INTERCOSTAL NERVE LOOP AS AN ORIGINAL TREATMENT FOR LONG-TERM POSTTHORACOTOMY PAIN

Up to now, the treatment for long-term postthoracotomy pain has been p roblematic. Conservative methods, surgical, or percutaneous rhizotomie s or implantation of a permanent nerve stimulator have failed in many patients, and were not without risk. Because of this, we looked for a fundamental physiologically based approach to manage this pain problem with minimal risks but long lasting effect. As most patients obtained complete temporary pain relief after an intercostal nerve block of se rial dermatomes bordering the thoracotomy, nerve ischemia, nerve entra pment in scar tissue, nerve compression due to abnormal bone formation and neuroma function may all have been mechanisms resulting in pain. Subsequently, three intercostal nerve loops between the six intercosta l nerves, belonging to the three ribs above and below the thoracotomy, were performed. This technique creates permanent anesthetic dermatome s, thus avoiding nociceptive afferent stimuli and preventing recurrenc e of aberrant nerve regeneration responsible for chronic pain. This te chnique was applied successfully in five cases with a mean follow-up o f 13 months. As nerve regeneration has stopped at that time, neuroma f ormation is prevented and pain recurrence is not to be expected. We, t herefore, propose that if an anatomical pain distribution pattern alon g the thoracotomy scar is found in patients with long-term post-thorac otomy pain, serial intercostal nerve loops might be indicated as prima ry treatment.