At some point, all mesothelioma patients will need to address pain management. A common pain management method is using opioid medications, however these come with side effects and risks and these can be undesirable.
A recent piece of research from the UK suggests more consideration should be given to pain management with a percutaneous cervical cordotomy (PCC).
Percutaneous cervical cordotomy
Pain is transmitted by nerves and a PCC aims to reduce pain by blocking the signals from affected nerves. This is a particularly good option for cancer patients with pain in one side, which is common with mesothelioma patients.
Although patients are awake during a PCC, it is a big procedure and normally requires a hospital stay of between three and five days. The procedure is performed under x-ray control, this allows the precise location to be found. The patient is injected just below the ear on the non-painful side and local anaesthetic is used to numb the area. The doctor then uses a special needle to pass a mild electrical current through the nerve fibres to locate the painful nerves. When the specific nerves are located, the needle tip is electrically heated, numbing the nerve fibres.
Currently, there is a lack of studies for PCC as a pain management method for mesothelioma but the few studies that do exist appear to support the use of PCC as an effective way to manage pain.
Five year study
The study started in 2012 and ran to 2017. There were 159 participants, all of whom had pain caused by cancer. Of those 159 participants, 57% had pleural mesothelioma. The participants had their PCC at different times after their diagnosis, the median time from diagnosis to PCC was 13 months and the longest time was almost 24 hours.
Prior to the PCC procedure, patients reported their pain level out of ten, the average being six. After the procedure the patients were followed up on average, day nine, and the average pain score had reduced to just two.
PCC is not for everyone
As with any treatment, patients all react differently to PCC. Unfortunately, some are unable to tolerate the procedure. In this study, only six of the 159 participants reported any PCC-related adverse effects.
The researchers concluded that PCC is an effective method of pain management for mesothelioma patients but found that “PCC referrals tended to be late in patients’ disease trajectories.”
Further studies are needed to really show the benefits of PCC for mesothelioma patients, as well as investigating when the best time is for patients to undergo the procedure, for maximum benefit.
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Poolman, M, et al, “Percutaneous cervical cordotomy for cancer-related pain: national data”, March 27, 2020, https://spcare.bmj.com/content/early/2020/03/26/bmjspcare-2019-002057