma, also the anxiety, insomnia and nausea.
Patients may benefit from relaxation techniques as the experience of pain is connected to our thoughts and feelings. Anxiety and depression make pain worse, and vice versa.
PCC in Mesothelioma Pain Management
In The UK there has been recent research into Percutaneous Cervical Cordotomy (PCC) to help manage the pain from mesothelioma. This is surgical technique that is minimally invasive and uses an electrode to destroy a small set of nerves in the Lateral Spinothalamic Tract of the spinal cord. The Lateral Spinothalamic Tract is a pathway located within the peripheral white matter of the spinal cord. It is primarily responsible for transmitting pain and temperature to the Brain.
The PCC electrode is fitted with a clamp that is adjusted so that the tip of the electrode protrudes 4–5 mm beyond the end of the spinal needle. The electrode is connected to a generator and the patient is positioned on an X-ray table. Once the Spinal cord has been penetrated, stimulation at 100 Hz follows to warm the tip of the needle. At this stage, the cooperation of the patient in reporting the sensory experience is essential as the interpretation of the responses to motor and sensory stimulation is crucial to the procedure.
With satisfactory stimulation responses, Radiofrequency Thermocoagulation can proceed. Sequential lesions at rising temperatures from 70 ºC to 85 ºC for 20 - 45 seconds are created. This controlled heating is thought to contract collagen fibres and destroy the nerves within the disc, thereby diminishing pain. The success of the procedure should be immediately obvious, with reduced pain within the treated area.
Results of Percutaneous Cervical Cordotomy Tests
The study had 159 patients with pain from cancer, including 57% with Pleural Mesothelioma and ran from 2012-17.
Before the procedure, patients had an average cancer pain score of 6 out of 10. 9 days later, the average score had dropped to 2 out of 10. Other issues linked to mesothelioma pain management were also positively impacted.
Marlise Poolman from The Institute for Health and Medical Research at Bangor University concluded:
“ The median reduction in strong opioid dose at follow-up was 50 percent, With the exception of activity, all health-related quality of life scores either improved or were stable after PCC. Only six patients had any PCC-related adverse events. The team concludes that PCC is effective for mesothelioma pain management but that PCC referrals tended to be late in patients’ disease trajectories. ”
If you have any questions or would like advice on whether you can claim for Mesothelioma, please contact us on the number below and ask for Kathy Cooke or Warren Miller