Post Thoracotomy Pain (Intercostal)

//Post Thoracotomy Pain (Intercostal)
Post Thoracotomy Pain (Intercostal) 2018-10-02T16:44:11+00:00

What Is Post Thoracotomy Pain?

If you’ve had any surgery where you had to have the chest cavity opened, you may be suffering afterwards from chest pain around the incision. This is known as post thoracotomy pain. This is what you should know.

A thoracotomy is a surgical procedure that involves opening up the chest cavity. It can be a very painful incision, as the operating physician must penetrate several layers of muscle tissue, neurovascular bundles, along with other soft tissue structures of the thoracic region. All of this occurs while the patient is still under constant motion as they continue to breathe.

The most common location for thoracotomy incisions is at the side of the patient’s chest. The precise location for the thoracotomy incision will depend on the underlying condition. Other incision sites can be used to provide the operating physician with access to the:

  • Lungs
  • Throat
  • Diaphragm muscle
  • Aorta
  • Heart

The pain that occurs following a thoracotomy procedure, which is also known as post thoracotomy pain, is quite commonly very severe. The International Association for the Study of Pain (IASP) defines post thoracotomy pain as symptoms of pain occurring within the area of the thoracotomy incision and persisting for at least two months or more following the surgical procedure.

During World War II, surgeons regularly described post thoracotomy pain, which at the time was referred to as intercostal pain, in patients who had undergone a thoracotomy to treat chest trauma. Post thoracotomy pain that begins to interfere with daily function has been reported to occur following nearly half of all thoracotomy procedures.

Post thoracotomy pain symptoms

This type of pain nearly mirrors that of neuropathic pain, though a number of patients will also report experiencing symptoms of non-neuropathic pain as well.

The most common post thoracotomy pain symptoms include:

  • Sharp, stabbing pain along the area of the incision scar
  • Constant shooting pain
  • Pinching sensations
  • Constant dull, achy, and even vague feelings of pain and discomfort
  • Cramping
  • Either heightened or blunted sensory sensitivity (e.g., unable to tolerate anything coming into contact with the site of the scar)
  • Localized tenderness
  • Tingling, prickly, or even cool sensations
  • Itching
  • Shoulder dysfunction, which may lead to frozen shoulder

Following a thoracotomy procedure, patients may also report symptoms of:

  • Fatigue
  • Shortness of breath
  • Bleeding or infection at the site of the incision
  • Dyspnea
  • Depression

Managing post thoracotomy pain symptoms and maintaining a patient’s comfort after surgery and during recovery is incredibly important, as this can decrease their risk for pulmonary complications.

Moreover, patients who are not able to effectively manage their symptoms of post thoracotomy pain are at risk for impairment in respiratory function. This is because patients who are suffering from severe pain often have difficulty with inspiration, or taking air into their lungs. This may also lead to issues with their diaphragm muscle.

Post Thoracotomy Pain (Intercostal) | PainDoctor.com

Post Thoracotomy Pain Causes

What causes post thoracotomy pain is not fully understood. It’s likely due to damage to the intercostal nerve, which is not uncommon during the thoracotomy procedure. Pericostal sutures to the fifth and seventh ribs during the procedure may also cause damage and injury to the intercostal nerve fibers.

In order to reduce the risk of injury to the intercostal nerve, physicians have begun to employ alternative techniques, such as using intracostal sutures. These techniques have shown some promise in preventing severe post thoracotomy pain.

Of course, damage to the intercostal neural tissue does not completely account for the full range of post thoracotomy pain symptoms. Another explanation is tissue inflammation in and near the:

  • Ribs
  • Muscles of the chest wall
  • Surrounding neural tissue
  • Pulmonary lining of the lungs

Further, it is not uncommon for patients to suffer from muscle wasting, or atrophy, of the chest muscles following thoracotomy surgery. This can occur as the result of rib spreading.

Finally, scar tissue may also contribute to a patient’s symptoms of post thoracotomy pain.

Post Thoracotomy Pain Treatments

Given the severity of post thoracotomy pain symptoms, it is not uncommon for patients with severe pain to be prescribed with opioids prior to trying other, more conservative, forms of treatment. However, studies note that opioids may only provide partial relief from the pain. Further, there are many risks and side effects associated with opioid use. For this reason, trying other treatments or a combination of treatments is important.

For mild to moderate symptoms of post thoracotomy pain, traditional non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aspirin, or naproxen, may help with pain relief.

Interventional treatments

For persistent post thoracotomy pain that is unresponsive to oral analgesics, injection-based approaches, like epidural injections and nerve blocks, may help. These techniques allow for a more targeted delivery of the analgesic medication.

During these procedures, a physician will inject an analgesic medication into the epidural space or neural tissue. For both methods, the goal is to interrupt pain signals from the peripheral nerves to the spinal cord and brain. This can help provide the patient with pain relief.

You can learn more about epidural steroid injections in the following video.

 

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 help with chronic and refractory pain.

Conclusion

Thoracotomy surgery, or chest surgery, can be one of the most painful surgeries. Patients who undergo this surgery are at a very high risk for developing severe symptoms of nerve pain.

Pain management, however, is incredibly important for thoracotomy patients during the post-operative stage. These symptoms can lead to additional impairments in functioning, risks, and other complications. Irritation, compression, and damage within the region of the incision may account for much of a patient’s pain after surgery. Other likely causes for pain include inflammation, muscle atrophy, and the development of scar tissue.

Given the severity of post thoracotomy pain symptoms, it’s not uncommon for post-thoracotomy patients to receive opioid medications as a first-line treatment method. Due to the risks of the medications, though, other medications and therapies should be attempted.

For cases of persistent and refractory pain, epidural injections or nerve blocks may help as these techniques provide a targeted delivery of medication.

If you’re suffering from pain after a thoracotomy procedure, talk with your doctor. They can help you manage any difficult symptoms that arise post-operation. If you’re struggling with severe and chronic post thoracotomy pain, you may need to talk to a pain specialist. You can find a pain doctor in your area by clicking the button below or looking for one in your area by using the tips here: https://paindoctor.com/pain-management-doctors/.

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References

  1. Hazelrigg SR, Cetindag IB, Fullerton J. Acute and chronic pain syndromes after thoracic surgery. Surg Clin N Am 2002;82:849–865.
  2. Gerner P. Post-thoracotomy pain management problems. Anesthesiol Clin 2008;26:355–vii.
  3. Perttunen K, Tasmuth T, Kalso E. Chronic pain after thoracic surgery: A follow-up study. Acta Anaesthesiol Scand 1999;43:563-567.
  4. Dajczman E, Gordon A, Kreisman H, Wolkove N. Long-term post-thoracotomy pain. Chest 1991;99:270-274.
  5. Hopkins KG, Rosenzweig M. Post-thoracotomy pain syndrome: Assessment and intervention. Clin J Oncol Nurs 2012;16:365-370.
  6. Keller SM, Carp NZ, Levy MN, Rosen SM. Chronic post thoracotomy pain. J Cardiovasc Surg 1994;35:161-164.
  7. Wildgaard K, Ravn J, Kehlet H. Chronic post-thoracotomy pain: A critical review of pathogenic mechanisms and strategies for prevention. Eur J Cardiothoracic Surg 2009;36:170-180.

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