In general people think of treatment option in terms of eliminating the cancer from the patient's body. While doctors and patients often focus on treating the cancer, in many mesothelioma cases, the treatment of pain becomes the focus, either when little hope exists for effective treatment of the cancer, or when the treatment for the cancer causes a great deal of pain itself. For this reason, several treatment options exist to deal with a patient's pain management.
Once the doctor has assessed the pain, the doctor develops a treatment plan and discusses it with the patient. Medicines (also called drug therapy) are the main way to treat cancer pain. They include the use of opioids (or narcotics, the strongest pain relievers available), non-opioids (pain relieving medicines that are not opioids, such as acetaminophen and non-steroidal anti-inflammatory drugs, or NSAIDs), and adjuvant analgesics (medicines for purposes other than treatment of pain but that help in relieving pain in some situations). Other therapies such as relaxation techniques or biofeedback, physical therapy, anesthesia procedures, and surgical procedures can also help in treating some patients' cancer pain.
Non-opioids include medicines such as acetaminophen (also called Tylenol®), and NSAIDs such as ibuprofen. These medicines, the first choice for mild pain, relieve bone pain, superficial pain, muscle pain, and some other types of pain. In treating cancer pain, doctors often recommend the maximum daily dose. Anything greater than the maximum daily dose can cause significant side effects such as organ damage. Side effects vary, but in general NSAIDs use can result in gastrointestinal toxicity, with the most serious effects being ulcers and bleeding. NSAIDs also slow blood clotting, so they must be used cautiously in patients with bleeding or clotting disorders.
Opioids, the strongest pain relieving medicines including codeine, oxycodone, morphine, fentanyl, and hydromorphone, are excellent medicines for the treatment of cancer pain.
Opioids are sometimes classified as weak or strong depending on their effectiveness in relieving pain. Opioids such as morphine, hydromorphone, oxycodone, fentanyl, methadone, and levorphanol may have side effects that can limit the dose of the drug a patientc can receive. As a result, with any opioid managing the side effects is critical in effective pain control. These medicines can be given in a variety of ways, including orally and intervenously.
Adjuvant analgesics are medicines that have a purpose other than treatment of pain but that help relieve pain in some situations. A variety of adjuvant analgesics used to help relieve cancer pain exist. Doctors have found that some antidepressants relieve neuropathic pain as well as decrease depression. Anticonvulsants, generally used for seizure disorders, are useful in relieving tingling and burning pain, such as neuropathic pain. Doctors may use steroids relieve pain associated with swelling and with bone pain. Finally, local anesthetics can be put on the skin, injected into the spinal canal, and in some cases, be taken orally, and are useful for relieving tingling, burning-type pain.
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