Pleurectomy for persistent pain in benign asbestos-related pleural disease

Our plain-English summary of Pleurectomy for persistent pain in benign asbestos-related pleural disease, by D.I. Fielding, J.L. McKeon, W.A. Oliver, et al (Thorax, 1995).

The study

• Authors: D.I. Fielding, J.L. McKeon, W.A. Oliver, K. Matar, I.G. Brown
• Journal: Thorax
• Published: 1995;50(2):181-3
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Persistent severe pain is a rare complication of benign asbestos-related pleural disease.

Methods: Four patients are described in whom pain persisted for more than one year (range 18 months to five years) which was incompletely relieved by opioid medication and nerve blocking procedures. All underwent pleurectomy in an attempt to relieve it.

Results: At operation the pleura was considerably thickened in all cases. Two of the four patients had successful relief of pain. The other two had a neuralgic component to their pain before surgery which persisted afterwards. One of these patients underwent successful cervical cordotomy.

Conclusions: Pleurectomy may provide relief in patients with constant pleuritic pain due to benign asbestos-related pleural thickening. It seems, however, that patients in whom the pain has a neuralgic component are unlikely to benefit.

In plain English

This short paper was a case series of four patients with benign asbestos-related pleural disease. All had persistent chest pain that conventional painkillers, including high-dose opioids, relieved only partly. The patients were aged 44 to 62 and reported 5 to 30 years of asbestos exposure. The article does not name a fiber type. All four had a pleurectomy (surgical removal of the pleura) in Queensland, Australia, during one 12-month period, and pain was the only reason for the operation. Tissue examination showed pleural thickening, fibrotic plaques and chronic inflammation. No asbestos bodies and no cancer were found. One patient had permanent relief, and another had significant improvement. The other two had a neuralgic (nerve-type) component to their pain before surgery. In both, pain returned after about six months of relief, which was partial in one of them. One of these two was later relieved by a cervical cordotomy. The authors concluded that pleurectomy may relieve constant pleuritic pain from benign asbestos-related pleural thickening, but that patients whose pain has a neuralgic component are unlikely to benefit.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case series (four patients)
• Who was studied: Four patients aged 44 to 62 with persistent pain from benign asbestos-related pleural disease. All had pleurectomy over a 12-month period. They were the only documented cases of this kind known to the operating thoracic surgeons in Queensland, Australia.
• Exposure: Occupational asbestos exposure of 5, 30, 16 and 11 years. The occupations listed in a garbled table appear to be waterside worker, builder, ship's painter and welder. No fiber type is reported.
• Main results:
  • In all four patients, tissue examination showed no asbestos bodies (along with pleural thickening, fibrotic plaques and chronic inflammation), though the plaques were consistent with asbestos pleural disease.
  • No patient showed evidence of malignancy.
  • Patient 2 had permanent pain relief, although a pleural space infection around the time of surgery required reoperation and drainage.
  • Patient 3 had significant improvement in pain, but developed mild pain on the opposite side of the chest nine months after the operation.
  • Patient 1 had partial relief for six months before the pain recurred, and still had pain on both sides two years after surgery.
  • Patient 4 had relief for six months before the pain recurred.
  • One of the two patients whose pain persisted (patient 4) later had a successful cervical cordotomy.
  • Both patients whose pain persisted after pleurectomy had a neuralgic component to their pain before surgery.
  • These four operations made up 3% of all pleurectomies performed in that period.
• The authors' conclusion: The authors concluded that pleurectomy may provide relief in patients with constant pleuritic pain due to benign asbestos-related pleural thickening, but that patients whose pain has a neuralgic component are unlikely to benefit.
• Limitations the authors state:
  • Repeated lung function testing was difficult because of the patients' chest pain.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Asbestos-Related Pleural Disease, Pleura, Pleuritic Chest Pain, Pleural Thickening.

Related studies

• Chronic pleuritic pain in four patients with asbestos induced pleural fibrosis — A. Miller (1990)
• Cordotomy in mesothelioma-related pain: a systematic review — B.D. France, R.A. Lewis, et al. (2014)
• Chest pain in asbestos-exposed individuals with benign pleural and parenchymal disease — S. Mukherjee, N. de Klerk, et al. (2000)
• A retrospective study of chest pain in benign asbestos pleural disease — R.K. Allen, T. Cramond, et al. (2011)
• Is Radiotherapy Useful for Treating Pain in Mesothelioma?: A Phase II Trial — N. MacLeod, A. Chalmers, et al. (2015)
• Radiotherapy for the treatment of pain in malignant pleural mesothelioma: a systematic review — N. Macleod, A. Price, et al. (2014)

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