Advertisement

Chronic Post-Thoracotomy Pain Syndrome

  • Peter Gerner
  • Peter Gerner
Chapter

Abstract

Postthoracotomy pain syndrome (PTPS), also known as chronic postthoracotomy pain or postthoracotomy neuralgia, is defined by the International Association for the Study of Pain (IASP) as “pain that recurs or persists along a thoracotomy incision at least 2 months following the surgical procedure.” In general, it is burning and stabbing pain (spontaneous pain) with dysesthesia and thus shares many features of neuropathic pain. The sensation of evoked pain, in response to a normally nonpainful stimulus (allodynia), such as tactile allodynia, or an exaggerated response to a slightly painful stimulus (hyperalgesia), such as mechanical and thermal hyperalgesia, especially when accompanied by numbness, is considered diagnostic for nerve injury. These symptoms occur frequently along the innervation area of the intercostal nerves and are the most frequent feature of postthoracotomy pain. PTPS is increasingly acknowledged by anesthesiologists and surgeons as significant and potentially modifiable.(1)

Keywords

Postthoracotomy neuralgia Postthoracotomy pain syndrome Chronic postthoracotomy pain Central sensitization Intercostal nerve damage Cryoanalgesia/cryoablation Preemptive analgesia 

Selected References

  1. 1.
    Gottschalk A, Cohen SP, Yang S, Ochroch EA. Preventing and treating pain after thoracic surgery. Anesthesiology. 2006;104(3):594–600.PubMedCrossRefGoogle Scholar
  2. 2.
    Perttunen K, Tasmuth T, Kalso E. Chronic pain after thoracic surgery: a follow-up study. Acta Anaesthesiol Scand. 1999;43(5):563–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Conacher ID. Therapists and therapies for post-thoracotomy neuralgia. Pain. 1992;48(3):409–12.PubMedCrossRefGoogle Scholar
  4. 4.
    Kawasaki Y, Zhang L, Cheng JK, Ji RR. Cytokine mechanisms of central sensitization: distinct and overlapping role of interleukin-1beta, interleukin-6, and tumor necrosis factor-alpha in regulating synaptic and neuronal activity in the superficial spinal cord. J Neurosci. 2008;28(20):5189–94.PubMedCrossRefGoogle Scholar
  5. 5.
    Suter MR, Wen YR, Decosterd I, Ji RR. Do glial cells control pain? Neuron Glia Biol. 2007;3(3):255–68.PubMedCrossRefGoogle Scholar
  6. 6.
    Rogers ML, Henderson L, Mahajan RP, Duffy JP. Preliminary findings in the neurophysiological assessment of intercostal nerve injury during thoracotomy. Eur J Cardiothorac Surg. 2002;21(2):298–301.PubMedCrossRefGoogle Scholar
  7. 7.
    Benedetti F, Vighetti S, Ricco C, et al. Neurophysiologic assessment of nerve impairment in posterolateral and muscle-sparing thoracotomy. J Thorac Cardiovasc Surg. 1998;115(4):841–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Ochroch EA, Gottschalk A, Augoustides JG, Aukburg SJ, Kaiser LR, Shrager JB. Pain and physical function are similar following axillary, muscle-sparing vs posterolateral thoracotomy. Chest. 2005;128(4):2664–70.PubMedCrossRefGoogle Scholar
  9. 9.
    Maguire MF, Ravenscroft A, Beggs D, Duffy JP. A questionnaire study investigating the prevalence of the neuropathic component of chronic pain after thoracic surgery. Eur J Cardiothorac Surg. 2006;29(5):800–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Landreneau RJ, Mack MJ, Hazelrigg SR, et al. Prevalence of chronic pain after pulmonary resection by thoracotomy or video-assisted thoracic surgery. J Thorac Cardiovasc Surg. 1994;107(4):1079–85.PubMedGoogle Scholar
  11. 11.
    Yashpal K, Katz J, Coderre TJ. Effects of preemptive or postinjury intrathecal local anesthesia on persistent nociceptive responses in rats. Confounding influences of peripheral inflammation and the general anesthetic regimen. Anesthesiology. 1996;84(5):1119–28.PubMedCrossRefGoogle Scholar
  12. 12.
    Fridrich P, Colvin HP, Zizza A, et al. Phase 1A safety assessment of intravenous amitriptyline. J Pain. 2007;8(7):549–55.PubMedCrossRefGoogle Scholar
  13. 13.
    Dahl JB, Kehlet H. The value of pre-emptive analgesia in the treatment of postoperative pain. Br J Anaesth. 1993;70(4):434–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Kissin I. Preemptive analgesia. Why its effect is not always obvious. Anesthesiology. 1996;84(5):1015–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Senturk M. Acute and chronic pain after thoracotomies. Curr Opin Anaesthesiol. 2005;18(1):1–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Bong CL, Samuel M, Ng JM, Ip-Yam C. Effects of preemptive epidural analgesia on post-thoracotomy pain. J Cardiothorac Vasc Anesth. 2005;19(6):786–93.PubMedCrossRefGoogle Scholar
  17. 17.
    Katz J, Jackson M, Kavanagh BP, Sandler AN. Acute pain after thoracic surgery predicts long-term post-thoracotomy pain. Clin J Pain. 1996;12(1):50–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Kavanagh BP, Katz J, Sandler AN, et al. Multimodal analgesia before thoracic surgery does not reduce postoperative pain. Br J Anaesth. 1994;73(2):184–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Obata H, Saito S, Fujita N, Fuse Y, Ishizaki K, Goto F. Epidural block with ­mepivacaine before surgery reduces long-term post-thoracotomy pain. Can J Anaesth. 1999;46(12):1127–32.PubMedCrossRefGoogle Scholar
  20. 20.
    Aida S, Baba H, Yamakura T, Taga K, Fukuda S, Shimoji K. The effectiveness of preemptive analgesia varies according to the type of surgery: a randomized, double-blind study. Anesth Analg. 1999;89(3):711–6.PubMedGoogle Scholar
  21. 21.
    Schultz AM, Werba A, Ulbing S, Gollmann G, Lehofer F. Peri-operative thoracic epidural analgesia for thoracotomy. Eur J Anaesthesiol. 1997;14(6):600–3.PubMedCrossRefGoogle Scholar
  22. 22.
    Katz J, Kavanagh BP, Sandler AN, et al. Preemptive analgesia. Clinical evidence of neuroplasticity contributing to postoperative pain. Anesthesiology. 1992;77(3):439–46.PubMedCrossRefGoogle Scholar
  23. 23.
    Senturk M, Ozcan PE, Talu GK, et al. The effects of three different analgesia techniques on long-term postthoracotomy pain. Anesth Analg. 2002;94(1):11–5. Table.PubMedCrossRefGoogle Scholar
  24. 24.
    Doyle E, Bowler GM. Pre-emptive effect of multimodal analgesia in thoracic surgery. Br J Anaesth. 1998;80(2):147–51.PubMedGoogle Scholar
  25. 25.
    Kissin I. Preemptive analgesia. Anesthesiology. 2000;93(4):1138–43.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Peter Gerner
    • 1
  • Peter Gerner
    • 2
  1. 1.Department of Anesthesiology, Critical Care and Pain MedicineParacelsus Medical University, Salzburg General HospitalSalzburgAustria
  2. 2.Harvard Medical School General HospitalBostonUSA

Personalised recommendations