Neurophysiological Characterization of Persistent Postthoracotomy Pain

Abstract

Neurophysiological assessments indicate nerve injury to be common in pain and pain-free patients after thoracotomy. The combination of increased thresholds together with hyperesthesia, suggests consequences of nerve injury to be more pronounced in PTPS patients.

Test-retest Agreement and Reliability of Quantitative Sensory Testing 1 Year After Breast Cancer Surgery

“…However, loss of sensory function has been reported in both pain and pain-free patients in the postsurgical patient population. 7,17,18 The reliability analysis of pain scores is comparable to other studies of reliability of "current pain" scores. 32 The reliability of pain scores is lower than QST, suggesting that pain is a more dynamic condition than sensory dysfunction.…”

“…Thus, it is clinically useful and allows comparing measurement error with clinically relevant changes. 14 Despite the fact that QSTs have been used extensively in persistent postsurgical pain patients such as those undergoing hernia surgery, [15][16][17] thoracic surgery, 7,8,18 and breast cancer surgery, [2][3][4][5] further characterization of the reliability of QST in the postsurgical population is needed to fully account for the variation from the test itself, when interpreting the results. Therefore the aim of the present study was to evaluate the test-retest reliability of mechanical and thermal thresholds and sensory mapping in a well-characterized population of breast cancer patients 12 months after surgery.…”

“…[2][3][4][5] These findings are in accordance with those from other surgical models such as hernia 6 and thoracic surgery. 7,8 However, before the results from QST can be translated into evidence and clinical practice, it is essential that detailed assessments on the reliability of the tests are gained. Furthermore, neuroplastic changes in the somatosensory system may occur after nerve damage, 9 adding to variability of QST measurements after surgery.…”

Perioperative Epidural or Intravenous Ketamine Does Not Improve the Effectiveness of Thoracic Epidural Analgesia for Acute and Chronic Pain After Thoracotomy

“…1,2,30 Persistent postoperative pain after thoracotomy seems to be a consequence of direct surgical damage to the intercostal nerves, which produces severe postoperative pain capable of triggering central sensitization processes and subsequent spinal events. 31 NMDAr play an important role in the development of the central sensitization that is associated with neuropathic symptoms such as hyperalgesia. 3,32 In addition to the intercostal nerve damage, inflammation in the surgical area contributes to the intense noxious stimulus and its role in PPP must also be considered.…”

Ultrasound therapy reduces persistent post-thoracotomy tactile allodynia and spinal substance P expression in rats

“…Patients report a 50% incidence of persistent postoperative pain at 3 and 6 months after thoracotomy,1 while thoracotomy and rib retraction (TRR) lead to detectable nerve damage2 or presumed nerve injury 3. Nerve injury commonly causes neuropathic pain characterized by mechanical allodynia and thermal hyperalgesia 4.…”