Pleural mesothelioma patients with severe pain may benefit from a surgical procedure to disable certain pain-conductors in the spinal cord.
The procedure, called cordotomy, is the subject of a newly-published report in BMJ Supportive and Palliative Care. Cordotomy is typically performed on patients in severe pain due to cancer or other incurable diseases. It is usually done with a needle under fluoroscopic guidance. Most mesothelioma patients who undergo cordotomies have only local anesthesia.
Although the procedure is sometimes offered for patients with advanced mesothelioma, evidence of its effectiveness is still limited. To get a better sense of the value of cordotomy in mesothelioma, British Researchers from the North Wales Centre for Primary Care Research at Bangor University conducted a systematic review of the medical literature.
The researchers searched 14 databases from inception to March 2012 and found 9 studies that met their criteria. The studies involved a total of 160 mesothelioma patients who underwent cordotomies for severe pain. “All studies demonstrated good pain relief in the majority of patients,” report author Barbara France and colleagues.
Most patients experienced the greatest reduction in their pain immediately after surgery. Side effects including headache, mirror pain, and motor weakness were common but went away quickly. None of the mesothelioma patients experienced more difficulty in breathing as a result of the cordotomy procedure and no patients died because of the procedure.
While the results appear to be encouraging for mesothelioma patients, the research team cautions, “The available evidence is significantly limited in quantity and quality…more reliable evidence is needed to aid decision making on continued provision.” To gather that evidence, France and colleagues suggest the establishment of a national registry in the UK to keep track or cordotomies and their level of success.
Chest pain is a common problem for patients in the later stages of malignant pleural mesothelioma. Cordotomy offers a way of controlling pain that avoids the heavy sedation associated with many pain-relieving medications. Unfortunately, the mesothelioma pain relief from cordotomy is often only temporary.
France, Barbara et al, “Cordotomy in mesothelioma-related pain: a systematic review”, 2014, March 2014, BMJ Supportive and Palliative Care, pp. 19-29