No matter whether you choose to use natural methods or traditional medicine, sometimes the alternative methods simply don’t work well enough and a prescription or mild pain reliever is in order. There is no doubt that pain becomes severe in the final stages of mesothelioma. The tumor growth continues and then runs out of space, eventually pushing on organs and putting the patient in severe pain.
Sometimes the treatment for mesothelioma causes body pain almost as bad as the disease itself. In the later stages of the disease, you might not be able to control the pain with alternative methods and have to request prescription drugs or even over the counter drugs for pain relief.
The main goal for pain medication is to bring as much relief as possible with as little side effects as possible. The treatment for pain should be easy for the patient to use, in addition to bringing relief. It becomes a juggling act to give the maximum pain relief with the minimum of medications. Since the body builds a tolerance for many medications, doctors attempt to keep the dosage as low as possible and still maintain pain relief.
Prescription pain relief
Mesothelioma pain can sometimes be relieved with the use of prescription-strength pain relievers such as acetaminophen drugs. While they are similar to the over-the-counter drugs you can purchase without a prescription, they are often stronger. If the pain is milder, doctors may simply suggest you use the over-the counter variety. Acetaminophen drugs are analgesics that change the way the body senses pain, therefore relieving it. Tylenol is probably the best known of these types of drugs.
NSAIDs
In addition to the analgesic drugs, doctors often recommend pain-relieving drugs with non-steroid anti-inflammatory properties. These are NSAIDs. The body uses special enzymes, Cox-1 and Cox-2, to produce prostaglandins. The prostaglandins cause swelling and pain. Non-steroid anti-inflammatory drugs (NSAIDs) stop the body from producing these two enzymes and therefore prevent the production of the prostaglandins. If there’s less prostaglandins, there’s less swelling and with that, less pain.
The drugs are well known. For instance, aspirin is one of them. Of course, most people recognize Bufferin, Bayer or Excedrin when they think of aspirin. Ibuprofen is another NSAID, which includes Advil, Motrin and Nuprin to name a few. Not so readily know are the two last categories, Ketoprofen, whose brand names include Actron and Orudis and Naproxen, which includes Aleve.
Sometimes doctors prescribe drugs that combine acetaminophen with other drugs. They may contain aluminum hydroxide, magnesium hydroxide systemic, aspirin, caffeine and acetaminophen. These are analgesic combinations used strictly for the treatment of pain. Your physician may try a number of milder drugs or other combinations. Finding the right pain reliever for your situation isn’t easy. Some people react better to certain drugs or combinations than others do.
Risks and side-effects
Even though these are over the counter drugs and available to everyone, there are still risks involved. For instance, any drug, or for that matter herbal remedy, can cause an allergic reaction. However, drugs with acetaminophen can cause damage to the liver and fasting increases the chance of a toxic reaction. The body needs glutathione to metabolize the acetaminophen safely. Fasting lowers the stored reserves of glutathione.
Since many cancer victims feel too sick to eat after chemotherapy or radiation treatment, it’s important to administer the proper dosage and watch for the warning signals. Liver damage can occur at recommended doses, to people who unintentionally over-medicate with acetaminophen.
The drugs grouped as NSTAIDs, such as aspirin, also can have side effects, which you need to watch. One of these is gastrointestinal distress caused by erosion of the stomach lining. It can cause internal bleeding of the stomach or the duodenum, perforation and ulcers and obstruction from scarring and swelling. It is easy to miss these symptoms or attribute them to the effects of chemotherapy.
In addition, aspirin increases the potency of any blood thinner so if the patient is taking any herb, prescription drug or other medication causing blood to thin, it’s important to let the doctor know.
Palliative surgery
If pain becomes more severe, sometimes palliative surgery helps reduce the pain. Palliative surgery can bring pain relief but it doesn’t provide a cure. If fluid develops in the chest, the doctors might use a form of palliative surgery called “thoracentesis” to drain the fluid. The removal of the fluid can bring dramatic relief to the mesothelioma patient.
When fluid accumulates in the chest, it accumulates in the pleural lining, the area between the lung and the chest wall. If the doctors have to remove fluid a second time, or believe it will return, they often perform a pleurodesis. In this surgery, they inject a powder such as talcum in the area. The powder causes irritation and ultimately scarring that seals them together to prevent further fluid build-up.
If fluid builds in the abdominal cavity, doctors perform a paracentesis to remove the fluid and help ease the pain. Just like the thoracentesis, this doesn’t provide a cure but relieves much of the pain caused from the pressure of the accumulated fluid. It requires the doctor to inject a long hollow needle into the abdomen to draw off the fluid.
Surgery to remove the tumor is another potential way doctors can reduce the pain of mesothelioma. While the removal of some of the mass is not a cure, it reduces the pressure on the lungs or internal organs and eases the pain for a while, thus improving the quality of life.
Corticosteroids and Cox II inhibitors
Normally, rather when pain increases despite fluid removal, doctors look to adjuvant medications besides the NSAIDS. These might include corticosteroids such as prednisone or dexamethasone. Cox II inhibitors are also beneficial they work similarly to the NSAIDS but only affect the Cox II and leave the Cox I to create enzymes to coat the stomach so it removes much of the potential for damage from the drugs. The addition of the corticosteroids and Cox II inhibitors are particularly good for bone pain in mesothelioma patients.
Other opiate and non-opiate pain relievers
After palliative surgery and the lower level of pain killers, there’s still a large number of more effective pain killers both opiate and non-opiate. For instance, nerve pain from mesothelioma frequently subsides with the use of triclyclic antidepressants such as amitriptylline. This drug is a depression treatment but is also helpful for pain. Doctors frequently prescribe it for neuralgia, pain from the nerves, which occurs after shingles and even migraine headaches. It increases substances in the brain to improve mood and modify pain.
Another medication used to treat nerve pain is Duloxetine. You may know it by the name Cymbalta. While this drug is also one that doctors frequently prescribe for depression, it too is excellent as a pain reliever when the pain is nerve pain. Doctors often prescribe it for people who suffer from diabetic neuropathy, nerve damage from diabetes.
They also use it for the pain that occurs from fibromyalgia, a condition causing muscle stiffness, tenderness and pain. The pain that comes from cancer is the third place this drug is effective in pain management. Duloxetine is a serotonin and norepinephrine reuptake inhibitor (SNRIs). It increases the brain’s norepinephrine and serotonin levels. These substances help stop the movement of pain signals through the brain.
The side affects of the duloxetine can be vomiting, nausea, dizziness, insomnia, sleepiness, constipation, sweating, abnormal dreams, gas, dry mouth, sweating, anxiety, agitation, blurred or abnormal vision, headache and sexual dysfunction. The triclyclic antidepressants have similar side effects but can also include dizziness, confusion, difficulty urinating, hair loss, changes in weight, changes in libido or erectile dysfunction, increased sweating and changes in blood sugar levels.
Anti-convulsants
Doctors also use anticonvulsants such as Lyrica or Neurontin for nerve pain. It’s another drug used effectively for nerve pain which comes from shingles, diabetic neuropathy, cancer and fibromyalgia. It can causes thoughts of suicide or suicidal behavior, worsen depression, cause swelling in the hands, legs and feet making it dangerous for those with heart problems. It also can cause blurred vision, weight gain, dizziness and sleepiness.
Opiods
If these drugs don’t work and the palliative surgery doesn’t help relieve pain, the next step is the opioids. Probably the best known of the opioids is morphine. Morphine comes from the sap of the opium poppy, Papaver Somniferum, which means, “sleep bringing poppy.” Most doctors feel it is the top or gold standard for pain relief to those in severe pain. The morphine acts rapidly on the central nervous system to bring pain relief and sleep to those suffering from late stage mesothelioma.
Amazingly, even though morphine is a controlled substance, you’ll often find the opium poppy in gardens across America. Only certain poppies contain the alkaloids to make morphine and other pain relievers, such as codeine, papaverine and thebaine. The morphine comes from the juice or latex from the seedpod and the poppy straw. Some people use the pods from opium poppy to create a tea that brings pain relief, although the tea is not legal to make.
However, the best method of pain relief is to follow the prescription from the doctor. Prescription morphine is in purer form and measured in amounts appropriate and safe for those suffering from mesothelioma. Another drug produced from the opium poppy is codeine.
Morphine is highly addictive so many doctors wait until the last stages of the disease, when it is necessary to use a strong painkiller. The body can develop a tolerance for the medication and using it too soon in the process increases the body’s need in later stages of the disease.
Opioids target the opiate receptors found in the brain. It doesn’t matter how you take the drug, eventually it gets into the bloodstream and goes into the brain. There are receptor sites in the brain that normally bind with enkephalins and endorphins to bring natural pain relief. The opiate binds with these receptors making it unnecessary for the body to produce endorphins to bring pain relief. While the method of delivery insures immediate relief on command, it’s best to use natural pain relievers and the body’s own mechanism to produce them as long as possible.
One of the side effects of using opiates is the effect on the hormone levels in the body. Once the doctor prescribes opioids and the patient uses them, most users find that there’s a dramatic drop in their sex drive. The opium based drug reduces the hormones released in the body and the neurotransmitters that affect the libido.
Doctors administer morphine either orally, sublingual, rectal, subcutaneous or through an IV. Sublingual is under the tongue, while subcutaneous is under a layer of skin but not in the vein like an IV. Each type of administration has various benefits. Your physician can help find the one that delivers the most pain relief with the greatest ease.
Oral morphine comes in two types, short-acting and long-acting. Short-acting morphine treats the intense pain that comes in bursts when people are in chronic pain. It immediately gets into the blood stream but can have more side effects than the long-lasting agents do. Some of the side effects are nausea, euphoria and sedation.
Long-acting agents are sustained release morphine, oxycodone and fentanyl patches. These substances require less frequent administration and maintain a smoother opioid level in the blood, which reduces the potential side effects.
Kadian is one of the newer forms of morphine. This medication is inside small polymeric encapsulated beads. One capsule per day is often all that is necessary to achieve pain relief. However, most physicians that prescribe this also allow for doses of pain relief as needed if the Kadian isn’t enough at times. If the patient can’t swallow a pill, the Kadian is simple to use even then. The caretaker simply opens one of the capsules and sprinkles the beads onto food, such as applesauce or cottage cheese. The beads even can go into a gastric tube if necessary. One drawback to this medication is the expense.
For patients that can’t take oral medication because of vomiting, rectal administration of slow release morphine drugs is almost as effective. In some situations when the patient suddenly finds swallowing difficult, rectal administration gives time to the clinician to find an alternative pain-relief delivery method.
Hydromorphone, while very similar to morphine in the amount of time it provides relief from pain, is far more potent. In fact, it tends to be between five and seven times more potent. There are a number of ways to deliver the drug. You can use an elixir or a pill and give it orally or use it in suppository form. If you use subcutaneous administration of pain relief, hydromorphone offers the ability for delivery in high concentrations.
Oxycodone, another opioid pain reliever, is one and a half times more potent than morphine when compared on a milligram to milligram basis. It comes in slow release forms also. One dose of slow release oxycodone is similar to two Percocet tablets for pain relief spread out over 12 hours. Some believe the oxycodone causes fewer mental status changes than the morphine does. One study showed that this drug proved better for patients prone to delirium and those with significant renal failure.
Fentanyl patches are often best for patients with chronic but stable pain, who find oral opioid administration too difficult. The patches can’t fight acute pain or those with pain which fluctuates between high and low dramatically. However, since the delivery method is non-invasive, it provides an easy alternative for pain relief. The patches are expensive and those with oily or hairy skin find that they don’t work as well.
Since the medication absorption increases with body temperature, those with a fever may receive too much medication and those in the process of dying who may have hypothermia, absorb too little. One word of warning, unlike pills which can be cut in half to reduce dosage, cutting a patch in half does not affect the dosage.
Methadone
Another potent pain reliever is methadone, administered as necessary, or on a schedule. It has a liquid form that makes it easier to give to patients on a feeding tube, or those unable to swallow pills. Lower doses of methadone are good for chronic low-grade pain but it does take some time to achieve serum levels necessary to combat pain. It is inexpensive but requires days to build the methadone to the proper levels. However, if switching from opioids to methadone, it’s important to note that methadone is far more potent than previously known.
Some medications combine opioids with other ingredients. Oxycodone is in Percocet and Percodan. Hydrocodone is in Vicodin. One problem with taking these drugs is that once in use, if severe acute pain occurs, many doctors are uncomfortable prescribing a stronger opiate to relieve the pain. For example if the patient is on Percocet, which is a combination of acetaminophen and oxycodone, it might be best simply to give the oxycodone alone for more pain relief.
Nerve blocks
As a final method of relieving pain, doctors may try several different types of nerve blocks to ease the pain of mesothelioma. An intercostal nerve block is an injection of Novocain or other anesthetic in the area where the intercostals nerve is located, between two ribs. It helps relieve chest pain by temporarily blocking the nerve impulses associated with it. The doctor may even cause a permanent destruction of the local area nerve, such as with cryoablation.
Other methods of surgical intervention into pain include spinal medications given either epidural or intrathecal. Doctors may put in temporary catheters to block pain or implant pumps to deliver pain blocking medication. A TENS machine might offer relief. Tens stands for Transcutaneous Electrical Nerve Stimulation. Spinal cord stimulation may also help.
An epidural pain management system delivers the medication to the space outside the spine, the dura. The dura is the covering of the spine that runs the entire length of the spine. When doctors inject medication into this space, it goes to the nerve roots and blocks pain. An epidural can bring pain relief for several days or months.
Intrathecal pain management uses a drug pump or pain pump giving medication directly to the spinal cord. The doctors place the pump directly under the skin of the abdomen and it delivers the medication via a catheter to the spinal cord. It’s very similar to an epidermal but for long lasting effects. Since the medication goes directly into the spine, less medication is necessary to relieve pain.
Spinal cord stimulation is another method of pain control. A low level electrical current applied to the dorsal are of the spine blocks many sensations of pain. The device that delivers this must be surgically implanted. Some devices have an exterior power source and others are full systems implanted in the body. These units are also referred to as TENS units.
There are an abundant number of ways to relieve the pain from mesothelioma. Each has benefits and produces results. The best way to select pain relief is to use the least invasive, easiest to use, lowest cost and most effective method for your level of pain and progression of the disease. Pain management makes all the difference in quality of life and that should be the most important goal when fighting mesothelioma. The higher the quality of life, the more probability the patient will have the strength to fight the disease.