Only half of the chronic pain after thoracic surgery shows a neuropathic component

Chronic pain is a common complication after thoracic surgery. The cause of chronic post-thoracotomy pain is often suggested to be intercostal nerve damage. Thus chronic pain after thoracic surgery should have an important neuropathic component. The present study investigated the prevalence of the ne...

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Bibliographic Details
Published in:	The journal of pain Vol. 9; no. 10; p. 955
Main Authors:	Steegers, Monique A H, Snik, Daphne M, Verhagen, Ad F, van der Drift, Miep A, Wilder-Smith, Oliver H G
Format:	Journal Article
Language:	English
Published:	United States 01-10-2008
Subjects:	Adult Age Factors Aged Chronic Disease Female Humans Male Middle Aged Netherlands - epidemiology Neuralgia - epidemiology Neuralgia - etiology Neuralgia - physiopathology Pain Measurement - methods Pain, Postoperative - epidemiology Pain, Postoperative - etiology Pain, Postoperative - physiopathology Postoperative Period Prevalence Radiotherapy - adverse effects Radiotherapy - methods Retrospective Studies Risk Factors Statistics as Topic Surveys and Questionnaires Thoracic Surgery - classification Thoracic Surgery - methods Thoracic Surgery, Video-Assisted - methods Thoracic Surgical Procedures - methods Thoracoscopy - adverse effects Thoracoscopy - methods Thoracotomy - adverse effects Thoracotomy - methods Treatment Outcome Netherlands
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Summary:	Chronic pain is a common complication after thoracic surgery. The cause of chronic post-thoracotomy pain is often suggested to be intercostal nerve damage. Thus chronic pain after thoracic surgery should have an important neuropathic component. The present study investigated the prevalence of the neuropathic component in chronic pain after thoracic surgery. Furthermore, we looked for predictive factors for prevalence and intensity of chronic pain. We contacted 243 patients who underwent a video-assisted thoracoscopy (VATS) or thoracotomy in the period between January 2004 and September 2006 by mail. Patients retrospectively received a questionnaire with the Dutch version of the PainDETECT Questionnaire, a validated screening tool for neuropathic pain. Results were analyzed from 204 patients (144 thoracotomies, 60 VATS). The prevalence of chronic pain was 40% after thoracotomy and 47% after VATS. Definite chronic neuropathic pain was present in 23% of the patients with chronic pain, with an additional 30% having probable neuropathic pain. Greater probability of neuropathic pain (ie, a higher total score of the PainDETECT) correlated with more intense chronic pain. Predictive factors for chronic pain were younger age (P = .01), radiotherapy (P = .043), pleurectomy (P = .04) and more extensive surgery (P < .001). Up to half the chronic pain after thoracic surgery is not associated with a neuropathic component, which has not been reported to date. More extensive surgery and pleurectomy are predictive factors for chronic pain after thoracic surgery, suggesting a visceral component apart from nerve injury.
ISSN:	1528-8447
DOI:	10.1016/j.jpain.2008.05.009