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Predictors of one year chronic post-surgical pain trajectories following thoracic surgery



Chronic post-surgical pain (CPSP) is a highly prevalent complication following thoracic surgery. This is a prospective cohort study that aims to describe the pain trajectories of patients undergoing thoracic surgery beginning preoperatively and up to 1 year after surgery


Two hundred and seventy nine patients undergoing elective thoracic surgery were enrolled. Participants filled out a preoperative questionnaire containing questions about their sociodemographic information, comorbidities as well as several psychological and pain-related statuses. They were then followed-up during their immediate postoperative period and at the three, six and 12 month time-points to track their postoperative pain, complications and pain-related outcomes. Growth mixture modeling was used to construct pain trajectories.


The first trajectory is characterized by 185 patients (78.1%) with mild pain intensity across the 12 month period. The second is characterized by 32 patients (7.5%) with moderate pain intensity immediately after surgery which decreases markedly by 3 months and remains low at the 12 month follow-up. The final trajectory is characterized by 20 patients (8.4%) with moderate pain intensity immediately after surgery which persists at 12 months. Patients with moderate to severe postoperative pain intensity were much more likely to develop CPSP compared to patients with mild pain intensity. Initial pain intensity levels immediately following surgery as well as levels of pain catastrophizing at baseline were predicting pain trajectory membership. None of the surgical or anesthetic-related variables were significantly associated with pain trajectory membership.


Patients who undergo thoracic surgery can have postoperative pain that follows one of the three different types of trajectories. Higher levels of immediate postoperative pain and preoperative pain catastrophizing were associated with moderately severe CPSP.

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Hance Clarke is supported by a Merit Award from the Department of Anaesthesia at the University of Toronto. M Gabrielle Pagé is a Junior 1 research scholar from the Fonds de recherche du Québec en santé. Joel Katz is supported by a Canadian Institutes of Health Research, Canada Research Chair in Health Psychology at York University. This study is funded by a peer-reviewed grant from Physician Services Incorporated.


KL is a co-principal investigator for an observational study of medical cannabis funded by Shopper’s Drug mart.

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Correspondence to Hance Clarke.

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KL is a co-principal investigator for an observational study of medical cannabis funded by Shopper’s Drug mart. The other authors have no conflicts of interest to declare.

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Liu, C.W., Page, M.G., Weinrib, A. et al. Predictors of one year chronic post-surgical pain trajectories following thoracic surgery. J Anesth 35, 505–514 (2021).

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  • Post-thoracotomy pain syndrome
  • Chronic post-surgical pain
  • Thoracotomy
  • Thoracic surgery
  • Pain trajectory