Post-Thoracotomy Pain Syndrome

Post-thoracotomy pain syndrome usually results from surgical trauma or fibrosis of the intercostal nerves. Thoracotomy is one the more painful procedures that a patient can undergo, and is one that is more commonly associated with long term pain. The pain is typically a neuropathic pain, usually in the distribution of the affected intercostal nerve. An important point, however, with the development of pain after a thoracotomy that has been performed for oncologic reasons, is that tumor recurrence must be ruled out. Management of the pain is similar to other neuropathic pain states, with the use of tricyclic antidepressants and anticonvulsants. The intercostal nerves are fairly accessible, and long term pain control can be achieved with repetitive local anesthetic and steroid blocks. For cancer patients with limited life expectancy, i.e., tumor found to be unresectable at the time of thoracotomy, implantation of an epidural portacath for home epidural infusion can be of undeniable benefit.