Post-Thoracotomy Pain

What is Post-Thoracotomy Pain?

Intercostal neuralgia is caused by inflammation, damage or compression to the intercostal nerves. These nerves lie between each of the twelve ribs. Post-thoracotomy pain is felt in the back and chest region following surgery in the chest. As much as 50 percent of patients may experience persistent pain following a thoracotomy, and as much as 30 percent of patients may continue to experience the pain for four to five years after the surgery or even permanently.

Post-thoracotomy pain syndrome (PTPS) is most likely felt to be a combination of damage to the intercostal nerves that unfortunately, may not be avoidable, as well as damage to the muscles between the ribs.

What are the causes?

The cause of intercostal neuralgia is related to irritation to the intercostal nerves. This can be related to compression of the nerves, muscles and ligaments via trauma or scar tissue, or a direct injury to the area from surgery. Other causes include inflammation of the intercostal nerves associated with an outbreak of shingles, tumor, or radiation for the treatment of some cancers.

Which patients go on to develop persistent pain following a thoracotomy is unclear. Research is being done to look at different surgical approaches and different pain treatment plans prior to, during, and after a thoracotomy to see whether it will help reduce the incidence of PTPS.

What are the symptoms?

Intercostal neuralgia is described as pain that wraps around your chest, sometimes described as a band radiating from the back of the body to the front chest or upper abdomen. The pain may be described as burning, spasm-like, aching, gnawing and stabbing.  The pain may worsen with sudden movements of the chest such as laughing, coughing or taking deep breaths with exertion.

In patients who had a thoracotomy surgery, they may experience pain that radiates along the rib cage or just experience persistent pain along the incision site. The description of the pain is similar, and it may be severe and debilitating.

What are the treatments?

Given the severity of symptoms typically associated with post-thoracotomy pain, it is not uncommon for patients with severe pain to be prescribed with opioids prior to trying other, more conservative, forms of treatment. Even so, previous studies have indicated that treatment with opioids alone may only provide partial relief from the pain. For cases of moderate to more mild symptoms of post-thoracotomy pain, traditional non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aspirin, or naproxen, may be sufficient in providing the patient with relief from pain.

For instances of persistent post-thoracotomy pain that have been unresponsive to oral analgesics, injection-based approaches may be warranted as these techniques allow for a more targeted delivery of the analgesic medication. During this procedure, an analgesic medication is injected into the epidural space or neural tissue in the affected area. These techniques are known as epidural injections and nerve blocks. For both methods, the goal is to interrupt the transmission of pain information from the peripheral nerves to the spinal cord and brain, thereby providing the patient with relief from pain.
In some cases, a single injection of analgesic medication is not sufficient to provide long-term relief from post-thoracotomy pain. Implants, which provide a continuous flow of medication directly to the targeted area, may be warranted for instances of chronic and refractory pain.

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