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Mesothelioma pain management
Mesothelioma patients and their families many times fear physical pain as much as the disease itself. It is important to understand, however, that most cancer pain can be controlled. Nine out of ten cancer patients will find relief by using a combination of medications. No patient should have to deal with unmanaged pain.
Pain management is one of the most important aspects of palliative care. Because it is now considered a medical specialty, you may wish to consult a physician well versed in pain management if your physician seems unable or unwilling to provide adequate pain control.
There are some types, or causes of Cancer Pain:
Pain from the tumor. Most cancer pain occurs when a tumor presses on bone, nerves, or body organs, and may vary according to location, (i.e., a small tumor pressing on a nerve or vital organ may cause severe pain, while a larger tumor elsewhere may cause little discomfort.)
Pain from cancer treatment. Cancer treatments, including surgery, chemotherapy, and radiation may also cause pain. Painful conditions are more likely to occur in patients whose immune system has been suppressed as a result of these therapies.
Pain from other causes. Like everyone else, cancer patients have pain that has no relationship to their illness. Headaches, muscles strains, or other aches and pains associated with arthritis, kidney stones, etc., may cause pain, too. These conditions can normally be treated along with cancer pain.
Each patient's pain is unique, therefore, it is important that each individual have a treatment plan that addresses his/her individual needs. The patient and his/her doctor must work together to reduce unnecessary pain and improve quality of life.
Side Effects of Pain Medication
Most medications have some side effects, although they may affect different people in different ways and at different levels. Generally, most side effects will occur in the few first few hours of treatment and then will gradually disappear. If side effects persist, the doctor may choose to switch a patient's pain medication to make sure the patient gets maximum pain control with a minimum of side effects.
Constipation: The best way to prevent constipation is to drink plenty of fluids such as water or juice, and to eat more fruits (uncooked, skin on) and vegetables as well as whole grain breads and cereals. Adding 1 to 2 tablespoons of unprocessed bran to your food may also help. Exercise to the extent you are able also prevents constipation. If you still have a problem, your doctor may prescribe a stool softener or laxative.
Several options are available to help you deal with pain.
Develop a plan
Once you have described your pain, your doctor will work with you to develop a treatment plan. Doctors normally prescribe medicines as the first line of defense for treating cancer pain.
Non-opioids like acetaminophen (e.g., Tylenol®), and NSAIDs such as ibuprofen-best for mild pain-can relieve superficial pain, bone pain, muscle pain, and some other types of pain. Usually you will take the maximum daily dose but not more; too much may cause significant side effects such as organ damage. Side effects vary, but in general NSAIDs can lead to toxicity in the digestive system, and even to ulcers and bleeding. They must be used cautiously if you have any bleeding or clotting disorders as they slow the blood's ability to clot.
Opioids (including codeine, oxycodone, morphine, fentanyl, and hydromorphone) vary in their ability to relieve pain but in general are excellent medicines for helping with pain you may have because of mesothelioma. Opioids (morphine, hydromorphone, oxycodone, fentanyl, methadone, and levorphanol) may be given orally or intravenously. But they can have side effects, and also be addictive, so it's important to have your doctor regulate the dosage for you.
A variety of adjuvant analgesics (medicines designed for other purposes) may help relieve some kinds of pain in certain situations. Some antidepressants relieve neuropathic pain as well as decrease depression. Anticonvulsants (normally used for seizures) can help with relieving tingling and burning pain, such as neuropathic pain. Steroids can help ease pain that's connected to swelling and/or with bone pain. Pain-killing drugs can be applied to the skin, injected into the spinal canal, and even sometimes given orally for relieving tingling, burning-type pain.
Nerve blocks may help to relieve pain by blocking the pain pathways in the nerves themselves and preventing pain messages from getting to the brain. Types include long-acting local anesthetics, chemicals, freezing (cryotherapy) or heat (radiofrequency thermo-coagulation).
Transcutaneous electrical nerve stimulation (TENS)
The TENS procedure stimulates the nerves to your brain so that the body releases its own natural painkillers (endorphins). TENS has been known to relieve localized cancer pain fairly well.
Acupuncture may work in a similar way to TENS (by stimulating the body to produce endorphins) and may be helpful for some people with cancer. Some specialists may use acupuncture (see Specialists), but your doctor or support group may have local sources you can contact.
Distraction can work better than drugs for sudden or intense pain or if it is relatively brief (say 5 to 45 minutes). It can provide temporary relief for even the most intense pain and is good to try while you're waiting for a painkilling medication to begin working.Doing anything you enjoy can be good distraction, especially working with your hands, such as doing needlework, building models, or painting. Reading or watching television or a movie are also good distraction methods. Focusing on breathing slowly can distract as well as relax you.
Groups that are organized specifically for those with cancer and their families can be very helpful. Sometimes sharing experiences with others who face the same challenges can be a source of new information and support and provide a chance to talk openly in a safe environment about your feelings. Health professionals sometimes run such groups, but more often they are led by people with cancer. Many teach coping strategies as well as giving practical information and emotional support.
Hypnotherapy can help relieve cancer pain but is rarely effective on its own. However, self-hypnosis can be a valuable part of the whole relaxation process, which is used to reduce the effect of emotional upset on pain.
Learning to relax
A technique called progressive muscle relaxation involves getting to know particular groups of muscles in the body and learning to tense and relax them. Once you can relax and contract stomach muscles, neck muscles and others individually or together you can start using the technique during stressful periods to reduce tension, and therefore pain. Yoga can help you to train to control your muscles and breathing.
When you relax each part of your body - arms, legs, hands, feet, etc - it can be helpful to think about space, heaviness or warmth within those areas. Again, when you have mastered the basic techniques you can use them to assist with pain relief during difficult times.
Some people are able to relieve some of their pain without drugs. Relaxation techniques, imagery, distraction, and others may also be used with pain medicines. You can find more information about non-drug treatments for pain at a local hospice, cancer treatment center, or hospital pain clinic.
There are many different types of meditation, but they are all aimed at calming your mind and becoming "at peace" with yourself. You can try meditation by sitting quietly, and being aware of your breathing, without trying to control it. Whenever you become aware that thoughts have come up in your mind, just come back to the awareness of your breathing. Instead of paying attention to your breathing you can put an object, like a candle or a stone, in front of you and pay attention to that.
Meditation can be very difficult at first and you may feel that you are getting worse as you become aware of how busy your mind is. However, it will become easier as you practice. It can be very beneficial to let go of your distressing or depressed thoughts for a period of time once or twice each day. It is helpful to practice meditation regularly and have guidance from an experienced meditator. You can find details of meditation organizations in your local phone book.
Serious illness often leads people to question the meaning of life and to stop taking things for granted. Some people who have religious beliefs may find their faith severely shaken by their cancer diagnosis. Even people who have never been regular worshippers may suffer spiritual as well as emotional pain. People often ask questions like 'Is there life after death?' or 'Why should the people I love suffer?' Unanswered questions like this involving our deepest beliefs can cause great emotional and spiritual distress that heighten our sense of the pain we experience.
Visualization (creating mental images) is a technique in which you 'see' and 'hear' images and sounds that bring you pleasure. It's totally up to you what you create; if you can focus on these images very strongly, you can, to some extent, shut out symptoms of pain and discomfort. Relaxation tapes can help.
Emotions such as fear, anxiety and depression are common reactions to cancer and can make pain worse. It is important to get emotional help as part of the overall control of your pain. Talk about your worries and fears with people you trust, acknowledge the emotions you are feeling and try not to bottle things up. It is perfectly natural to feel a whole range of powerful emotions, including depression, when your life is suddenly turned upside down by cancer.
Sharing your feelings with your partner, a close friend or relative can be very helpful. But if you find it upsets you too much, ask your doctor or nurse to refer you to a counselor. You can locate one yourself through one of the counseling organizations listed under useful organizations.
Religion can be a comfort to some people at this time, so ask to speak to a local minister, hospital chaplain or other religious leader if it feels right to you. But if not, then talking with family and friends and/or with a counselor or someone from a cancer support group may help.
In the early stages, pain is usually controlled with over-the-counter products such as aspirin, acetaminophen, or ibuprofen. Although surgery, chemotherapy, and radiation are used to arrest the disease process and alleviate the initial pain symptoms, the treatments themselves may not be pain-free. The needs of the patient and the type of procedure done will determine the kinds of medication that can be given.
As mesothelioma progresses, the cancer may spread to areas such as the chest wall, ribs, and surrounding muscles. Because soft tissue and nearby nerves may be destroyed, pain may become more localized and chronic. In the case of peritoneal mesothelioma, bowel obstruction may lead to more severe pain. New innovations, such as implant devices that deliver pain-fighting drugs to the central nervous system, offer more relief to severe pain that is unresponsive to oral medications, intravenous infusions, or intramuscular injections of narcotics.
When a patient can no longer get relief even from the most potent oral or intravenous medications, doctors may offer an epidural implant. This form of pain management is accomplished with a thin catheter surgically implanted beneath the skin. A combination of medicines is then programmed to flow through tubing into the epidural area of the spinal canal at pre-set amounts and intervals. This can be successfully administered at home under the supervision of home health care agencies and your doctor.
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