The morbidity, time course and predictive factors for persistent post‐thoracotomy pain

Abstract

After thoracotomy, patients often suffer from a persistent pain syndrome called post-thoracotomy pain. To elucidate morbidity, time course, and predictive factors for this syndrome, we analyzed follow-up data for 85 post-thoracotomy patients. We used a four-point scale to assess pain: none, slight, moderate and severe. Of 85 patients, 50 reported pain (39 slight, 11 moderate) one day after surgery. A year after surgery, the patients were polled using a simple questionnaire received by the mail. Sixty patients reported persistent pain (34 slight, 14 moderate, 12 severe) a month after surgery, and 35 patients reported persistent pain (33 slight, two moderate) around the time of the poll (1 year after surgery). Although pain deterioration was observed in 40% (34/85) of patients during month 1 after surgery, pain alleviation was seen in 48% (41/85) of patients during months 2-12. Stepwise regression analysis revealed that female gender and pain at postoperative day 1 were predictive for persistent pain both 1 month and 1 year after thoracotomy. Among 35 patients with persistent pain 1 year after surgery, 24 cases reported paresthesia-dysesthesia, and 14 cases reported hypoesthesia. The present data thus suggests that persistent pain is common and often severe 1 month after surgery but is alleviated after 1 year. Clinical time course and symptoms indicate that nerve impairment rather than simple nociceptive impact may be involved in this syndrome.

Postthoracotomy Pain Management Problems

“…The sensation of pain in response to a normally non-painful stimulus (allodynia) or an exaggerated response to a slightly painful stimulus (hyperalgesia), especially when accompanied by numbness, is considered diagnostic for nerve injury. These symptoms occur frequently along the distribution area/innervation area of the intercostal nerves and are the most frequent feature of post-thoracotomy pain (39). Neurophysiological assessment of the intercostal nerve during thoracotomy has demonstrated total conduction block, implying nerve injury during rib retraction (40;41).…”

Post-trauma and postoperative painful neuropathy

“…Since many surgeries producing persistent post-surgery pain are associated to nervous injury, techniques to prevent such injuries seem to be useful to prevent post-surgery NP, for example, laparoscopic hernia repair, which may decrease the risk of nervous injury as compared to open surgery, intercostobrachial nerve preservation in mastectomy, intracostal suture to avoid direct nerve compression after thoracotomy and minimally invasive techniques in other procedures, such as nephrectomy and sternotomy 14,34,[39][40][41][42] . Post-thoracotomy pain syndrome is relatively common and is present in approximately 50% of patients after thoracotomy, and around 30% experience pain 4 to 5 years after surgery.…”

Anesthesia for Thoracic Surgical Procedures

“…Insult to the intercostal nerves, soft tissue damage and inflammation, bone and joint disturbance, and visceral manipulation all contribute to the severity of pain [88]. The estimated incidence of chronic pain following thoracotomy is between 30-40%, with approximately 10% with severe disabling pain [109,110]. Pain control is crucial after thoracic surgery not only for immediate pain relief, but also to prevent pulmonary complications.…”