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The pain associated with MPM is extremely challenging to manage. Patients will often require a multitude of analgesic drugs since opioids alone are often insufficient to control the pain. It is not uncommon for patients to be on paracetamol, anti inflammatories, opioids, adjuvant analgesics in addition to topical treatments. For some, this combination of drugs may provide adequate analgesia. However, many patients continue to suffer from pain despite this cocktail of drugs. In these patients, other options should be considered. Chemotherapy, while offering a potential survival advantage, does not appear to have a significant impact on pain. Radiotherapy may be of benefit in some patients though prospective randomised data is lacking. Finally, again, despite a lack of prospective randomised data, neuroaxial pain therapy or cordotomy should be considered for patients whose pain is refractory to other treatments.
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