A Retrospective Study of Chronic Post-Surgical Pain following Thoracic Surgery: Prevalence, Risk Factors, Incidence of Neuropathic Component, and Impact on Qualify of Life

Abstract

BackgroundThoracic surgeries including thoracotomy and VATS are some of the highest risk procedures that often lead to CPSP, with or without a neuropathic component. This retrospective study aims to determine retrospectively the prevalence of CPSP following thoracic surgery, its predicting risk factors, the incidence of neuropathic component, and its impact on quality of life.MethodsPatients who underwent thoracic surgeries including thoracotomy and VATS between 01/2010 and 12/2011 at the First Affiliated Hospital, School of Medicine, Zhejiang University were first contacted and screened for CPSP following thoracic surgery via phone interview. Patients who developed CPSP were then mailed with a battery of questionnaires, including a questionnaire referenced to Maguire's research, a validated Chinese version of the ID pain questionnaire, and a SF-36 Health Survey. Logistic regression analyses were subsequently performed to identify risk factors for CPSP following thoracic surgery and its neuropathic component.ResultsThe point prevalence of CPSP following thoracic surgery was 24.9% (320/1284 patients), and the point prevalence of neuropathic component of CPSP was 32.5% (86/265 patients). CPSP following thoracic surgery did not improve significantly with time. Multiple predictive factors were identified for CPSP following thoracic surgery, including age<60 years old, female gender, prolonged duration of post-operative chest tube drainage (≥4 days), options of post-operative pain management, and pre-existing hypertension. Furthermore, patients who experienced CPSP following thoracic surgery were found to have significantly decreased physical function and worse quality of life, especially those with neuropathic component.ConclusionsOur study demonstrated that nearly 1 out of 4 patients underwent thoracic surgery might develop CPSP, and one third of them accompanied with a neuropathic component. Early prevention as well as aggressive treatment is important for patients with CPSP following thoracic surgery to achieve a high quality of life.

High- and low-dose-rate intraoperative radiotherapy for thoracic malignancies resected with close or positive margins

“…However, the nature and incidence of those complications led us to conclude that they were not related to IORT. For example, our observed rate of chronic post-surgical pain (6.8%) compares favorably to a recent study reporting the incidence following thoracic surgery as high as 24.9% (6). We also observed a 6.8% (4/58) incidence of grade 3 wound infections, which is not significantly greater than reported rates of deep chest infections after cardiothoracic surgeries on the order of 5.0% (7).…”

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

“…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].…”

Comparison of operant escape and reflex tests of nociceptive sensitivity

“…Injury to paraspinal tissues that occurs during exposure of a spinal nerve for ligation is quite extensive and could affect stability of the spine, providing a model of tissue injury pain. Supporting the finding that "sham" surgery can be painful long-term, investigations of humans have documented chronic post-surgical pain other than neuropathic pain that can occur for some individuals (Aveline et al, 2013;Gjeilo et al, 2014;Haroutiunian et al, 2013;Martinez et al, 2013;Meyhoff et al, 2006;Mongardon et al, 2011;Owen et al, 2010;Peng et al, 2014;Wong et al, 2007;Wylde et al, 2011) (see also Section 4).…”

“…The reduction in pain sensitivity can be understood in terms of reduced cerebral cholinergic systems that normally direct attention and control anxiety/fear and stress reactions to threatening stimuli such as those which are painful. Reduced cerebral cholinergic tone results in sedation (Conner et al, 1977;Longo, 1966), impairs attention (Furey, 2011;Klinkenberg et al, 2011;Sarter et al, 2005;Thienel et al, 2009), reduces the normal enhancement of pain by fear/anxiety (Brioni et al, 1993;Castillo et al, 2013;File et al, 2000;Kamboj and Curran, 2006;Newman et al, 2001;Parr et al, 2012;Phillips and LeDoux, 1992;Storage et al, 2013;Zale et al, 2013) and impairs the activation of central stress circuitry Gilad et al, 1985;Janowsky et al, 1983;Lai et al, 1986).…”