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Chronic post thoracotomy pain

S M Keller1, N Z Carp, M N Levy

  • 1Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.

The Journal of Cardiovascular Surgery
|December 1, 1994
PubMed
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Chronic post-thoracotomy pain (CPP) affects 11% of patients, particularly after chest wall resection or pleurectomy. Preoperative narcotic use predicts CPP, which can be managed with NSAIDs, antidepressants, and pain procedures.

Area of Science:

  • Thoracic Surgery
  • Pain Management
  • Oncology

Background:

  • Chronic post-thoracotomy pain (CPP) is a significant clinical challenge.
  • Management strategies for CPP remain underexplored.

Purpose of the Study:

  • Identify risk factors for CPP.
  • Determine optimal treatment strategies for CPP.

Main Methods:

  • Retrospective review of 238 patients undergoing thoracotomy.
  • CPP defined as pain >3 months post-surgery requiring regular analgesics.
  • Analysis of patient records, including surgical procedure, preoperative narcotic use, and pain management interventions.

Main Results:

  • CPP occurred in 11% of patients (25/238).

Related Experiment Videos

  • Higher CPP incidence observed after chest wall resection (50%) and pleurectomy (20%) compared to pulmonary resection (5%).
  • Preoperative narcotic use was a significant predictor of CPP (52% incidence).
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) and tricyclic antidepressants improved pain control.
  • Pain procedures (e.g., trigger-point injections, nerve blocks) were required in 10 patients.
  • Recurrent cancer was identified as the cause of worsening pain in 20 patients after initial pain control.

    • Conclusions:

    • CPP is more prevalent after chest wall resection and pleurectomy.
    • Preoperative narcotic use is a key risk factor for developing CPP.
    • Prompt investigation for tumor recurrence is crucial for patients experiencing worsening pain after initial relief.