A Prospective Study of Chronic Pain after Thoracic Surgery

Bayman, Emine O.; Parekh, Kalpaj R.; Keech, John; Selte, Atakan; Brennan, Timothy J.

doi:10.1097/aln.0000000000001576

Cited by 200 publications

(219 citation statements)

References 51 publications

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“…Experts currently suggest that aggressive treatment of acute pain may have potential benefits in preventing the transition to persistent postsurgical pain. [30][31][32] …”

Section: Evaluating the Role Of New Interfascial Plane Blocksmentioning

confidence: 99%

Interfascial Plane Blocks

Elsharkawy

Pawa

Mariano

2018

Regional Anesthesia and Pain Medicine

168

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Ultrasound-guided interfascial plane blocks are a recent development in modern regional anesthesia research and practice and represent a new route of transmission for local anesthetic to various anatomic locations, but much more research is warranted. Before becoming overtaken with enthusiasm for these new techniques, a deeper understanding of fascial tissue anatomy and structure, as well as precise targets for needle placement, is required. Many factors may influence the ultimate spread and quality of resulting interfascial plane blocks, and these must be understood in order to best integrate these techniques into contemporary perioperative pain management protocols.

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“…Experts currently suggest that aggressive treatment of acute pain may have potential benefits in preventing the transition to persistent postsurgical pain. [30][31][32] …”

Section: Evaluating the Role Of New Interfascial Plane Blocksmentioning

confidence: 99%

Interfascial Plane Blocks

Elsharkawy

Pawa

Mariano

2018

Regional Anesthesia and Pain Medicine

168

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“…Chronic pain is one of the most common health problems and it is known that approximately 22.5% of chronic pain is secondary to surgical procedures [12]. Although the prevalence of PTPS after thoracic surgery ranged from 14% to 83% [14], the incidence of PTPS neuropathic pain ranged from 35 to 83% and neuropathic pain is associated with more severe chronic pain [15,16].…”

Section: Prevalencementioning

confidence: 99%

“…Only 5% of patients develop severe pain and disability-related difficulties in daily living activities [1,4,5,11]. One study reported that 27% of patients described chronic pain at 6 months post-thoracotomy and 8.2% had pain at a level that limited their daily activities [12]. Approximately half of the patients describe persistent thoracotomy pain between the first and second years after surgery and 30% between the fourth and fifth years [5,13].…”

Section: Introductionmentioning

confidence: 99%

Current treatment options for post-thoracotomy pain syndrome: a review

Yakşi¹,

Yakşi²

2017

Curr Thorac Surg

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Thoracotomy is one of the most painful surgical procedures known. Chronic pain in the postoperative period after thoracotomy is a common complication. Post-thoracotomy pain syndrome (PTPS) is a chronic pain with neuropathic and non-neuropathic components, continuing after 2 months of thoracotomy, causing disability by affecting the daily activities and functions of patients. Patients generally describe neuropathic symptoms such as hyperalgesia, allodynia, hypoesthesia at the site of the incision or related dermatomes. Etiology includes preoperative, intraoperative and postoperative factors. Although the mechanism of PTPS formation is not clear yet, the most common cause is the intercostal nerve injury. PTPS treatment is complex because of the neuropathic component of the pain.The risk of PTPS formation can be reduced by controlling early pain before the onset of the disease.When pain occurs, medical treatments are implemented and also minimally invasive interventional procedures could be performed if necessary.

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“…We appreciate Holm et al 's interest in our paper (1). By design, our study was not powered to answer each secondary result.…”

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confidence: 99%

Response to “Editorial on pain following thoracic surgery”

et al. 2017

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We appreciate Holm et al. 's interest in our paper (1). By design, our study was not powered to answer each secondary result. This point was already acknowledged in the limitations section. The primary outcome variable of our study was the incidence of chronic pain, at 6 months, for any patient undergoing thoracic surgery. We tested the primary hypothesis of whether variables from preoperative evaluation can predict chronic pain after thoracic surgery. Based on our data from 99 patients who were followed for 6 months, the answer was no. Acute postsurgical pain was the only covariate associated with the presence of chronic pain.Different from many previous studies where the psychosocial measurements were assessed after surgery (2) or only a limited number of psychosocial assessments were conducted before surgery (references 4 and 5 of Holm et al.) (3,4), we assessed all relevant psychosocial measurements preoperatively in our study. For example, our lack of association of preoperative anxiety and depression with chronic pain after thoracotomy are consistent with the results of previous studies that Holm et al. mentioned (3,4); however, to the best of our knowledge, no other study assessed all the preoperative psychosocial factors for thoracic surgery patients prior to our study.The first point made by the commentary was "there being obvious problems with selection bias of both patients and surgeons in the study". We do not agree with this comment. We worked with all the thoracic surgeons at our institution. We also approached all the patients meeting the broad inclusion criteria of our study. Because of the non-randomized nature of our study, patients were more inclined to be included in this prospective observational study. Patients converted from thoracoscopy to thoracotomy were followed. Similarly, patients likely to undergo thoracotomy but then were completed with VATS were also included. Therefore, we believe, the generalizability of the study is higher than a randomized clinical trial.The second comment was "a major problem regarding interpretation of chronic pain development when postoperative pain management differed between the two groups." We agree with the comment that the postoperative pain management differed between the thoracotomy and VATS groups as it does in most practices. Even though we could not find a significant type of surgery effect, as we indicated in the Type of Surgery subsection of the Results, the surgery effect was examined in the final multiple logistic frequentist and Bayesian regression models. When type of surgery is added to the model, there was no increase on the AUC or differences on the inferences from the models compared to the model not including the type of surgery. Therefore, we do not agree with the comment that the differing postoperative pain management makes the meaningful comparison of chronic pain after thoracic surgery very difficult. In addition, there is little data to support that treatment of acute pain influences the development of chronic pain for thoracic s...

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A Prospective Study of Chronic Pain after Thoracic Surgery

Cited by 200 publications

References 51 publications

Interfascial Plane Blocks

Interfascial Plane Blocks

Current treatment options for post-thoracotomy pain syndrome: a review

Response to “Editorial on pain following thoracic surgery”

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