Mesothelioma Pain Management

Medications are the cornerstone of mesothelioma pain management, and their use is aimed at providing the greatest pain relief possible with the fewest number of side effects and the most ease of administration. What medications should be used for each person, and for each kind of cancer pain that should be treated with medications, forms the art of effective mesothlioma pain management.

Medications used for cancer pain are selected by health care professionals to meet the pain needs of the patient. For some kinds of pain related to cancer, non-prescription medications may be sufficient. For other degrees and kinds of pain, prescription medications are used.

The following medications may be used, based on the severity of the pain caused by mesothelioma:

Mesothlioma pain management for mild pain - For mild mesothelioma pain, acetaminophen or nonsteroidal anti-inflammatory medications (NSAIDs), such as ibruprofen, are often used. Mild to Moderate Pain – For mild to moderate mesothelioma pain, when pain relief is not achieved with acetaminophen or NSAID medications, opioid medications are often used, usually as combination tablets with NSAIDs or acetaminophen. Some of the opioid medications used as combination products are hydrocodone, codeine, or oxycodone. Adjuvant medications may also be used for pain that is difficult to manage. Adjuvants are medications that were originally designed to treat conditions other than pain, such as tricyclic antidepressants.

Mesothlioma pain management for moderate to severe pain – Moderate to severe pain is usually best treated with higher doses of opioid medications often not given as combination products. Adjuvant medications, NSAIDs, and acetaminophen may also be used. The opioid medications used to treat moderate to severe pain include morphine, fentanyl, oxycodone, and hydromorphone.

Additionally, breakthrough pain medications are often provided, intended to deliver quick relief for flares of pain that occur despite the use of other pain medications. These medications are used only when breakthrough pain occurs and are intented to provide quick relief. See the section on breakthrough pain medications.

When you begin taking medications for cancer pain, it's very important to tell your health care providers what other medications (prescription and over-the-counter) you may be taking to treat other health-related conditions. You should also discuss any vitamin or mineral supplements or herbs that you take on a regular basis. Medications can and do interact, sometimes harmfully -- and this process of full disclosure will reduce the chances of problems occurring in your pain treatment.

It's useful to understand some basic facts about each kind of medication used for mesothlioma pain management, and its side effects. Remember, side effects should not prevent you from using medications for your cancer pain. Discuss side effects with your health care provider, and get assistance in managing these.

1. NSAIDs (ibuprofen, aspirin, naproxen, acetaminophen)

These medications, available over-the-counter as well as by prescription, do their work by reducing swelling and inflammation. Some NSAIDs, notably ibuprofen, aspirin and naproxen, have a greater impact on inflammation than does acetaminophen. As mentioned above, sometimes NSAIDs are combined with opioids to fight pain.

Side Effects. Some NSAID medications can cause gastrointestinal problems, especially ibuprofen and aspirin. Acetaminophen does not cause this side effect, and the newest NSAIDs, the COX-2 inhibitors Celebrex and Vioxx, reportedly have a minimal impact on the gastrointestinal tract. However, it's important to know that the COX-2 inhibitors have not been tested for cancer pain relief, and are presently used only to treat arthritis pain. Acetaminophen should not be taken by people who have three or more alcoholic drinks in the course of 24 hours, as damage to the liver can result.

If you are taking cancer pain medications that contain NSAIDs, don't take additional over-the-counter pain medications without discussing this with your physician or nurse who handles your mesothlioma pain management.

2. Opioids

These medications are most often used to treat moderate to severe cancer pain, and they are always prescription medications. Opioids are sometimes combined with acetaminopen (Percocet) or aspirin (Percodan), for example. These medications can be taken in a wide variety of ways orally, by patch, rectally, by injection, transmucosally and are formulated to be long- and short-acting. Almost always, opioid treatment for mesothelioma pain management begins with a low dose, and the dosage is increased until pain relief is satisfactory to the person in pain.

For many people experiencing cancer pain that is expected to continue, opioids should be administered on an around-the-clock basis, rather than given only when pain becomes intense. The around-the-clock approach provides a consistent level of the medication in the blood, and this helps to provide a fairly consistent level of pain relief, preventing abrupt peaks and valleys of pain. Additionally opioid formulations for breakthrough pain probably should be provided.

Side Effects. Opioid medications can produce a variety of side effects. The most important to know about are:

Constipation. Almost without exception, every person using opioid medications on a regular for mesothelioma pain management experiences constipation, unless he or she is given information about a special bowel regimen designed to head off this problem, which can be very painful. Many mesothelioma pain experts recommend that a bowel regimen be started immediately when opioid medications are prescribed. People taking these medications should also drink 8- 10 glasses of water each day, and increase fiber in their diet, if possible.

Nausea and vomiting. Some people experience nausea and sometimes vomiting when they begin using opioids. There are excellent anti-emetic (anti-nausea) prescriptions medications available today, such as Zofran and Kytirl; ask your health care provider about using them to combat nausea. For most people, the nausea fades away after taking the medication for a short period of time.

Sleepiness. It is not unusual for some people beginning opioids to experience sleepiness for several days during mesothlioma pain management. For most people, this is a temporary side effect, and it is worthwhile to stay on the medications for a few days to see if the drowsiness fades away. If the sleepiness is severe, contact your health care provider.

Respiratory depression. A serious side effect of opioids is slow, shallow breathing. This side effect rarely occurs when opioids are taken as prescribed. If you have concerns about this side effect, be sure to discuss them with your health care provider.