Chronic Postthoracotomy Pain and Health-Related Quality of Life

Abstract

Background Pain following thoracotomy is common. The objective of this study was to assess whether pain 3 months post-thoracotomy negatively impacts quality of life. Methods One hundred ten patients were prospectively assessed using the Short Form-36 (SF-36) Health Survey before and 3 months after elective thoracotomy. Pain and medication use were evaluated by questionnaire. Patients experiencing pain at 3 months were compared with patients who did not have post-thoracotomy pain. Results Seventy-five patients (68%) had pain 3 months post-thoracotomy; 12 patients (11%) rated their average pain greater than 3 (out of 10). Eighteen (16%) patients required opioid analgesics. The pain group reported lower SF-36 scores in: physical functioning (P=0.049), bodily pain (P=0.0002), and vitality (P=0.044). There were no other significant differences in any SF-36 scale between the pain and non-pain groups. Conclusion Pain is commonly reported at 3 months following elective thoracotomy, but is generally mild, shows improvement over with time, and does not usually require opioid analgesics. Patients who experience post-thoracotomy pain at 3 months are at risk for significantly decreased physical functioning and vitality, but are not at risk for significantly decreased social, emotional, or mental health functioning compared with patients who do not experience post-thoracotomy pain at 3 months.

Impact of intercostal paravertebral neurectomy on post thoracotomy pain syndrome after thoracotomy in lung cancer patients: a randomized controlled trial

“…Overall, the rate of neuropathic pain was rather low in our study (26-28%) compared to previous studies with neuropathic rates reported to range between 40-50% (3,17,19). Again, studies were quite heterogeneous concerning patient characteristics and surgical approaches.…”

“…In this regard the international association for the study of pain defines Post Thoracotomy Pain Syndrome (PTPS) as a pain that recurs or persists along a thoracotomy incision at least two months following the surgical procedure (2). Of note PTPS is a very common condition following thoracotomy with incidence rates reportedly ranging between 30% and 50% (3)(4)(5). In addition PTPS is mainly attributed to neuropathic pain (6).…”

Current treatment options for post-thoracotomy pain syndrome: a review

“…Treatment is generally conservative because it does not cause disability and limitations in daily life activities in the vast majority of patients. Only 5% of patients develop severe pain and disability-related difficulties in daily living activities [1,4,5,11]. One study reported that 27% of patients described chronic pain at 6 months post-thoracotomy and 8.2% had pain at a level that limited their daily activities [12].…”

Update on paravertebral blocks

“…Patients who experience post-thoracotomy pain at 3 months are at greatest risk for significantly decreased physical functioning and vitality [9]. A recent systemic review of literature pointed the evidence in favor of thoracic paravertebral block or thoracic epidural analgesia as the first-choice therapies for post-thoracotomy analgesia [10].…”

“…Minimally invasive cardiac surgery through thoracotomy also carries increased risk of severe post-thoracotomy pain syndrome compared with median sternotomy [14] Again, the primary factor that might influence post-thoracotomy pain is the severity of pain in the immediate postoperative period. Thus, inadequately controlled pain can increase postoperative morbidity, as well as reduce quality of life and patient satisfaction [9].…”