Only half of the chronic pain after thoracic surgery shows a neuropathic component.
ABSTRACT Chronic pain is a common complication after thoracic surgery. The cause of chronic post-thoracotomy pain is often suggested to be intercostal nerve damage. Thus chronic pain after thoracic surgery should have an important neuropathic component. The present study investigated the prevalence of the neuropathic component in chronic pain after thoracic surgery. Furthermore, we looked for predictive factors for prevalence and intensity of chronic pain. We contacted 243 patients who underwent a video-assisted thoracoscopy (VATS) or thoracotomy in the period between January 2004 and September 2006 by mail. Patients retrospectively received a questionnaire with the Dutch version of the PainDETECT Questionnaire, a validated screening tool for neuropathic pain. Results were analyzed from 204 patients (144 thoracotomies, 60 VATS). The prevalence of chronic pain was 40% after thoracotomy and 47% after VATS. Definite chronic neuropathic pain was present in 23% of the patients with chronic pain, with an additional 30% having probable neuropathic pain. Greater probability of neuropathic pain (ie, a higher total score of the PainDETECT) correlated with more intense chronic pain. Predictive factors for chronic pain were younger age (P = .01), radiotherapy (P = .043), pleurectomy (P = .04) and more extensive surgery (P < .001). PERSPECTIVE: Up to half the chronic pain after thoracic surgery is not associated with a neuropathic component, which has not been reported to date. More extensive surgery and pleurectomy are predictive factors for chronic pain after thoracic surgery, suggesting a visceral component apart from nerve injury.
[Show abstract] [Hide abstract]
ABSTRACT: To present the recent literature on chronic postsurgical pain in children.Current Opinion in Anaesthesiology 07/2014; 27(5). DOI:10.1097/ACO.0000000000000110 · 2.53 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Objective: To review the literature on the progression from acute to chronic postoperative pain, to evaluate the evidence for the risk of progressing to persistent postoperative and chronic pain, and to identify characteristics of pharmacologic treatments to best tailor therapy to an individual patient's pain profile. Background: Pain is most commonly classified by duration (acute, chronic) and pathophysiology (nociceptive, neuropathic); however, these descriptors alone incompletely describe pain. Additionally, the transition between acute and chronic postoperative pain is not well understood. Methods: We conducted a qualitative review and evaluation of the literature on postoperative pain with respect to the above objectives. Results: Individualized pharmacologic treatments require a complete characterization of a patient's pain profile, in terms of frequency of pain over the course of a 24-hour day and over time thereafter, frequency and duration of pain flares, and presence of neuropathic pain. These considerations can help guide the choice of pharmacologic treatment to meet patient needs over a 24-hour day and over time after surgery. With respect to opioid analgesics, acute pain requires rapid onset of analgesia and the ability to titrate analgesia to the changing characteristics of pain over a short period. For these reasons, short-acting opioid analgesics have been preferred; however, there are opioid formulations with rapid onset and extended release for reduced dosing frequency. Although nociceptive pain can typically be controlled by titration of the dose of an opioid analgesic, neuropathic pain may respond better to the addition of an antineuropathic medication rather than to opioid dose escalation. Conclusion: Advances in individualized pharmacologic treatment for postoperative pain have resulted in better pain control. Moreover, the recognition of sub-acute pain as a new entity is important because many surgical patients will need therapy beyond the first 8 days after surgery. In this group of patients the diagnosis of a neuropathic pain component will be important so that appropriate multimodal therapy may be implemented.Postgraduate Medicine 07/2014; 126(4):42-52. DOI:10.3810/pgm.2014.07.2782 · 1.54 Impact Factor
Journal of Cardiothoracic and Vascular Anesthesia 08/2014; 28(4):1060-1068. DOI:10.1053/j.jvca.2014.02.021 · 1.48 Impact Factor