title: A prospective study of neuropathic pain induced by thoracotomy: incidence, clinical description, and diagnosis.
abstract: This study evaluated prospectively the incidence of neuropathic pain after thoracotomy, described its clinical characteristics, and delineated landmarks for its diagnosis in daily practice. We evaluated clinically painful symptoms and sensory deficits in 54 patients after lateral/posterolateral thoracotomy for broncho-pulmonary carcinoma with standardized surgical and analgesic procedures. At 2months, 49 patients suffered from non malignant thoracic pain, and at 6months 38 patients (loss to follow-up for 7) reported persisting pain. In 35 patients, painful symptoms and sensory deficits could be evaluated using a standardized clinical bedside procedure. According to the grading system proposed by Treede et al. [41], neuropathic pain was considered probable in 21 patients, while use of the DN4 questionnaire concluded that neuropathic pain was probable in 17 patients. The two diagnostic procedures provided similar conclusions in 16 patients. Morphine consumption during the early post-operative period (mean 111.3±30.8mg/day) and pain intensity (VAS: mean 5.71±2.1) were significantly higher in patients suffering from neuropathic pain than in other patients with pain (mean 80±21.4mg/day; VAS: mean 3.9±2.4). The clinical picture in most patients with neuropathic pain included electric shocks and severe multimodal hypoesthesia in the sensory area of 5th/6th intercostal nerves. Thus, our results indicate a minimal incidence of chronic post-thoracotomy pain at 70% and that of neuropathic pain at 29%, this latter being clinically suggested by a combination of certain symptoms and reinforced by the DN4 questionnaire when sensory deficit at scar is present.
authors.affiliation: CHU Clermont-Ferrand, Unité de Soins Palliatifs, Centre d'Evaluation et de Traitement de la Douleur, CIC 501, Service d'Anesthésiologie, Service de Chirurgie thoracique, Service de Pharmacologie, Clermont-Ferrand CEDEX, F-63003, France CHU Lyon, Centre d'Evaluation et de Traitement de la Douleur, Hôpital Neurologique, LYON Cedex 4 F-69394, France CH Moulins, Unité de Traitement de la Douleur, F-03000 Moulins, France Clermont Université, Université d'Auvergne, UFR Médecine, Laboratoire de Pharmacologie, Clermont-Ferrand CEDEX 1 F-63001, France INSERM, UMR 766, UFR Médecine, Clermont-Ferrand CEDEX 1 F-63001, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Guastella
authors.forename: Gérard
authors.initials: G
authors.lastname: Mick
authors.forename: Christophe
authors.initials: C
authors.lastname: Soriano
authors.forename: Laurent
authors.initials: L
authors.lastname: Vallet
authors.forename: Georges
authors.initials: G
authors.lastname: Escande
authors.forename: Claude
authors.initials: C
authors.lastname: Dubray
authors.forename: Alain
authors.initials: A
authors.lastname: Eschalier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D010147:Pain Measurement; D011183:Postoperative Complications; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013908:Thoracotomy / Q000009:adverse effects*; D055815:Young Adult