Cancer patients often suffer pain and it can be difficult to manage pain with medication. The side effects of pain medication, such as morphine, can also affect a patient’s quality of life, causing tiredness, nausea, confusion and other unwelcome symptoms.
Mesothelioma patients may suffer with pain which can be hard to control with opiate painkillers. A percutaneous cordotomy could help alleviate pain in both pleural and peritoneal mesothelioma sufferers.
A percutaneous cordotomy is a surgical procedure that disables pain conducting tracts in the spinal cord. It is an irreversible procedure and so is only considered when major opiates, such as morphine, are no longer providing adequate pain relief.
The procedure does not remove all pain, but aims to reduce pain to affected areas so that the pain can be managed with lower doses of medication, thus increasing quality of life. As with all surgical procedures, success cannot be guaranteed but around eight out of ten patients who opt for a percutaneous cordotomy report a reduction in pain.
A percutaneous cordotomy is performed under local anaesthetic and sedation. The patient lies on their back underneath an x-ray camera while a needle is inserted into the neck on the opposite side to where the pain is experienced. The x-ray camera is used to see where the needle is and guides through the neck. To position the needle, gentle electrical stimulation is used and the patient is asked to report what they can feel. When the needed is in the right location, the tip is heated, destroying the nerves that cause the pain.
Following the procedure, the patient will be kept under observation and will stay in hospital for a minimum of one night. Painkillers will be decreased by up to 50% and then adjusted accordingly to manage the patient’s remaining pain.
As with any procedure, there are potential side effects. Patients may experience weakness in the arm and/or leg although in most cases this is temporary. There may also be a change or loss of sensation in the affected side of the body. Serious side effects are extremely rare, affecting less than 1% of patients. For the majority of patients who do suffer side effects, the pain relief the procedure provides outweighs these.
Unfortunately, the procedure is not always successful. If the pain pathway cannot be found, the procedure cannot be completed. This happens around once in every 20 procedures done.
There are currently only four clinics offering this procedure in the UK, based in Portsmouth, Oldham, Warwick and Liverpool.
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