title: The Influence of Type of Anesthesia, Perioperative Pain, and Preoperative Health Status on Chronic Pain Six Months After Thoracotomy-A Prospective Cohort Study.
abstract: BACKGROUND
  Chronic post-thoracotomy pain (CPP) has a high incidence. However, less is known about risk factors and the influence of different analgesia therapies.
  
  
  METHODS
  In this prospective cohort study, patients either received standardized epidural analgesia or began an oral analgesic protocol with controlled-release oxycodone immediately postoperatively. Patients answered a baseline questionnaire on the day before surgery and a follow-up questionnaire six months postoperatively. The questionnaire included Short-Form 12, the Neuropathic Pain Scale, and descriptive questions for CPP. Pain protocols of all patients were examined. Logistic regression was used to analyze the risk factors related to CPP.
  
  
  RESULTS
  One hundred seventy-four patients were enrolled; data of 131 patients were available after the six-month follow-up period. Fifty-one patients (39%) had CPP six months postoperatively. Of these, more than 80% had impaired daily activity or ability to work, or reported sleeping disturbance due to CPP. The strongest predictive factors for the development of CPP were: thoracic pain for three months preoperatively (odds ratio [OR] = 3.54, 95% confidence interval [CI] = 1.69-7.40, P = 0.001), thoracic pain for 12 months preoperatively (OR = 2.73, 95% CI = 1.28-5.83, P = 0.009), and higher pain scores at rest in the first five postoperative days compared with patients without CPP (OR = 1.79, 95% CI = 1.24-2.57, P = 0.002). Neuropathic pain was present in 4.8% of patients. Patients with CPP had a reduced physical (P = 0.005) and mental health status (P = 0.03) six months after surgery compared with patients without CPP.
  
  
  CONCLUSIONS
  Preoperative thoracic pain and higher pain scores in the first five postoperative days seem to be the strongest risk factors for the development of CPP. CPP patients reported poorer mental and physical health before and six months after surgery.
authors.affiliation: Department of Anesthesiology and Pain Medicine.|Department of Anesthesiology and Intensive Care Medicine, University Hospital Magdeburg, Otto von Guericke University Magdeburg, Magdeburg, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Kampe
authors.affiliation: Department of Anesthesiology and Pain Medicine.
authors.forename: Bianca
authors.initials: B
authors.lastname: Geismann
authors.affiliation: Department of Pneumology.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Weinreich
authors.affiliation: Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
authors.forename: Georgios
authors.initials: G
authors.lastname: Stamatis
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital Magdeburg, Otto von Guericke University Magdeburg, Magdeburg, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Ebmeyer
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Marienhospital Gelsenkirchen, Gelsenkirchen, Germany.
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Gerbershagen
mesh_terms: D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods; D000700:Analgesics / Q000627:therapeutic use*; D000758:Anesthesia / Q000379:methods; D059350:Chronic Pain / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000188:drug therapy*; D010149:Postoperative Pain / Q000188:drug therapy; D011446:Prospective Studies; D013908:Thoracotomy / Q000009:adverse effects*
chemical_list: D000700:Analgesics
keywords: Acute Pain; Chronic Postoperative Pain; Pain Management; Postoperative Pain