Costopleural syndrome
Mesothelioma is typically present with chest pain which
may be pleuritic, lateralized, dull or diffuse. It typically
progresses relentlessly during the course of mesothelioma
and is often difficult to control. In mesothelioma this
syndrome is referred to as a ‘costopleural syndrome’.
The pain frequently has neuropathic components due
to entrapment of intercostal thoracic, autonomic or
brachial plexus nerves.97
Percutaneous cervical cordotomy has been
proven to provide relief of pain in patients
with costopleural syndrome.
97 This procedure
interrupts the spinothalamic tract at C1/2 causing
a contralateral loss of pain perception below the
level of the lesion.98 Complications of cordotomy
include thermo-anesthesia, troublesome dysesthesia
and persisting motor weakness. One study reported
a reduction in pain in 83% of patients following
this procedure and 38% were able to stop opiate
completely99 (See section on interventional
procedures).