Pain Management Strategies for Chronic Pain after Thoracic Surgery: From Pharmacological Therapy to Regenerative...

Thoracic surgery is commonly performed for the management of conditions involving the lungs, mediastinum, pleura, and chest wall. Despite advances in surgical techniques and perioperative care, postoperative pain remains a frequent complication. In some patients, pain may persist and progress into chronic post-thoracotomy pain syndrome (CPTPS), defined as pain lasting more than 2 months after surgery. The prevalence of chronic pain ranges from 21% to 91%, with lower rates observed in minimally invasive approaches such as video-assisted thoracoscopic surgery (VATS) (~35.5%) and robotic-assisted thoracic surgery (RATS) (11.2%-34.6%).

This study presents a literature review evaluating the epidemiology, pathophysiology, and management of CPTPS, including pharmacological, interventional, and rehabilitation-based approaches, as well as emerging biological therapies.

Chronic pain is multifactorial, involving tissue injury, inflammation, intercostal nerve damage, and central sensitization. It is associated with impaired respiratory function, reduced mobility, sleep disturbances, and decreased quality of life. Multimodal analgesia and regional anesthesia are key strategies, while rehabilitation supports functional recovery. Emerging biological therapies show promise but remain limited in evidence.

A multidisciplinary approach is essential to reduce CPTPS and improve long-term outcomes and quality of life.