&lt;p&gt;Pain management in patients with malignant mesothelioma: challenges and solutions&lt;/p&gt;

Saunders, Jimmy; Ashton, Miranda; Hall, Charlie; Laird, Barry; MacLeod, Nicholas

doi:10.2147/lctt.s192558

Cited by 8 publications

(16 citation statements)

References 53 publications

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“…When cancer pain is resistant to conventional pharmacological therapies, interventional techniques may be employed; according to previous reports, instead of a last resort, these could be utilized at any stage [5]. As for MPM, previous reports have advocated that percutaneous cervical cordotomy (PCC) and peripheral nerve blocks ameliorate challenging pain syndromes [4]. Other interventional techniques for cancer pain include SCS and an implantable drug delivery system that involves placing a subarachnoid catheter for infusing a combination of opioids and adjunct medications directly into the central nervous system [5].…”

Section: Discussionmentioning

confidence: 99%

“…MPM frequently inflicts both nociceptive and neuropathic pain due to direct infiltration into the chest wall and nerves. Despite the use of multiple analgesics, its aggressiveness often poses major challenges in pain management [3,4]. Therefore, rapid and adequate pain assessment in patients with MPM by an expert in pain management is essential for guiding the appropriate choice of treatment, as neuropathic pain may be resistant to opioids.…”

Section: Introductionmentioning

confidence: 99%

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Spinal cord stimulation alleviates intractable pain due to malignant pleural mesothelioma: a case report

et al. 2020

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Background Patients with malignant pleural mesothelioma (MPM) frequently complain of intractable pain that is resistant to conservative treatments. Although spinal cord stimulation (SCS) may be promising in the alleviation of such devastating pain, the effects of SCS on MPM-associated pain and the appropriate timing of its application remain unknown. Case presentation A 66-year-old man diagnosed with MPM presented with severe neuropathic pain due to rapid progression of the tumor to the intercostal nerves. The patient immediately decided to receive SCS implantation and burst stimulus, which relieved the conservative therapy-resistant pain and improved his sleep and daily activities. Conclusion This report suggests that the execution of SCS as soon as possible may help to alleviate MPM symptoms. Since MPM extends aggressively to the thorax and nerves that cause mixed nociceptive and/or neuropathic pain, appropriate pain management requires the proper assessment of the etiology by an expert in pain management.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Spinal cord stimulation alleviates intractable pain due to malignant pleural mesothelioma: a case report

et al. 2020

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“…A multimodal approach to the management of pain in mesothelioma is required as it commonly presents with rapidly progressing nociceptive-neuropathic pain. 39,40 Pharmacologic management of pain should be made in accordance with local guidelines and analgesia requirements reviewed on a regular basis, particularly during progression. Pharmacologic management of progressive dyspnea includes benzodiazepines and opioids as well as physical strategies (fans) and should be managed in accordance with local protocols.…”

Section: Symptom Managementmentioning

confidence: 99%

“…43 It provides significant reduction in pain with minimal toxicity, particularly in the context of chest wall involvement or neuropathic pain secondary to nerve entrapment. 39,43 Dose and fractionation recommendations vary, with retrospective series suggesting that response rates may be higher in patients treated with doses such as 36 Gy in 4 Gy per fraction rather than lower total doses (reviewed in Gomez et al 14 ). However, decision making should be individualized according to the clinical scenario.…”

Section: Symptom Managementmentioning

confidence: 99%

Management of Advanced Pleural Mesothelioma—At the Crossroads

Nowak

Jackson

Sidhu

2022

JCO Oncology Practice

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The management of pleural mesothelioma has changed with the demonstration that first-line checkpoint blockade therapy improves survival. This review covers issues of relevance to the practicing medical oncologist, with an emphasis on the palliative setting and on new information. Until recently, standard systemic therapy for mesothelioma was combination chemotherapy with platinum and pemetrexed. In 2020, combination immunotherapy with ipilimumab and nivolumab was approved as first-line systemic therapy for mesothelioma following release of the results from the CheckMate 743 trial. This trial showed improved overall survival for patients receiving ipilimumab and nivolumab over those treated with platinum and pemetrexed chemotherapy. When the survival results were examined by histologic subtype, the survival benefit was most significant in those with nonepithelioid mesothelioma, a group for which combination immunotherapy is now standard of care. The most important outstanding issue from CheckMate-743 is a better understanding, through translational studies, of which patients with epithelioid mesothelioma may benefit from combination immunotherapy. The next generation of first-line clinical trials in mesothelioma will report the results of first-line combination chemoimmunotherapy. For those patients who receive first-line dual checkpoint blockade, there is no evidence as to the efficacy of subsequent chemotherapy. However, given the known first-line efficacy of cisplatin or carboplatin and pemetrexed, combination chemotherapy is an appropriate subsequent choice for those who progress on or after dual immunotherapy. For those who previously received chemotherapy without immunotherapy, single-agent nivolumab provides benefit over best supportive care. In summary, both chemotherapy and immunotherapy should be considered for all patients during their disease course. Another topical issue is the growing appreciation that some individuals have an inherited predisposition to mesothelioma; referral to a clinical geneticist should be considered under some circumstances. The role of surgery and multimodality therapy is controversial, with results awaited from the fully recruited MARS-2 clinical trial. Patient selection, staging, and multidisciplinary review are critical to identify those who might benefit from a multimodality approach. Finally, a proactive, multidisciplinary approach to symptom management and the principles of management of pleural effusions are critical to manage the symptom burden of mesothelioma and optimize patient well-being.

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“…83 The 2018 Lancet Commis- Pain in MPM can present with mixed nociceptive and neuropathic features owing from direct infiltration of soft tissue, bone, and intercostal nerves. 85 Pain for patients with MPM can therefore be complex and challenging, requiring a multifaceted approach for effective management.…”

Section: The Importance Of Palliative Care In Mpmmentioning

confidence: 99%

The minimum standard of care for managing malignant pleural mesothelioma in developing nations within the Asia‐Pacific Region

Kao

Lee

et al. 2021

Asia-Pac J Clncl Oncology

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Malignant pleural mesothelioma (MPM) is an incurable malignancy associated with high symptom burden and poor prognosis. The relationship between asbestos exposure and MPM incidence is well‐established. The incidence rate of MPM in Australia and New Zealand is among the highest globally. Matching the experience of other nations with legal restrictions on asbestos, incidence is expected to fall. In contrast, the incidence of MPM is rising in the developing nations of the Asia‐Pacific as consumption and mining (albeit to a lesser extent) of asbestos continues. The incidence of MPM in these nations is currently low or unknown, reflecting insufficient latency periods since industrial use of asbestos, deficient resources for accurate diagnosis, and lack of occupational disease or cancer registries. The landscape of treatment for MPM is rapidly changing with combination immunotherapy now demonstrating improved survival in the first‐line setting. Considering vast global inequity in access to anticancer treatments, establishing minimum standard of care for MPM in developing nations is of greater significance. Here, we review the evidence that form the basis of our minimum‐standard recommendations for diagnosis, systemic treatment, management of recurrent pleural effusions, and symptom management. We also briefly review evidence‐based treatment that may be considered for those with access.

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<p>Pain management in patients with malignant mesothelioma: challenges and solutions</p>

Cited by 8 publications

References 53 publications

Spinal cord stimulation alleviates intractable pain due to malignant pleural mesothelioma: a case report

Spinal cord stimulation alleviates intractable pain due to malignant pleural mesothelioma: a case report

Management of Advanced Pleural Mesothelioma—At the Crossroads

The minimum standard of care for managing malignant pleural mesothelioma in developing nations within the Asia‐Pacific Region

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