Chronic pain after thoracic surgery: a follow‐up study

Perttunen, K; Tasmuth, Tiina; Kalso, Eija

doi:10.1034/j.1399-6576.1999.430513.x

Cited by 312 publications

(217 citation statements)

References 8 publications

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“…Furthermore, despite a commonly held belief that post-thoracotomy pain is transient, there is no evidence that the pain experience decreases significantly over time. For example, incidence of long-term post-thoracotomy pain has been reported to be 80% at 3 months, 75% at 6 months, and 61% at one year after surgery; incidence of severe pain is 3-5%, and pain that interferes with normal life is reported by about 50% of patients (31). In one study, 66% of the patients with PTPS received treatment for pain.…”

Section: Prevalence Of Post-thoracotomy Painmentioning

confidence: 99%

Postthoracotomy Pain Management Problems

Gerner

2008

Anesthesiology Clinics

226

130

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SynopsisPain after thoracotomy is very severe, probably the most severe pain experienced after surgery. It is also unique as this pain state has multiple implications, including respiratory failure due to splinting; inability to clear secretions by effective coughing, with resulting pneumonia; and facilitation of the often incapacitating chronic pain: the post-thoracotomy pain syndrome. Thoracic epidural analgesia has greatly improved the pain experience and its consequences and has been considered the 'gold standard' for pain management after thoracotomy. This view has recently been challenged by the use of paravertebral nerve blocks. Nevertheless, severe ipsilateral shoulder pain and the prevention of the post-thoracotomy pain syndrome remain the most important challenges for post-thoracotomy pain management.

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Section: Prevalence Of Post-thoracotomy Painmentioning

confidence: 99%

Postthoracotomy Pain Management Problems

Gerner

2008

Anesthesiology Clinics

226

130

View full text Add to dashboard Cite

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“…This conclusion has clinical applications: according to the Complex Regional Pain Syndrome (CRPS) Diagnosis Criteria (Bruehl et al 1999), mechanical allodynia is considered to be a sensory sign with a corresponding symptom of ''hyperaesthesia'' because the patient himself perceives the stimulus which does not normally provoke pain as painful. In fact, the patients, when asked about their sensation, prefer using the word ''hypersensitivity'' (Woolf 1983(Woolf , 1994, ''tenderness'' (Perttunen et al 1999), or ''tender'' in the McGill Pain Questionnaire (Melzack 1975) to describe this phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Static mechanical allodynia (SMA) is a paradoxical painful hypo-aesthesia: Observations derived from neuropathic pain patients treated with somatosensory rehabilitation

Spicher

Mathis

Degrange

et al. 2008

Somatosensory & Motor Research

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The present study aimed at investigating the time span it takes to remove a static mechanical allodynia (SMA) in humans suffering from chronic peripheral neuropathic pain. Forty-three subjects were included in the study and, during somatosensory rehabilitation, their SMA territory was precisely mapped. They then underwent distant vibrotactile counter stimulation (DVCS) treatment. It was observed that, with DVCS, SMA disappeared in all cases, and was transformed into an underlying hypoaesthesia. It was found that the ''tenderness to touch'' symptom (which is SMA) was located in the same territory as the underlying hypoaesthesia, which was located on a part of the cutaneous territory of a partially damaged nerve. These results demonstrate that treating patients suffering from neuropathic pain with DVCS revealed a skin territory of denervation that was previously masked by SMA. Thus, SMA can be considered as a paradoxical painful hypoaesthesia. Furthermore, mapping SMA is a valuable source of information for our understanding of abnormal sensory processing in neuropathic pain patients. We conclude that the mapping of the zone of hypersensitivity on the skin in humans suffering from chronic peripheral neuropathic pain improves diagnosis. The mapping of the zone of hypersensitivity is a tool to presume which branch of the peripheral nerve is damaged. The location of the axonal lesions is at the periphery, while the mechanism of pain sensitization is probably central and referred peripherally to the skin by a painful hypoaesthesia.

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“…Post-thoracotomy pain is found in 20% to 80 % patients who have undergone thoracotomy using a chest retractor through the intercostal space (1)(2)(3)(4)(5)(6)(7)(8)(9). Epidural analgesia is known to be the gold standard for controlling pain during the perioperative period (10)(11)(12); however, its effectiveness has not been satisfactory after thoracotomy (7,13,14).…”

Section: Introductionmentioning

confidence: 99%

Impact of pregabalin on early phase post-thoracotomy pain compared with epidural analgesia

et al. 2017

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Background: The purpose of this randomized study was to compare the effects of pregabalin with epidural analgesia on early phase post-thoracotomy pain. Methods: This study was conducted on 90 adult patients who underwent thoracotomy. Patients were randomly divided into two groups, an epidural analgesia group, where 45 patients received 0.2% ropivacaine hydrochloride and fentanyl through a thoracic epidural catheter, and a pregabalin group, where 45 patients received 75 mg pregabalin orally twice daily. Both groups were also administered orally with celecoxib along with each treatment. Numerical rating scale (NRS) and sleep interference rate (SIR) were evaluated on the first day, third day, and fifth day after surgery. Anesthetic induction time, operation time, recovery time, the use of additional analgesic drugs and adverse effects were also examined. Results: NRS and SIR were significantly lower in the pregabalin group at all time points (P<0.05). The number of patients requiring additional analgesic drugs within 24 hours after surgery showed no difference between the two groups; however, the number was significantly decreased in the pregabalin group after post-operative day 1 (P<0.001). Adverse effects including pneumonia, dysuria, constipation and nausea were identified among many patients in the epidural analgesia group (P<0.05). Operation time and recovery time were the same for both groups, while the epidural analgesia group showed a significantly longer anesthetic induction time (P<0.001).Conclusions: Pregabalin is considered to be a safe and effective treatment method which is an alternative to epidural analgesia for acute post-thoracotomy pain.

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Chronic pain after thoracic surgery: a follow‐up study

Abstract: A significant proportion of patients undergoing thoracotomies will suffer from chronic pain. Surgeons and anaesthetists should be aware of this fact and they should look for effective means of preventing and treating this pain syndrome.

Cited by 312 publications

References 8 publications

Postthoracotomy Pain Management Problems

Postthoracotomy Pain Management Problems

Static mechanical allodynia (SMA) is a paradoxical painful hypo-aesthesia: Observations derived from neuropathic pain patients treated with somatosensory rehabilitation

Impact of pregabalin on early phase post-thoracotomy pain compared with epidural analgesia

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