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 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).


CONCLUSIONS
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.
Steegers
Monique A H
MA
Pain and Nociception Research Group, Department of Anaesthesiology, Pain and Palliative Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. m.steegers@anes.umcn.nl
Snik
Daphne M
DM
Verhagen
Ad F
AF
van der Drift
Miep A
MA
Wilder-Smith
Oliver H G
OH
D000328:Adult; D000367:Age Factors; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009437:Neuralgia / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D011184:Postoperative Period; D015995:Prevalence; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D013223:Statistics as Topic; D011795:Surveys and Questionnaires; D013903:Thoracic Surgery / Q000145:classification / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D019616:Thoracic Surgical Procedures / Q000379:methods*; D013906:Thoracoscopy / Q000009:adverse effects / Q000379:methods; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome