Chronic post‐thoracotomy pain: a retrospective study

Pluijms, W.A.; Steegers, Monique A H; Verhagen, Ad F. T. M.; Scheffer, Gert-Jan; Wilder–Smith, Oliver H.G.

doi:10.1111/j.1399-6576.2006.01065.x

Cited by 173 publications

(99 citation statements)

References 16 publications

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“…1,[4][5][6][7] The International Association for the Study of Pain defines PTPS as pain that recurs or persists along a thoracotomy scar longer than 2 months after surgery. 2,[4][5][6][7][8][9][10][11] The syndrome is thought to be predominantly of neuropathic origin, 1,9,12 secondary to damage to the intercostal nerves, causing neuralgia, but also caused by myofascial pain. 13 Many risk factors have been implicated and include genetic susceptibility, young age, female sex, pain before surgery, severe acute postoperative pain, and high postoperative opioid consumption.…”

Section: Methodsmentioning

confidence: 99%

“…13 Many risk factors have been implicated and include genetic susceptibility, young age, female sex, pain before surgery, severe acute postoperative pain, and high postoperative opioid consumption. 1,4,6,[14][15][16] Mechanisms leading to PTPS and other chronic postoperative pain syndromes are not well understood. It is suggested that intense nociceptive stimulation activates N-methyl D-aspartate receptors, and opioid-induced hyperalgesia after the use of highdose opioids leads to wind-up, facilitation, central sensitization, and long-term potentiation.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Impact of Pregabalin on the Occurrence of Postthoracotomy Pain Syndrome

Brulotte

Ruel

Lafontaine

et al. 2015

Regional Anesthesia and Pain Medicine

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Impact of Pregabalin on the Occurrence of Postthoracotomy Pain Syndrome

Brulotte

Ruel

Lafontaine

et al. 2015

Regional Anesthesia and Pain Medicine

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“…All of these factors can be linked to altered pain processing. Lower age, consistently associated with higher incidences of chronic postoperative pain, may be associated with a more vigorous neuroplastic response, whereas gender-dependent differences in pain modulation are now well described in the literature (3,4,7,8,10,(12)(13)(14)(15)(16)(17)(18). Surgery-related factors linked to increased incidences of chronic pain after surgery, including more preoperative pain, more pain and higher analgesia consumption in the early postoperative period, more extensive surgery, and nerve damage have increased pain sensitivity in common, in that these factors can all be either expressions of hyperalgesia (more preoperative or postoperative pain, more postoperative analgesia consumption), or a cause thereof (nerve damage, more extensive surgery) (3, 4, 7, 8, 10-12 18-25).…”

Section: Clinical Risk Factors For Chronic Pain After Surgery and Altmentioning

confidence: 97%

Chronic Pain and Surgery: A Review of New Insights from Sensory Testing

Wilder–Smith

2011

Journal of Pain & Palliative Care Pharmacotherapy

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Chronic pain is increasingly recognized as an undesirable outcome after surgery. Predicting risk of postoperative chronic pain, as well as chronic pain prevention or treatment, requires understanding of the processes underlying its development. Quantitative sensory testing research over the last decade has made it possible to start understanding the alterations in central pain processing associated with chronic pain and its development. Chronic pain syndromes are typically characterized by a pronociceptive state of pain processing, e.g., generalized hyperalgesia as a sign of supraspinal central sensitization and poor inhibitory or even facilitatory descending modulation. In the perioperative context, development and progression of chronic pain are accompanied by signs congruent with a shift towards a pronociceptive state. Preoperatively, hyperalgesia and poor descending inhibitory modulation appear to increase the risk of subsequent chronic pain. Postoperatively, abnormal persistence and spread of hyperalgesia, compatible with rostral neuraxial spread of central sensitization, are increasingly linked to the development and progression of chronic pain. These findings, which need further confirmation, suggest that perioperative quantitative sensory testing of pain sensitivity and pain modulation has the potential to become a valuable clinical tool for assessing risk of chronic pain development and for managing its prevention and treatment.

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“…16,17 In the study, we also found that acute postoperative pain after thoracotomy was an independent risk factor for the development of CPTP. This was not consistent with the reports of Perttunen et al 18 The primary cause of this difference may be associated with the study design, such as significant recall bias in retrospective investigations or using analgesic consumption as an indirect measurement instead of the acute pain scores immediately after surgery.…”

Section: Discussionmentioning

confidence: 83%

Chronic Postthoracotomy Pain and Perioperative Ketamine Infusion

Hu¹,

Liao²,

Zhang³

et al. 2014

Journal of Pain & Palliative Care Pharmacotherapy

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The objectives of this study were to investigate whether continuous intravenous ketamine during the first 72 hours after thoracotomy could reduce the incidence and intensity of chronic postthoracotomy pain (CPTP) and to define the incidence and risk factors of CPTP. Seventy-eight patients receiving thoracotomy for lung tumor (benign or malignant) were randomly divided into two groups: ketamine group (n = 31) and control groups (n = 47). Patients in the ketamine group received intravenous ketamine 1 mg/kg before incision, followed by 2 μg/kg/minute infusion for 72 hours plus sufentanil patient-controlled intravenous analgesia after thoracotomy. Patients in the control group received intravenous a 0.9% normal saline and infusion plus sufentanil patient-controlled intravenous analgesia. The solutions patients received were blinded. The numerical rating scale (NRS) pain scores and the incidence and risk factors of CPTP were recorded during the first 6 months after surgery. Compared with control group, the incidence of chronic pain in the ketamine group did not decrease at 2 months (χ(2) = 1.599, P = .206) and 6 months (χ(2) = 0.368, P = .544) after surgery. Postoperative pain scores in the ketamine group were not significantly different from those of the control group patients at 2 months (U = 677.5, P = .593) and 6 months (U = 690.5, P = .680). The incidence of CPTP was 78.2% (61/78) at 2 months and 53.8% (42/78) at 6 months after surgery. Retractor used time (OR = 5.811, P = .002), inadequate acute pain control (NRS ≥ 5) (OR = 5.425, P = .048), and chemotherapy (OR = 3.784, P = .056) were independent risk factors for chronic postthoracotomy pain. The authors conclude that continuous intravenous ketamine (2 μg/kg/min) during the first 72 hours after thoracotomy was not beneficial to prevent chronic postthoracotomy pain. The independent risk factors for chronic postthoracotomy pain were retractor used time, inadequate acute pain control, and chemotherapy.

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Chronic post‐thoracotomy pain: a retrospective study

Abstract: Our study confirms that chronic post-thoracotomy pain is a common problem. The results from our study suggest that chronic post-thoracotomy pain may be associated with more intensive and extensive nociceptive input due to thoracic surgery.

Cited by 173 publications

References 16 publications

Impact of Pregabalin on the Occurrence of Postthoracotomy Pain Syndrome

Impact of Pregabalin on the Occurrence of Postthoracotomy Pain Syndrome

Chronic Pain and Surgery: A Review of New Insights from Sensory Testing

Chronic Postthoracotomy Pain and Perioperative Ketamine Infusion

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