Palliative Treatment and Pain Management

Controlling the pain of mesothelioma

Palliative treatment is performed to alleviate a patient’s symptoms without curing the disease.  Because there is not yet a cure for mesothelioma, much of the care that a patient receives will be palliative.  Unfortunately, mesothelioma is a painful disease, and all mesothelioma patients will be forced to consider the issue of pain management.  The disease process itself causes pain; and that pain is compounded by all the treatments used to slow progression of the disease: surgery, chemotherapy and radiation. 

Pain affects the lives of the patient and the patient’s family.  Pretending that pain doesn’t exist or that it should be “handled” on one’s own will inevitably lead to anxiety, frustration and needless suffering for everyone involved.  The severe pain associated with mesothelioma can also affect several aspects of essential everyday living.  A person in pain doesn’t want to eat, even though proper diet is critical in fighting cancer.  Severe pain prevents people from sleeping, yet a good night’s rest is needed, especially when the patient is undergoing a round of chemotherapy or radiation.  Sleep is also necessary if a patient is attempting to maintain a job, whether outside or inside the home.  This is true not just for the patient, but also for the caregiver.  If a patient is not sleeping, it’s likely that family members are not getting much rest either.  Pain will also make any sort of travel very difficult.  Yet it is helpful to lift the patient’s spirits to spend time with loved ones.  All of these important daily activities will be easier for the entire family when the patient’s pain is under control.

The first step is to talk about pain management with the doctor.  But the willingness or ability to talk about pain is especially difficult for men.  Some men feel that their inability to just “buck–up and handle it” is a weakness.  It’s a mistake to hold on to that attitude when fighting mesothelioma.  Cancer is not a headache or a touch of arthritis.  The pain caused by mesothelioma is simply not bearable without medication.  And it’s not going to get better.  It has to be addressed. 

Without input from the patient and the patient’s family, the doctor will only be able to estimate the level of pain at a given stage of the disease or following a particular surgery or round of chemotherapy.  There is no need for the doctor to guess, however.  The patient must tell the doctor how he or she is feeling at all times and whether the prescribed pain medications are working adequately to control the pain.  This is especially true with mesothelioma because the level and location of pain will change as the disease progresses; different pains will be felt in different places at different times.

As part of the pain management effort, the patient should keep a notebook describing the pain and show it to the doctor during visits so the medical team is in the best position to prescribe the types of medication that will do the most good when needed.  There are several important things for the doctor to know:

  • The time of day when the pain is the worst
  • Where the pain is found
  • The pain’s intensity
  • Whether anything causes the pain to increase or decrease
  • If the pain comes and goes, how often
  • How the pain affects the patient’s everyday life
  • How well the current pain medication is working

Mesothelioma doctors are familiar with the progression of the cancer and the pain that usually comes with it.  They may suggest several different types of pain medication, from familiar over–the–counter remedies to much stronger prescription opioids, such as morphine.  The patient should feel comfortable to question the physician about these medications to avoid problems.  Important considerations include:

  • What medications will control the patient’s specific type of acute or chronic pain
  • Each medicine’s most common side effects
  • How much of the drug can safely be taken and for how long
  • Whether pain medications may interact with other drugs the patient is taking

Opioid pain medications, like morphine, sometimes make a patient feel disoriented or unable to function properly.  Should this occur, the doctor can reduce the prescribed dosage or adjust the pain medication so that disorientation is not a problem.  Adjustments in pain medication are no trouble for the physician and are expected in pain management.