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Post-Thoracotomy Pain Syndrome: Assessment and Intervention

Kathleen Garrubba Hopkins
Margaret Rosenzweig
CJON 2012, 16(4), 365-370 DOI: 10.1188/12.CJON.365-370

Surgery is a cornerstone of treatment in early-stage non-small cell lung cancer. Chronic postoperative thoracotomy pain, post-thoracotomy pain syndrome (PTPS), is a condition occurring in 50% of postsurgical patients with lung cancer and is largely unrecognized. This article examines the diagnosis and treatment of PTPS to assist oncology nurses in providing better care to this patient population. Post-thoracotomy pain in patients with lung cancer may be under-reported and undertreated. Causes from the thoracotomy can be trauma and compression to the intercoastal nerves, fractured and compressed ribs, inflammation of the chest muscles, atrophy of chest muscles, or scar tissue rubbing. This article examines the diagnosis and treatment of PTPS to assist oncology nurses in providing better care to this patient population. If left untreated, chronic pain can have a deleterious effect on patients' recovery and overall well-being. Oncology nurses should be aware of the signs and symptoms of PTPS so that more patients are diagnosed and choose to seek treatment.


Alberts, M. W. (2007). Diagnosis and management of lung cancer executive summary: In ACCP Evidence-Based Clinical Practice Guidelines. <i>Chest, 132</i>(3, Suppl.), 1S-19S. doi:10.1378/chest.07-1860

Alexander, J. K., DeVries, A. C., Kigerl, K. A., Dahlman, J. M., & Popovich, P. G. (2009). Stress exacerbates neuropathic pain via glucocorticoid and NMDA receptor activation. <i>Brain Behavior and Immunity, 23</i>, 851-860. doi:10.1016/j.bbi.2009.04.001

American Cancer Society. (2012). <i>Facts and figures 2012.</i> Atlanta, GA: Author.

Backonja, M. M., & Kraus, S. J. (2003). Neuropathic pain questionnaire. <i>Clinical Journal of Pain, 19</i>, 315-316.

Benedetti, F., Vighetti, S., Ricco, C., Amanzio, M., Bergamasco, L., Casadio, C., … Maggi, G. (1998). Neurophysiologic assessment of nerve impairment in posterolateral and muscle-sparing thoracotomy. <i>Journal of Thoracic and Cardiovascular Surgery, 115</i>, 841-847.

Blades, B., & Dugan, D. J. (1944). War wounds of the chest observed at the Thoracic Surgery Centre, Walter Reed General Hospital. <i>Journal of Thoracic Surgery, 13</i>, 294-306.

Boffa, D. J., Allen, M. S., Grab, J. D., Gaissert, H. A., Haarpole, D. H., & Wright, C. D. (2008). Data from the Society of Thoracic Surgeons General Thoracic Surgery database: The surgical management of primary lung tumors. <i>Journal of Thoracic and Cardiovascular Surgery, 135</i>, 247-254.

Chan, K. S., Chen, W. H., Gan, T. J., Hseih, R., Chen, C., Lakshminarayanan, M., & Revicki, D. A. (2009). Development and validation of a composite score based on clinically meaningful events for the opioid-related symptom distress scale. <i>Quality of Life Research, 18</i>, 1331-1340.

Chapman, S. (2011). Chronic pain syndromes in cancer survivors. <i>Nursing Standard, 25</i>, 35-41.

Dajczman, E., Gordan, A., Kreisman, H., & Wolkove, N. (1991). Long-term postthoracotomy pain. <i>Chest, 99</i>, 270-274.

Demmy, T. L., Nwoqu, C., Solan, P., Yendamuri, S., Wilding, G., & DeLeon, O. (2009). Chest-tube delivered bupivacaine improves pain and decreases opioid use after thoracoscopy. <i>Annals of Thoracic Surgery, 87</i>, 1040-1047.

Deng, G., Rusch, V., Vickers, A., Malhotra, V., Ginex, P., Downey, R.,… Cassileth, B. (2008). Randomized controlled trial of a special acupuncture technique for pain after thoracotomy. <i>Journal of Thoracic and Cardiovascular Surgery, 136</i>, 1464-1469.

Dualé, C., Guastella, V., Morand, D., Cardot, J. M., Aublet-Cuvelier, B., Mulliez, A., … Dubray, C. (2011). Characteristics of the neuropathy induced by thoracotomy: A 4-month follow-up study with psychophysical examination. <i>Clinical Journal of Pain, 27</i>, 471-480.

Eaton, L. H., Tipton, J. M., & Irwin, M. (Eds.). (2009). <i>Putting evidence into practice: Improving oncology patient outcomes.</i> Pittsburgh, PA: Oncology Nursing Society.

Frola, C., Serrano, J., Cantoni, S., Casiglia, M., Turtulici, I., & Loria, F. (1995). CT findings of atrophy of chest wall muscle after thoracotomy: Relationship between muscles involved and type of surgery. <i>American Journal of Roentgeneology, 164</i>, 599-601.

Galer, B. S., & Jensen, M. P. (1996). Development and preliminary validation of a pain measure specific to neuropathic pain: The Neuropathic Pain Scale. <i>Neurology, 48</i>, 332-338.

Gilron, I. (2007). Gabapentin and pregabalin for chronic neuropathic and early postsurgical pain: Current evidence and future directions. <i>Current Opinion in Anesthesiology, 20</i>, 456-472.

Gray, P. (2008). Acute neuropathic pain: Diagnosis and treatment. <i>Current Opinion in Anesthesiology, 21</i>, 590-595.

Hollingshead, J., Dühmke, R. M., & Cornblath, D. R. (2006). Tramadol for neuropathic pain. <i>Cochrane Database of Systematic Reviews, 19</i>(3), CD003726.

International Association for the Study of Pain Subcommittee of Taxonomy. (1986). Classification of chronic pain: Descriptions of chronic pain syndromes and definitions of pain terms. <i>Pain, 3</i>(Suppl.), S138-S139.

Karmakar, M. K., & Ho, A. M. (2004). Post-thoracotomy pain syndrome. <i>Thoracic Surgery Clinics, 14</i>, 345-352.

Kingery, W. S., Agashe, G. S., Sawamura, S., Davies, M. F., Clark, J. D., & Maze, M. (2001). Glucocorticoid inhibition of neuropathic hyperalgesia and spinal Fos expression. <i>Anesthesia and Analgesia, 92</i>, 476-482.

Kopf, A., & Patel, N. B. (Eds.). (2010). <i>Guide to pain management in low-resource settings.</i> Seattle, WA: International Association for the Study of Pain.

Landreneau, R. J., Mack, M. J., Hazelrigg, S. R., Naunheim, K., Dowling, R. D., Ritter, P., … Ferson, P. F. (1994). Prevalence of chronic pain after pulmonary resection by thoracotomy or video-assisted thoracic surgery. <i>Journal of Thoracic and Cardiovascular Surgery, 107</i>, 1079-1085.

Lickiss, J. N. (2001). Approaching cancer pain relief. <i>European Journal of Pain, 5</i>(Suppl. A), 5-14. doi:10.1053/eujp.2001.0273

Mattia, C., Paoletti, F., Coluzzi, F., & Boanelli, A. (2002). New antidepressants in the treatment of neuropathic pain. <i>Minerva Anestesiologica, 68</i>, 105-114.

Melzack, R. (1975). The McGill Pain Questionnaire: Major properties and scoring methods. <i>Pain, 1</i>, 277-299.

Melzack, R. (1987). The short-form McGill Pain Questionnaire. <i>Pain, 30</i>, 191-197.

Perttunen, K., Tasmuth, T., & Kalso, E. (1999). Chronic pain after thoracic surgery: A follow-up study. <i>Acta Anaesthesiologica Scandinavica, 43</i>, 563-567.

Rogers, M. L., & Duffy, J. P. (2000). Surgical aspects of chronic post-thoracotomy pain. <i>European Journal of Cardio-Thoracic Surgery, 18</i>, 711-716. doi:10.1016/S1010-7940(00)00569-8

Sarna, L., Cooley, M. E., Brown, J. K., Chernecky, C., Padilla, G., Danao, L., Chakravarty, D., Elashoff, D. (2010). Women with lung cancer: Quality of life after thoracotomy: A 6-month prospective study. <i>Cancer Nursing, 33</i>(2), 85-92.

Sindrup, S. H., Otto, M., Finnerup, N. B., & Jensen, T. S. (2005). Antidepressants for neuropathic pain. <i>Basic and Clinical Pharmacology and Toxicology, 96</i>, 399-409.

Tiippana, E. M., Hamunen, K., Kontinen, V. K., & Kalso, E. (2007). Do surgical patients benefit from perioperative gabapentin/pregabalin? A systematic review of efficacy and safety. <i>Anesthesia and Analgesia, 104</i>, 1545-1556.

Wildgaard, K., Ravn, J., & Kehlet, H. (2009). Chronic post-thoracotomy pain: A critical review of pathogenic mechanisms and strategies for prevention. <i>European Journal of Cardiothoracic Surgery, 36</i>, 179-180. doi:10.1016/j.ejcts.2009.02.005

Wildgaard, K., Ravn, J., Nikolajsen, L., Jakobsen, E., Jensen, T. S., & Kehlet, H. (2011). Consequences of persistent pain after lung cancer surgery: A nationwide questionnaire study. <i>Acta Anaesthesiologica Scandinavica, 55</i>, 60-68. doi:10.1111/j.1399-6576.2010.02357.x

Williams, H. (2006). Assessing, diagnosing, and managing neuropathic pain. <i>Nursing Times, 102</i>, 22-24.