Genetic and environmental determinants of postthoracotomy pain syndrome.
OBJECTIVE
Pain after thoracic surgery may persist for up to a year or longer in as many as 50% of patients undergoing lung resection. There is currently no specific therapy, and our ability to predict who will develop a persistent pain syndrome is poor at best. Persistent pain after thoracotomy is not an acute somatic pain, rather it is a complex syndrome with many of the characteristics of neuropathic, dysesthetic pain.


RESULTS
The pain genetics field has been dominated by reports of single variants leading to severe phenotypes. These (Mendelian) diseases are not representative of the more common, complex phenotype that is characterized by the lay term 'pain threshold'. Recently, work describing the association of genetic variants with idiopathic pain disorders has appeared in the literature, and here the authors suggest that these concepts are applicable to postthoracotomy pain syndrome.


CONCLUSIONS
Postthoracotomy pain syndrome likely arises as a direct result of an environmental stress (surgery) occurring on a landscape of susceptibility that is determined by an individual's behavioral, clinical and genetic characteristics.
Shaw
Andrew
A
Department of Anesthesiology, Duke University, Durham, North Carolina 27710, USA. andrew.shaw@duke.edu
Keefe
Francis J
FJ
D004777:Environment; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery; D010149:Postoperative Pain / Q000209:etiology* / Q000235:genetics / Q000523:psychology; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*