Evaluation and Treatment of Mesothelioma Pain

Pleural mesothelioma patients with an abnormal response to cool sensations are more likely to experience more intense pain.

That is just one of the findings to come out of a new study on pleural mesothelioma pain conducted by Scottish researchers.

Pain is a common symptom of pleural mesothelioma, a fast-growing and treatment-resistant malignancy that grows on the membrane surrounding the lungs.

As tumors spread, the pleural lining thickens and becomes less flexible, making it harder for the lungs to expand normally and triggering chest and/or back pain. Another type of pain, called neuropathic pain, can result from damage to nerve fibers.

The primary risk factor for this rare cancer is working with asbestos.

Assessment of Mesothelioma Pain

Recognizing that effective pain assessment is the first step to alleviating mesothelioma pain, scientists at the University of Edinburgh and the Beatson West of Scotland Cancer Centre recruited 37 pleural mesothelioma patients.

The researchers used several different pain scales to evaluate the level of discomfort caused by pleural mesothelioma tumors including the Brief Pain Inventory (BPI), the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), the Short Form of the McGill Pain Questionnaire (SF-MPQ) and Quantitative Sensory Testing (QST).

On a 10-point scale, mesothelioma patients rated the average pain with their disease at a 4 and the worst pain at an 8. The researchers also found that mesothelioma patients who demonstrated an abnormal sensitivity to cool sensations on the QST had higher scores on the SF-MPQ.

The mesothelioma patients with high scores on the LANSS test for neuropathic pain also tended to have higher scores on the BPI and SF-MPQ tests.

Limitations in Mesothelioma Pain Evaluation

But the study also determined that current mesothelioma pain assessment tools have their limitations. According to study author Nicholas MacLeod, FRCR, writing in Pain Medicine,

“Twenty patients (54%) had a clinical diagnosis of neuropathic pain, and of these, only six patients (40%) screened positively for neuropathic pain using the LANSS.”

In other findings, experiencing neuropathic pain did not seem to have any impact on whether or not mesothelioma patients would get pain relief from radiotherapy.

The team concludes that mesothelioma pain can vary significantly between patients and that relieving it starts with an adequate pain assessment.

Last year, the same team of researchers determined that radiotherapy is effective at relieving mesothelioma pain in a proportion of patients. 

Source:

MacLeod, N, “Pain in Malignant Pleural Mesothelioma: A Prospective Characterization Study”, April 26, 2016, Pain Medicine, Epub ahead of print