CHRONIC POST THORACOTOMY PAIN

Chronic post-thoracotomy pain (CPP) is a vexing clinical problem whose management has received scant attention. In order to identify the ris k factors associated with CPP and determine the optimal treatment, the records of 238 consecutive patients who underwent thoracotomy were re viewed. CPP was defined as discomfort requiring the regular administra tion of analgesics that continued more than three months following sur gery. CPP was present in 25 (11%) patients: 10/20 (50%) chest wall res ections, 5/25 (20%) pleurectomies, 10/193 (5%) pulmonary resections. A mong the 23 patients who required preoperative narcotics, 12 (52%) dev eloped CPP. Improved pain control and decreased narcotic use was achie ved via the administration of nonsteroidal anti-inflammatory medicatio n and tricyclic anti-depressants. In addition, 10/25 patients required 11 pain procedures: trigger-point injection, intercostal blocks, inje ctions of epidural steroids, stellate ganglion block. Recurrent pain o ccurred in 20 patients following initial control. All were found to ha ve tumor regrowth. We conclude that CPP occurs more commonly following chest-wall resection and pleurectomy, and that preoperative narcotic use is a predictor of CPP. Worsening pain. following initial relief sh ould prompt a vigorous search for recurrent cancer.