Abstract
Postthoracotomy pain syndrome (PTPS) is a common complication following thoracic surgery. Most studies examining the influence of PTPS on patient-reported symptoms include few patients managed using a minimally invasive approach. Associated sensory changes, potentially neuropathic in origin, are not well described. We therefore examined the symptoms and quality of life (QOL) of patients with and without PTPS who underwent a standard thoracotomy (n = 43) or minimally invasive surgery (n = 54). Patients in this prospective, cross-sectional study completed questionnaires to assess pain (McGill Pain Questionnaire), neuropathic symptoms (Neuropathic Symptom Questionnaire), symptom distress (Symptom Distress Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and QOL (Functional Assessment Cancer Therapy-Lung). Excepting younger age (p = .009), no demographic or surgical characteristic differentiated patients with and without PTPS. Patients with PTPS described discomfort as pain only (15.1%), neuropathic symptoms only (30.2%) or pain and neuropathic symptoms (54.7%). Scores differed between patients with and without PTPS for symptom distress (p < .001), anxiety and depression (p < .001), and QOL (p = .009), with higher distress associated with PTPS. Despite new surgical techniques, PTPS remains common and results in considerable distress. A focused assessment is needed to identify all experiencing this condition, with referral to pain management specialists if symptoms persist.
Highlights
Postthoracotomy pain syndrome (PTPS) is defined as pain that develops after a surgical intervention, lasts longer than 2 months, and cannot be attributed to any other cause or condition (International Association for the Study of Pain [IASP], 2011)
Major Findings There were four major findings in this study: (1) patients who underwent a thoracotomy or thoracoscopic procedure using current surgical techniques did not differ in reports of symptoms consistent with PTPS; (2) patients who experienced PTPS had discomfort at varied locations; (3) PTPS discomfort manifested as pain only, neuropathic symptoms only, or as a combination of both; and (4) symptom distress and quality of life (QOL) differed significantly in patients with and without PTPS
There was no significant difference in report of symptoms related to the type of surgery (p = .382) or time since surgery (p = .380)
Summary
Postthoracotomy pain syndrome (PTPS) is defined as pain that develops after a surgical intervention, lasts longer than 2 months, and cannot be attributed to any other cause or condition (International Association for the Study of Pain [IASP], 2011). It has been suggested that minimally invasive thoracoscopic procedures may result in less injury and less risk for PTPS, most prior studies included few (Aoki et al, 2007; Furrer et al, 1997; Karasaki et al, 2009) or no patients managed using a minimally invasive approach (Dualé et al, 2011; Grosen et al, 2012; Guastella et al, 2011; Mongardon et al, 2011; Pluijms, Steegers, Verhagen, Scheffer, & Wilder-Smith, 2006, Sarna et al, 2008). The purpose of this study was to describe the symptoms and QOL of patients with and without PTPS who underwent a standard thoracotomy or minimally invasive surgery for lung cancer
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