UI  - 97380650
TI  - Malignant pleural mesothelioma in general practice; complex pain
      problems.
AB  - In three patients, men aged 67, 57 and 69 years, malignant pleural
      mesothelioma was diagnosed. All three had worked as coal miners and
      were presented with thoracic pain. They were among seven cases of
      malignant pleural mesothelioma diagnosed in a period of five years in
      one suburban general practice (adherence: 5600 patients) in the
      former mining area in the province of Limburg. The terminal phase of
      the disease was characterized by intractable pain. High doses of
      opioids and adjuvants were necessary to achieve acceptable pain
      relief. It is suggested that step one of the 'analgesic ladder for
      cancer pain management' of the WHO (non-opioids) should be followed
      soon by step three (strong opioids). Because the incidence of pleural
      mesothelioma is not yet decreasing, it is important to know that pain
      management remains a serious problem.