Mesothelioma Pain Management

Types of Mesothelioma Pain

There are several types of pain caused by mesothelioma. They have unique characteristics and different management approaches:

• Acute pain – Sudden and sharp pain, that typically lasts for a short period of time, resulting from tumor growth, diagnostic procedures or treatments
• Chronic pain – Persistent, long-lasting pain, ranging from mild to severe, often caused by ongoing tumor pressure, inflammation or treatment-related side effects
• Breakthrough pain – Intense, sudden flare-up of pain, occurring even when a patient is on regular pain medication and often requiring adjustments in medication dosage or additional fast-acting pain relief
• Neuropathic pain – Caused by irritation or damage to nerves from tumor growth, surgery, or chemotherapy and is often described as tingling, burning, shooting or electric shock-like pain

Pain related to mesothelioma requires comprehensive pain management techniques that include a combination of medications, treatments and complementary care.

4 Causes of Mesothelioma Pain

Pain can arise from both mesothelioma symptoms and side effects of treatment. The most common causes of pain include tumor growth, fluid buildup, nerve damage and treatment-related complications.

Tumor Growth and Pressure on Organs

• Mesothelioma tumors form in the pleura (lining of the lungs) or peritoneum (lining of the abdomen).
• As tumors grow, they press against nerves, organs and soft tissues, leading to acute, chronic pain and reduced organ function.
• Tumors in the pleura can cause chest pain and difficulty breathing, while tumors in the peritoneum may result in abdominal pain, bloating, and digestive problems.

Fluid Buildup (Effusion) in the Chest or Abdomen

• The pleura and peritoneum contain fluid that helps organs move smoothly. Mesothelioma disrupts the normal flow of this fluid, leading to pleural effusion (fluid in the lungs) or ascites (fluid in the abdomen).
• Pleural effusion puts pressure on the lungs and chest wall, making it difficult to breathe and causing chest pain and shortness of breath.
• Ascites can lead to abdominal swelling, pain, loss of appetite, constipation and bowel blockages.

Nerve Damage and Inflammation

• Tumor growth and invasive treatments – such as surgery, chemotherapy or radiation – can cause inflammation or damage to nerves, leading to neuropathic pain (burning, tingling or shooting pain).
• Inflammation caused by cancer itself or treatments can contribute to additional discomfort.

Side Effects of Treatment

• Surgical procedures may cause postoperative pain and scar tissue discomfort.
• Chemotherapy and radiation therapy can lead to nerve pain, tissue damage and inflammation, increasing pain levels.
• Radiation therapy can cause burns, irritation and sensitivity in the affected areas.

Because pain from mesothelioma has multiple causes, a personalized pain management plan is essential to help improve quality of life for patients.

Mesothelioma Pain Management Medications

Pain management for mesothelioma can involve a combination of different medication options. Pharmacology, or medication, management of cancer pain may include the use of opioids (narcotic pain medication), nonsteroidal anti-inflammatory drugs (NSAIDS, like Ibuprofen) or antidepressants, or a combination of some of these medications.

The addition of drug-free or alternative treatments – including physical therapy, massage therapy and acupuncture – can provide a more comprehensive relief of symptoms and ways to manage pain.

Opioids

Opioid pain relievers, also known as narcotic pain medications, are commonly prescribed for moderate to severe pain caused by mesothelioma. These medications work by binding to opioid receptors in the brain and spinal cord, effectively blocking pain signals and providing relief.

While opioids are effective in managing pain, they can also cause side effects, including:

• Constipation – A common problem requiring stool softeners and hydration
• Nausea and vomiting – Can often be managed with anti-nausea medications
• Drowsiness and dizziness – May decrease over time as the body adjusts
• Respiratory depression – A serious side effect requiring careful monitoring, especially at higher doses
• Physical dependence and addiction – Long-term use may lead to dependence, requiring gradual tapering under medical supervision

NSAIDS

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to relieve mild to moderate pain in mesothelioma patients by reducing inflammation and swelling caused by tumors or treatment-related side effects. They can be used alone or in combination with opioids to enhance pain relief while potentially lowering opioid dosage requirements.

While NSAIDs are effective, they can cause side effects, especially with long-term use:

• Stomach ulcers and gastrointestinal bleeding – NSAIDs can damage the stomach lining, increasing the risk of ulcers and bleeding
• Kidney damage – Prolonged NSAID use can impair kidney function, particularly in patients with preexisting kidney disease
• Increased risk of heart problems – Some NSAIDs may raise blood pressure or increase the risk of heart attack and stroke

Antidepressants

Antidepressants, commonly used for mood disorders, are effective in managing nerve-related pain associated with mesothelioma. They serve as an alternative or complement to opioid pain medications, particularly for patients experiencing neuropathic pain (nerve pain), which can feel like burning, tingling or electric shocks.

According to the Mayo Clinic, antidepressants help increase levels of neurotransmitters in the spinal cord, which reduces the intensity of pain signals sent to the brain. This makes them particularly useful for chronic pain conditions related to nerve damage from tumors, surgery or chemotherapy.

Considerations and Side Effects

• Antidepressants may take a few weeks to become fully effective.
• Potential side effects include dry mouth, dizziness, weight gain, drowsiness and changes in blood pressure.
• Some antidepressants may interact with other medications, so it’s important to discuss all prescriptions with a healthcare provider.

Marijuana

There has been a surge in support of marijuana for mesothelioma as a viable treatment to manage pain. Marijuana is also seen as a viable complementary therapy to help patients manage other mesothelioma symptoms and the side effects from standard treatments.

There is no scientific evidence supporting marijuana as a cancer-killing treatment. Experts believe in it purely for managing pain and symptoms, which can improve quality of life. This can be true for both “medical marijuana” and marijuana purchased without a medical prescription in states with legal recreational use.

Benefits of Marijuana

• Marijuana can decrease pain, help with nausea, and improve appetite, which helps offset fatigue and weakness.
• Marijuana can decrease anxiety, depression and stress, which are psychological feelings common for people with cancer.

What to Consider With Marijuana

There are things to consider with using marijuana as a treatment for mesothelioma pain. There are both legal risks and potential side effects. Speak with your doctor before using marijuana for pain management.

• Recreational and even medical marijuana are not legal throughout the country. As of March 2025, there are four states (Idaho, Kansas, South Carolina and Wyoming) where it’s entirely illegal. There are 24 states where use is legal both medically and recreationally. The remaining 22 states are a mix of “only medically legal”, “recreationally decriminalized”, and “only medically legal as CBD with THC”. Visit this website for more information.
• Marijuana is not approved by the U.S. Food and Drug Administration to treat mesothelioma. Talk with your doctor before using marijuana for pain and symptom management.
• Marijuana can cause side effects such as drowsiness, memory loss, and impaired reflexes or motor skills.

Mesothelioma Pain Management Procedures

Pain management is a way to help mesothelioma patients maintain their quality of life throughout their cancer journey. This treatment option should be offered at every stage of the disease and as part of a comprehensive treatment plan.

Methods of pain management for mesothelioma include medications, treatments and supportive care. Fluid buildup is a primary mesothelioma symptom and a common source of pain. Removing the fluid from around the lungs, in the abdomen or around the heart is one way doctors can help decrease pain and related symptoms.

Pleurodesis

Pleurodesis is a surgical procedure that can help to alleviate pain for patients with malignant pleural mesothelioma, which forms in the lining of the lungs (pleura). As tumors grow and spread, the fluid around the lungs can no longer drain normally – causing fluid to accumulate and press against the lungs and chest wall. The buildup of fluid is called pleural effusions.

During pleurodesis, the fluid is drained from the chest cavity, and the pleural space is permanently closed, eliminating future pleural effusions. Doctors use a talc-like substance to seal the two linings of the pleura together. A thoracoscopy, which is a thoracic scope with a camera attached, is used to perform the pleurodesis.

Steps of a Pleurodesis

Pleurodesis Surgery Time and Recovery

• The thoracoscopy with pleurodesis typically takes 1-2 hours to complete, according to St. Vincent’s Hospital.
• Recovery time is around 2-3 weeks, with the first 3-5 days spent in the hospital for monitoring.
• A chest tube drain may be placed at the time of the procedure and left in place for a few days to allow any remaining fluid to drain out.

Thoracentesis

A thoracentesis, also called pleurocentesis, is a procedure to drain fluid from the pleural space and chest cavity. It is similar to a pleurodesis but does not permanently close the pleural space. The procedure temporarily resolves pleural effusions, but fluid accumulation may occur again.

In some cases, thoracentesis can be used as a diagnostic procedure to test for cancerous cells in the pleural fluid, aiding in mesothelioma diagnosis.

Steps of a Thoracentesis

Thoracentesis Surgery Time and Recovery

• According to the National Heart, Lung, and Blood Institute, a thoracentesis typically takes about 15 minutes, though the duration may vary based on the amount of fluid needed to be removed.
• Recovery – Most patients can return home the same day and fully recover within one week.

Paracentesis

A paracentesis is a procedure to alleviate pain for people with peritoneal mesothelioma, which forms in the lining of the abdominal cavity (peritoneum), by removing excess fluid accumulation in the abdominal cavity. As tumors grow and spread in the abdomen, an abnormal amount of fluid builds up. This fluid build up in the peritoneum is called ascites.

Since fluid buildup may recur, repeat procedures may be necessary to manage ongoing symptoms.

Paracentesis can be used to diagnose peritoneal mesothelioma by allowing doctors to collect fluid samples or even remove small amounts of diseased tissue for pathology testing.

Steps of a Paracentesis

Paracentesis Surgery Time and Recovery

• The procedure typically takes about 30 minutes to complete.
• According to Memorial Sloan Kettering Cancer Center, most patients recover within a few days and are discharged from the hospital within a few hours after the procedure.

Pericardiocentesis

A pericardiocentesis is a procedure to drain fluid from the pericardium, which is the lining around the heart. This lining is where pericardial mesothelioma forms.

As tumors grow and spread in the abdominal lining, fluid builds up. The excess fluid around the heart can cause pain and prevent the heart from pumping blood at full function.

Steps of a Pericardiocentesis

Key Facts About Pericardiocentesis

• Critical monitoring – Since this procedure involves the heart and surrounding tissues, doctors closely monitor the patient’s blood pressure, pulse and cardiac function before, during and after the procedure.
• Minimally invasive – Compared to open-heart surgery, pericardiocentesis is a less invasive method for relieving fluid buildup from around the heart.

Other Pain Management Tips for Mesothelioma

In addition to medications and medical procedures, drug-free therapies can be a valuable part of comprehensive pain management for mesothelioma patients. These treatment options can help manage pain symptoms and treatment side effects while improving overall well-being and quality of life.

Physical Therapy

Physical therapy focuses on improving mobility, reducing stiffness, and strengthening muscles.
By enhancing flexibility and endurance, patients may experience:

• Less pain and discomfort in affected areas
• Improved range of motion for daily activities
• Better posture and body mechanics to reduce strain

Physical Therapy

Physical therapy focuses on improving mobility, reducing stiffness, and strengthening muscles.
By enhancing flexibility and endurance, patients may experience:

• Relaxing muscles and reducing tension-related pain
• Improving circulation, which can promote healing and reduce inflammation
• Alleviating stress and anxiety, contributing to overall pain relief

Acupuncture

Acupuncture is a traditional Chinese medicine practice that involves stimulating specific points on the body using thin needles. This therapy can:

• Activate nerves, muscles, and connective tissue to enhance the body’s natural pain relief system
• Boost endorphin production, which can help reduce pain sensations
• Support relaxation and stress relief, further aiding pain management