There are roughly 14,200 new cases of malignant pleural mesothelioma diagnosed each year worldwide, and 2,700 of those are diagnosed in the United Kingdom. The incidence in the UK is particularly high as a result of extensive usage of asbestos during the 20th century. The disease, which has a significant period of latency, has seen a two thirds increase in its diagnosis in the UK since the 1990s, and that is expected to continue. In response, researchers are working to both find an effective treatment as well as to determine the most robust methods of pain relief for those who are stricken with the disease. To that end, a group of researchers from the Beatson West of Scotland Cancer in Glasgow,, the Institute of Cancer Sciences at the University of Glasgow, the Institute of Genetics and Molecular Medicine at the University of Edinburgh, and St. Columba’s Hospice in Edinburgh have collaborated on a comprehensive study of pain management techniques, trying to identify what protocols will provide the most relief.
All Pain Management Options Reviewed
The researchers studied all of the pain relief techniques that are currently being administered to malignant pleural mesothelioma patients in the United Kingdom, identifying the advantages and disadvantages of each. Their study looked at the following methods:
- Pharmacological management – Medications are currently being administered in a laddered approach, starting with non-opioid, non-steroidal anti-inflammatory medications, then moving to a combination of those medications with weak opioids like codeine, and then moving on to strong opioids like morphine. They suggest that the second stage does patients little good, and suggest that it be eliminated, and also suggest additional medications such as transdermal patches, anti epileptics and antidepressants, particularly to address breakthrough pain.
- Radiotherapy – Radiation therapy delivered for palliative pain relief has been shown to provide significant pain relief in 47% of patients tested, and is viewed as an increasingly attractive option as radiotherapy techniques become more sophisticated and greater targeting of higher doses becomes a possibility.
- Interventional pain management – This approach seeks to stop significant pain by blocking the nerves that deliver pain messages. This is reserved for those whose pain is resistant to other protocols, and has been shown to effectively stop severe pain without inducing numbness. The specific technique investigated was a cervical cordotomy, which creates a lesion on a specific part of the spinal cord to stop pain below the cervical spine. The procedure can be done surgically under general anesthesia or under local anesthesia for patients who can tolerate the procedure. and though patients have adverse side effects immediately after the procedure, they are considered transient and delivered significant relief to 80% of patients.
Benefits of Surgery and Chemotherapy for Pain Found to be Questionable
The researchers also examined the role that both surgery and chemotherapy can play in palliative relief for mesothelioma patients, comparing the strengths and weaknesses of the EPP procedure vs the P/D procedure, as well as different types of chemotherapy agents. They conclude that the use of radiotherapy for pain control is growing while the use of cordotomy is still in its earliest stages and should be kept as a measure of last resort, while the use of surgery and chemotherapy for pain relief introduces numerous toxicities and complications that may impact patient quality of life.
If you or someone you love is struggling with malignant pleural mesothelioma and you need information about the resources that are available, the Patient Advocates at Mesothelioma.net can help. Contact us today at 1-800-692-8608.
