Chapter 29 - Chronic pain after thoracic surgery

Summary

Neuropathic pain can be continuous, intermittent or paroxysmal in nature. Specific pain assessment tools such as the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scale may help in formalizing a diagnosis. This is a standardized bedside test that identifies patients in whom neuropathic pain mechanisms predominate. Patients with complete disappearance of the superficial abdominal reflexes after thoracotomy experienced more severe acute and chronic post-operative pain than those in whom the reflexes are maintained, and those whose abdominal reflexes do not recover 2-3 months after operation are more likely to complain of pain. High consumption of analgesics during the first post-operative week is associated with a higher incidence of chronic post-thoracotomy pain. The neuropathic nature of chronic pain led clinicians to devise techniques to preserve the intercostal nerves. Pharmacotherapy remains the mainstay for treating neuropathic pain. Different drugs used to treat neuropathic pain include topical agents, anticonvulsants, and non-opioid analgesics.