title: Consequences of persistent pain after lung cancer surgery: a nationwide questionnaire study.
abstract: BACKGROUND
  post-thoracotomy pain syndrome (PTPS) and its social consequences have been inconsistently investigated as most studies were either small sized, focused on a limited number of risk factors or included heterogeneous surgical procedures. The current objectives were to obtain detailed information on the consequences of PTPS after thoracotomy and video-assisted thoracic surgery (VATS) from homogenous unselected nationwide data, and to suggest mechanisms for the development of PTPS.
  
  
  METHODS
  data from 1327 patients were collected using a prospective national database and combined with a detailed questionnaire.
  
  
  RESULTS
  the response rate was 81.5%, resulting in 546 patients without prior thoracic surgery for the final analysis. Follow-up was 22 months (range 12-36). PTPS occurred in 33% thoracotomy patients and 25% VATS patients. Clinically relevant pain was present in 11-18% of the patients and severe pain in 4-12% depending on the level of physical activity. In PTPS patients, 64% also had pain from other locations on the body. Perceived sensory changes in the thoracic area were present in 63% of PTPS patients vs. 25% in pain-free patients (P<0.001). When comparing VATS with thoracotomy, no consistent differences in the prevalence, distribution of pain, sensory changes or effect of pain on daily activities were observed although clinically relevant and severe pain was reduced after VATS.
  
  
  CONCLUSIONS
  this nationwide study corroborates that PTPS is a clinically relevant problem influencing daily activities a long time after thoracotomy and VATS. Nerve injury and increased pain responsiveness may explain the majority of symptoms, the prevalence and distribution of pain including perceived sensory sensations.
authors.affiliation: Section for Surgical Pathophysiology, Departments of Cardiothoracic Anaesthesia, Copenhagen University, Copenhagen, Denmark. wildgaard@thoracotomy.edu
authors.forename: K
authors.initials: K
authors.lastname: Wildgaard
authors.forename: J
authors.initials: J
authors.lastname: Ravn
authors.forename: L
authors.initials: L
authors.lastname: Nikolajsen
authors.forename: E
authors.initials: E
authors.lastname: Jakobsen
authors.forename: T S
authors.initials: TS
authors.lastname: Jensen
authors.forename: H
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D002908:Chronic Disease; D016208:Databases, Factual; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology* / Q000473:pathology / Q000523:psychology*; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013908:Thoracotomy / Q000009:adverse effects*
chemical_list: D000700:Analgesics