Mesothelioma Pain

Pain is a common symptom in mesothelioma, including chest pains caused by the pleural form and abdominal pain with peritoneal mesothelioma. Several factors cause pain, from tumors pressing on organs to treatments. The medical care team can help patients manage pain with medications, therapies, and complementary medicine.

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Types of Mesothelioma Pain

Pain is one of the most common symptoms of mesothelioma, both in peritoneal and pleural forms of the cancer.[1] The type of pain experienced may take one or more of several forms, depending on cancer type, stage, treatments, and other factors:[2]

• Chest pain. Some patients experience steady pain in the chest from tumors in pleural mesothelioma.
• Pain when breathing. Others experience more pain when breathing.
• Abdominal and visceral pain. Pain in the abdomen is typical with peritoneal mesothelioma, along with swelling and an uncomfortable sensation of fullness.
• Metastatic pain. When the cancer spreads, it causes pain in other parts of the body. The worst pain usually occurs in bone metastases.
• Neuropathic pain. Damaged or pressured nerves trigger pain in some patients.

Mesothelioma pain, and pain caused by any type of cancer, is often much worse than other types of pain. Researchers are still working on the mechanisms to determine what makes cancer pain so different.

What Causes Mesothelioma Pain?

The causes of pain experienced by mesothelioma ranges from cancer itself to the treatments and procedures. Many patients have different types of pain with different causes.[3]

Pain Caused by Tumors

Much of the pain of mesothelioma is triggered by the cancer itself. As tumors grow, they press on other tissues, organs, and nerves, causing pain.

In pleural mesothelioma, tumors press on the chest wall. The pain with breathing occurs because the tumors in the pleural tissue rub against the chest wall and lungs.

Swelling and tumors in the abdomen in peritoneal mesothelioma cause abdominal pain by pressing against the visceral organs.

In both types of mesothelioma, tumors may grow into other tissues, destroy tissue, press on bones, and press on or damage nerves, causing pain. Metastases from the primary tumors cause pain in the same way but in other parts of the body.

Pain Caused by Treatments

Unfortunately, many of the treatments designed to give mesothelioma patients a longer life expectancy also cause pain:

• Surgery. Any kind of surgery causes pain during recovery, which may last days or weeks. Surgery can also trigger phantom pain, resulting from tissue that has been removed from the body. Although there is no explanation for why it occurs, this is a real and recognized pain.
• Chemotherapy. Sometimes there are side effects that can be uncomfortable. Pain can come from mouth sores, sore throat, digestive issues, and other side effects. Chemotherapy can also cause neuropathy, a numbness, tingling, burning, or painful sensations in the feet, legs, hands, and arms.
• Radiation therapy. Radiation also damages healthy cells while killing cancer cells. It can cause pain from damaged skin at the site of radiation. It can also trigger pain due to damage to internal tissue and organs.

Managing Mesothelioma Pain

Patients should talk to their medical teams about pain. While pain is to be expected with cancer and its treatments, it should not be unbearable. Several management techniques can reduce pain and improve quality of life.

Palliative Procedures

Palliative care is any treatment aimed at relieving symptoms and side effects and improving quality of life. The focus of palliative care is not on cancer itself but on how the patient feels.[4]

Mesothelioma patients can benefit from surgical procedures to relieve pain, including thoracentesis or paracentesis to drain fluid from the chest or abdominal cavities. This relieves pain and pressure.[4]

Chemotherapy, radiation, or surgery can also help reduce tumor size. This can help relieve pain by taking pressure off organs and nerves.

Medications

Pharmacological management of mesothelioma includes the use of pain medications. Doctors typically begin with over-the-counter drugs and step up doses or move to more potent prescription drugs as needed. Many patients ultimately benefit from opioids.

A normal physiological process is tolerance, where the body gets used to a certain dose of pain medication and eventually needs a higher amount. Oncology patients with a history of drug abuse need to notify their medical team so that they can create an individualized pain management plan.

For those concerned with opioid dependence, speak with your practitioner. Specific guidelines exist for palliative care and the risk of dependence and are not considered a reason to undertreat pain. When pain is constant and severe, the benefits usually outweigh the risks.[5]

Medical cannabis is also helpful for some patients with cancer. It is legal in many states and can be used for anxiety, insomnia, and nausea as well.

Cordotomy

Often considered a strategy of last resort for pain management, cordotomy may provide relief for patients with severe pain. Research is limited but suggests that patients should have greater access sooner to this procedure.[4]

A cordotomy is a surgical procedure that makes a lesion in the spine. This disrupts specific nerves that send pain signals to the brain. A few studies of the procedure with mesothelioma patients show that it can provide significant and important pain relief.[4]

Complementary Therapies

Complementary and alternative medicine, or CAM, is a valid set of strategies that do not treat cancer but can help relieve symptoms and side effects, including pain. There are several types of CAM treatments that may work for some patients and not others:

• Acupuncture
• Biofeedback
• Exercise therapy
• Holistic medicine
• Massage therapy
• Nutrition
• Transcutaneous electrical nerve stimulation

Other Pain Management Techniques

The pain of mesothelioma is real and physical, but it also has a psychological component. Therapy with a focus on pain management can be useful, not for reducing physical pain but for coping with and tolerating it.

A therapist trained in pain management can help patients use breathing exercises, visualization techniques, and various types of meditation for coping. They also provide helpful tips and advice for managing pain, such as eating a better diet, getting more sleep, putting limitations on activities, and using distractions.  

Cancer Pain is Undertreated

Too often, cancer patients suffer unnecessarily. Treating late-stage oncology pain is complex, and having a trained medical practitioner to help guide this treatment can be helpful.

Patients are encouraged to be advocates in their medical care and ask questions about pain management recommendations. Some reasons that pain may be undertreated in cancer patients include:[6]

• A fear of addiction to painkillers, especially opioids
• Difficulty of talking about pain, or not wanting to bother doctors with this concern
• A fear that more medications or procedures will trigger more side effects
• Wanting to be strong for family and not complain or be a nuisance
• Inadequate training among oncologists with respect to pain management
• Poor communication between physicians and patients

Pain is a real and valid symptom of cancer that should be addressed. Talk to your doctors about pain, what you need, and what your priorities are in treatment. You do not have to simply take mesothelioma pain when treatments can help.

Page Medically Reviewed and Edited by Anne Courtney, AOCNP, DNP

Anne Courtney has a Doctor of Nursing Practice degree and is an Advanced Oncology Certified Nurse Practitioner. She has years of oncology experience working with patients with malignant mesothelioma, as well as other types of cancer. Dr. Courtney currently works at University of Texas LIVESTRONG Cancer Institutes.

Connect with Doctor of Nursing Practice Anne Courtney