Preventing the Development of Chronic Pain After Thoracic Surgery

Abstract

DESPITE CLINICIANS’ INCREASED KNOWLEDGE in the last decade of the pathophysiology and pharmacology of nociception, acute postoperative pain still remains a major problem. 1 Apfelbaum J.L. Chen C. Mehta S.S. et al. Postoperative pain experience from a national survey suggests postoperative pain continues to be undermanaged. Anesth Analg. 2003; 97: 534-540 Crossref PubMed Google Scholar Patients continue to report that their primary concern before surgery is the severity of postoperative pain. 1 Apfelbaum J.L. Chen C. Mehta S.S. et al. Postoperative pain experience from a national survey suggests postoperative pain continues to be undermanaged. Anesth Analg. 2003; 97: 534-540 Crossref PubMed Google Scholar This is justified because a recent survey has revealed that 31% of patients suffered from severe or extreme pain and another 47% from moderate pain. 1 Apfelbaum J.L. Chen C. Mehta S.S. et al. Postoperative pain experience from a national survey suggests postoperative pain continues to be undermanaged. Anesth Analg. 2003; 97: 534-540 Crossref PubMed Google Scholar Pain after thoracic surgery has been reported to be among the most intense clinical experiences known. 2 Loan W.B. Morrison J.D. The incidence and severity of postoperative pain. Br J Anaesth. 1967; 39: 695-698 Crossref PubMed Scopus (22) Google Scholar Moderate-to-severe postoperative pain may persist throughout the course of hospitalization and during the first postoperative month. 3 Ochroch E.A. Gottschalk A. Augostides J. et al. Long-term pain and activity during recovery from major thoracotomy using thoracic epidural analgesia. Anesthesiology. 2002; 97: 1234-1244 Crossref PubMed Scopus (80) Google Scholar Unrelieved acute pain after thoracic surgery cannot only contribute to postoperative pulmonary dysfunction 4 Johnson W.C. Postoperative ventilatory performance: Dependence upon surgical incision. Am Surg. 1975; 41: 615-619 PubMed Google Scholar but also may contribute to the development of post-thoracotomy pain syndrome (PTPS). 5 Perkins F.M. Kehlet H. Chronic pain as an outcome from surgery A review of predictive factors. Anesthesiology. 2000; 93: 1123-1133 Crossref PubMed Google Scholar , 6 Karmakar M.K. Ho A.M. Postthoracotomy pain syndrome. Thorac Surg Clin. 2004; 14: 345-352 Abstract Full Text Full Text PDF PubMed Google Scholar , 7 Dajczman E. Gordon A. Kreisman H. et al. Long-term post-thoracotomy pain. Chest. 1991; 99: 270-274 Crossref PubMed Google Scholar , 8 Perttunen K. Tasmuth T. Kalso E. Chronic pain after thoracic surgery: A follow-up study. Acta Anaesthesiol Scand. 1999; 43: 563-567 Crossref PubMed Scopus (165) Google Scholar Despite the identification of chronic postsurgical thoracic pain syndromes, little is known about the underlying mechanisms, natural history, and response to therapy. 5 Perkins F.M. Kehlet H. Chronic pain as an outcome from surgery A review of predictive factors. Anesthesiology. 2000; 93: 1123-1133 Crossref PubMed Google Scholar , 6 Karmakar M.K. Ho A.M. Postthoracotomy pain syndrome. Thorac Surg Clin. 2004; 14: 345-352 Abstract Full Text Full Text PDF PubMed Google Scholar , 7 Dajczman E. Gordon A. Kreisman H. et al. Long-term post-thoracotomy pain. Chest. 1991; 99: 270-274 Crossref PubMed Google Scholar , 8 Perttunen K. Tasmuth T. Kalso E. Chronic pain after thoracic surgery: A follow-up study. Acta Anaesthesiol Scand. 1999; 43: 563-567 Crossref PubMed Scopus (165) Google Scholar