Mesothelioma Pain-Relief Option Is Threatened

Clinical investigators conducted a study that may persuade the United Kingdom government to keep making percutaneous cervical cordotomy available to mesothelioma patients.

Currently, pleural mesothelioma victims can get the pain-controlling procedure at just four mesothelioma treatment centers. The government health system in the U.K. isn’t sure it’s worth leaving it on the menu of options.

The findings were published last year in BMJ Supportive & Palliative Care, an influential publication in the U.K. The research was conducted by the North Wales Centre for Primary Care Research at Bangor University.

The researchers concluded that it would be devastating to mesothelioma patients to toss out a procedure that is very often effective and improves quality of life.

They hope their study findings encourage the British government to give it a second look.

Percutaneous Cervical Cordotomy Reduces Pain

Percutaneous cervical cordotomy seeks to surgically short-circuit some of the wiring in the spinal cord.

Doing so has the effect of stopping the transmission of pain signals from its source to receptors in the brain — where those signals are translated into the physical sensation of hurt.

The procedure involves making an incision in the patient’s back. The opening gives access to a collection of nerves called the lateral spinothalamic tract.

Dividing the nerves in this group causes mesothelioma pain to be blocked on one side of the chest. This technique can’t be used to stop pain from both sides, so it’s offered only to patients with unilateral chest pain.

The procedure is performed several ways. Most common is with the aid of a fluoroscope to guide the surgeon’s hand. Patients are typically given nothing more than a sedative and local anesthesia.

Less Need to Use Mesothelioma Painkillers

The purpose of undergoing percutaneous cervical cordotomy is not only to reduce pain but to make the use of pain medications less necessary, especially at high doses.

The idea is that mesothelioma patients can enjoy a better quality of life if they’re not taking lots and lots of painkillers.

Most patients who receive the procedure say that it helps. However, what worries advocates in Britain is an absence of readily accessible hard evidence demonstrating its effectiveness.

That’s what the Bangor University researchers sought to remedy. To make the evidence more available, they went back and poured through nine previous studies looking at percutaneous cervical cordotomy.

The past studies were based on the experiences of 160 pleural mesothelioma patients. Each was a candidate for the procedure due to experiencing intractable pain.

“All studies demonstrated good pain relief in the majority of patients and increased performance status and increased total sleeping hours,” the researchers wrote.

There were come-and-go side effects such as headache and loss of motor control, but that was pretty much it.

Most patients reported being satisfied with the results, although they were none too happy that the pain relief wasn’t as great later on as it was right after the surgery.

The good news about that was the pain — when it did inch back — never got as bad as before the surgery.

At the close of their study, the researchers came to the conclusion that percutaneous cervical cordotomy appears to be a good choice for taming the pain produced by pleural mesothelioma.

The researchers used their findings to argue for creation of a national registry to track outcomes. This, they indicated, would eventually provide the government with the evidence needed to decide in favor of continued availability of the procedure.