A prospective study of neuropathic pain induced by thoracotomy: Incidence, clinical description, and diagnosis

Abstract

This study evaluated prospectively the incidence of neuropathic pain after thoracotomy, described its clinical characteristics, and delineated landmarks for its diagnosis in daily practice. We evaluated clinically painful symptoms and sensory deficits in 54 patients after lateral/posterolateral thoracotomy for broncho-pulmonary carcinoma with standardized surgical and analgesic procedures. At 2months, 49 patients suffered from non malignant thoracic pain, and at 6months 38 patients (loss to follow-up for 7) reported persisting pain. In 35 patients, painful symptoms and sensory deficits could be evaluated using a standardized clinical bedside procedure. According to the grading system proposed by Treede et al. [41], neuropathic pain was considered probable in 21 patients, while use of the DN4 questionnaire concluded that neuropathic pain was probable in 17 patients. The two diagnostic procedures provided similar conclusions in 16 patients. Morphine consumption during the early post-operative period (mean 111.3±30.8mg/day) and pain intensity (VAS: mean 5.71±2.1) were significantly higher in patients suffering from neuropathic pain than in other patients with pain (mean 80±21.4mg/day; VAS: mean 3.9±2.4). The clinical picture in most patients with neuropathic pain included electric shocks and severe multimodal hypoesthesia in the sensory area of 5th/6th intercostal nerves. Thus, our results indicate a minimal incidence of chronic post-thoracotomy pain at 70% and that of neuropathic pain at 29%, this latter being clinically suggested by a combination of certain symptoms and reinforced by the DN4 questionnaire when sensory deficit at scar is present.

Impact of intercostal paravertebral neurectomy on post thoracotomy pain syndrome after thoracotomy in lung cancer patients: a randomized controlled trial

“…Overall, the rate of neuropathic pain was rather low in our study (26-28%) compared to previous studies with neuropathic rates reported to range between 40-50% (3,17,19). Again, studies were quite heterogeneous concerning patient characteristics and surgical approaches.…”

Neurophysiological Characterization of Persistent Postthoracotomy Pain

“…Although the median force of the stimulating monofilament in this study (255 mN) was lower than in a postmastectomy pain study 14 (1236 mN) and after a hernia repair study 13 (588 mN), it was still 25-fold higher than a previous trial on thoracotomy (9.8 mN). 7 Third, a conservative measure of temporal summation was chosen, requiring an NRS increase of >2, which could lead to an underestimation of the prevalence of temporal summation.…”

“…10 Previous neurophysiological characterizations of postoperative nerve function after thoracotomy assessing PTPS have evaluated responses to mechanical stimuli. 5,7,11,12 These and other studies from persistent postsurgical pain states [13][14][15][16] have not managed to finally characterize persistent postsurgical pain states or have not compared pain patients to pain-free patients. Accordingly, our objective of this hypothesis-generating study was to quantitatively describe sensory changes in PTPS and painfree patients after thoracotomy using a detailed quantitative sensory testing (QST) protocol.…”

Post Thoracotomy Pain Syndrome

“…Moreover, the high variability in PTPS incidence may also be explained by the different attitude of patients towards discomfort (14). patients in terms of sensory loss and hypoesthesia to cold (16,17). These neuropathic phenomena are principally located within mammary and sub mammary areas and ipsilateral scapular and interscapular regions.…”