I am very worried about my pain. What if nothing can be done to help me? What if I take narcotics and get addicted?

Many patients with mesothelioma experience significant pain. Pain may be coming from the cancer if it has grown into the chest wall, or nerves, or muscles. Some pain may come from your surgical site if you have surgery. There are many different ways cancer causes pain.

If you had surgery, the people in the hospital should have been treating your pain all the way along, from the anesthesia before to whatever you need by injection or by mouth afterwards.

Separate from surgery, your oncologist, or whoever is managing your treatment, should be completely prepared to help relieve your pain. He or she should be able to prescribe or recommend whatever is necessary to achieve the best control of your pain. For mild pain, over-the-counter medications like ibuprofen or Tylenol may help, or prescriptions of the class of medications that ibuprofen belongs to may help, called non-steroidal anti-inflammatory agents. But usually these are not enough.

The next strongest medicines are narcotics taken by mouth. These range in strength from codeine and propoxyphene to hydrocodone and oxycodone. You and your doctor need to decide what might work best for you. If your pain is worsening, you need the stronger of the medications.

See Opioid & Acute Pain

If oral medication is not strong enough, you may need to have injections of narcotics, or you may be able to take some by patches applied to the skin or inside the mouth. There is a large group of these medications, and many different ways to take them. You may have to adjust what you take to deal with how much pain you are having.

See Breakthrough Pain

People are often afraid of narcotics. They do cause physical dependence and you do get tolerant to the effects of narcotics over time. But people taking narcotics for cancer pain to not become “addicts” who are just looking for drugs. They take narcotics because they need them. As your body becomes tolerant, your doctor can safely increase the dose or switch to a stronger medication. If your pain suddenly disappeared, you could be taken off the narcotics slowly and completely safely. It is more likely that you will need to take pain medicine, and your doctor should give you as much as you need, while making sure it is safe.

In terms of side effects, narcotics can cause nausea and vomiting, constipation and sleepiness. Usually these can be handled with other medication (for nausea and vomiting, for example) and also diminish with time.

There are many other medicines that help relieve pain, sometimes working with the other pain medicine. Antidepressants help reduce pain, as do certain anticonvulsants, that can help with pain from irritated nerves fibers (where the tumor is pressing on nerves). You may need a couple of different medicines.

There are procedures that might help certain types of pain. Radiation might be used to shrink your tumor, which can reduce pain. Nerve blocks can also relieve pain. Sometimes a surgical procedure might be useful depending on what is causing the pain.

Most likely you will need different things at different times. You must tell your doctor about your pain. He or she should be prepared to use any and all means available to help you. There are also specialists in pain control, who can be consulted to get other ideas.