title: Persistent postsurgical pain after video-assisted thoracic surgery--an observational study.
abstract: BACKGROUND
  The risk of persistent postsurgical pain (PPP) and subsequent pain-related functional impairment may potentially be reduced by video-assisted thoracic surgery (VATS) compared to thoracotomy. The aim of the study was therefore to assess in detail the incidence and consequences on activities of daily living of PPP after VATS.
  
  
  METHODS
  Using a prospective observational design, 47 patients undergoing VATS completed both preoperative, early postoperative and 3 months follow-up. Preoperative pain, pain characteristics, psychological factors, pain-related functional impairment and quantitative sensory testing (QST) including nociceptive thresholds were compared with postoperative data.
  
  
  RESULTS
  Only five (11%) patients developed PPP with NRS > 3 originating from the surgical area. However, about 30% of patients still reported some pain-related functional impairment from the surgical area within four well-defined domains of everyday activities. Psychological and sensory thermal tests did not predict persistent postoperative pain, except preoperative pin-prick sensitivity was higher in patients with PPP. Postoperative pain 7 days after surgery was significantly higher in PPP patients. Preoperative pain originating from remote areas did not predict PPP.
  
  
  CONCLUSIONS
  The incidence of PPP, nerve damage (based on QST) and pain-related functional impairment following VATS was lower than reported following thoracotomy. No psychological or other factors predicted PPP. These findings call for further large-scale studies to support VATS to decrease PPP.
authors.affiliation: Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Wildgaard
authors.affiliation: Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
authors.forename: T K
authors.initials: TK
authors.lastname: Ringsted
authors.affiliation: Department of Thoracic Surgery, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
authors.forename: H J
authors.initials: HJ
authors.lastname: Hansen
authors.affiliation: Department of Thoracic Surgery, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
authors.forename: R H
authors.initials: RH
authors.lastname: Petersen
authors.affiliation: Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000758:Anesthesia; D059350:Chronic Pain / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017288:Pain Threshold; D010149:Postoperative Pain / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D011446:Prospective Studies; D012307:Risk Factors; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome