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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald


CiteScore 2017: 0.84

SCImago Journal Rank (SJR) 2017: 0.401
Source Normalized Impact per Paper (SNIP) 2017: 0.452

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1877-8879
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Chronic pain after bilateral thoracotomy in lung transplant patients

Pernille L. Petersen
  • Corresponding author
  • Department of Ambulatory Surgery, Hvidovre Hospital, Copenhagen University Hospital, Kettegårdsalle 30, 2650 Hvidovre, Copenhagen, Denmark
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Pia Bredahl
  • Department of Thoracic Anaesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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  • De Gruyter OnlineGoogle Scholar
/ Michael Perch
  • Department of Cardiology, Section for Lung Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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  • De Gruyter OnlineGoogle Scholar
/ Christian H. Møller
  • Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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  • De Gruyter OnlineGoogle Scholar
/ Nanna B. Finnerup
  • Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
  • Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Lone Nikolajsen
Published Online: 2018-12-22 | DOI: https://doi.org/10.1515/sjpain-2018-0126

Abstract

Background and aims

The relative contribution of patient-related factors and intraoperative nerve damage for the development of chronic pain after surgery is unclear. This study aimed to examine chronic pain after bilateral thoracotomy. We hypothesized, that individual patient-related risk factors would be important resulting in an intraindividual uniformity of pain and hyperphenomena between the two sides of the thorax.

Methods

Twenty patients who had undergone lung transplantation via bilateral thoracotomy 6–12 months previously were included from the Danish Lung Transplant program, Rigshospitalet, Denmark, from October 2016 to August 2017. All patients answered questionnaires about pain in and around the scar, completed the Neuropathic Pain Symptom Inventory, and underwent bedside examination for hyperphenomena (brush- and cold-evoked allodynia, pinprick hyperalgesia) and pinprick hypoalgesia.

Results

Nine patients reported spontaneous pain bilaterally, five patients had pain on one side only, and six patients had no pain. Hyperphenomena were present on both sides of the thorax in 13 patients, on one side in four patients, and three patients had no hyperphenomena. The intraindividual uniformity of pain (p=0.029) and hyperphenomena (p=0.011) between the two sides of the thorax suggests that patient-related factors play an important role in the development of chronic pain.

Conclusions

The results of the present study provide support for the hypothesis of an individual predisposition for the development of chronic pain after thoracotomy.

Implications

Patient-related risk factors contribute to the development of chronic pain after thoracotomy. This result most likely can be transferred to chronic pain after other surgical procedures and therefore help us understand risk factors for chronic pain after surgery.

Keywords: chronic pain; thoracotomy; hyperalgesia; postoperative pain

References

  • [1]

    Macrae WA. Chronic post-surgical pain: 10 years on. Br J Anaesth 2008;101:77–86.Web of SciencePubMedCrossrefGoogle Scholar

  • [2]

    Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet 2006;13:1618–25.Google Scholar

  • [3]

    Johansen A, Romundstad L, Nielsen CS, Schirmer H, Stubhaug A. Persistent postsurgical pain in a general population: prevalence and predictors in the Tromsø study. Pain 2012;153:1390–6.CrossrefGoogle Scholar

  • [4]

    Fletcher D, Stamer UM, Pogatzki-Zahn E, Zaslansky R, Tanase NV, Perruchoud C, Kranke P, Komann M, Lehman T, Meissner W. Chronic postsurgical pain in Europe: an observational study. Eur J Anaesthesiol 2015;32:725–34.CrossrefPubMedGoogle Scholar

  • [5]

    Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, Cohen M, Evers S, Finnerup NB, First MB, Giamberardino MA, Kaasa S, Kosek E, Lavandʼhomme P, Nicholas M, Perrot S, Scholz J, Schug S, Smith BH, Svensson P, et al. A classification of chronic pain for ICD-11. Pain 2015;156:1003–7.PubMedWeb of ScienceGoogle Scholar

  • [6]

    Althaus A, Hinrichs-Rocker A, Chapman R, Arránz Becker O, Lefering R, Simanski C, Weber F, Moser KH, Joppich R, Trojan S, Gutzeit N, Neugebauer E. Development of a risk index for the prediction of chronic post-surgical pain. Eur J Pain 2012;16:901–10.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [7]

    Chapman CR, Vierck CJ. The transition of acute postoperative pain to chronic pain: an integrative overview of research on mechanisms. J Pain 2017;18, 359.e1–38.CrossrefGoogle Scholar

  • [8]

    Wildgaard K, Ravn J, Nikolajsen L, Jakobsen E, Jensen TS, Kehlet H. Consequences of persistent pain after lung cancer surgery: a nationwide questionnaire study. Acta Anaesthesiol Scand 2011;55:60–8.Web of ScienceCrossrefPubMedGoogle Scholar

  • [9]

    Steegers MA, Snik DM, Verhagen AF. Only half of the chronic pain after thoracic surgery shows a neuropathic component. J Pain 2008;9:955–61.CrossrefWeb of ScienceGoogle Scholar

  • [10]

    Guastella V, Mick G, Soriano C, Vallet L, Escande G, Dubray C, Eschalier A. A prospective study of neuropathic pain induced by thoracotomy: incidence, clinical description, and diagnosis. Pain 2011;152:74–81.CrossrefWeb of SciencePubMedGoogle Scholar

  • [11]

    Grosen K, Laue Petersen G, Pfeiffer-Jensen M, Hoejsgaard A, Pilegaard HK. Persistent post-surgical pain following anterior thoracotomy for lung cancer: a cross-sectional study of prevalence, characteristics and interference with functioning. Eur J Cardiothorac Surg 2013;43:95–103.PubMedCrossrefGoogle Scholar

  • [12]

    Rogers M, Henderson L, Mahajan RP, Duffy JP. Preliminary findings in the neurophysiological assessment of intercostal nerve injury during thoracotomy. Eur J Cardiothor Surg 2002;21:298–301.CrossrefGoogle Scholar

  • [13]

    Benedetti F, Vighetti S, Ricco C, Amanzio M, Bergamasco L, Casadio C, Cianci R, Giobbe R, Oliaro A, Bergamasco B, Maggi G. Neurophysiologic assessment of nerve impairment in posterolateral and muscle-sparing thoracotomy. J Thorac Cardiovasc Surg 1998;115:841–7.CrossrefPubMedGoogle Scholar

  • [14]

    Miyazaki T, Sakai T, Yamasaki N, Tagawa T, Mine M, Shibata Y, Nagayasu T. Assessment and follow-up of intercostal nerve damage after video-assisted thoracic surgery. Eur Cardiothorac Surg 2011;39:1033–9.CrossrefGoogle Scholar

  • [15]

    Maguire MF, Latter JA, Mahajan R, Beggs FD, Duffy JP. A study exploring the role of intercostal nerve damage in chronic pain after thoracic surgery. Eur J Cardiothorac Surg 2006;29:873–9.PubMedCrossrefGoogle Scholar

  • [16]

    Springer JS, Karlsson P, Madsen CS, Johnsen B, Finnerup NB, Jensen TS, Nikolajsen L. Functional and structural assessment of patients with and without persistent pain after thoracotomy. Eur J Pain 2017;21:238–49.CrossrefWeb of SciencePubMedGoogle Scholar

  • [17]

    Bouhassira D, Attal N, Fermanian J, Alchaar H, Gautron M, Masquelier E, Rostaing S, Lanteri-Minet M, Collin E, Grisart J, Boureau F. Development and validation of the neuropathic pain symptom inventory. Pain 2004;108:248–57.CrossrefPubMedGoogle Scholar

  • [18]

    Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: development and validation. Psychol Assess 1995;7:524–32.CrossrefGoogle Scholar

  • [19]

    Bruce J1, Drury N, Poobalan AS, Jeffrey RR, Smith WC, Chambers WA. The prevalence of chronic chest and leg pain following cardiac surgery: a historical cohort study. Pain 2003;104:265–73.PubMedCrossrefGoogle Scholar

  • [20]

    Streit F, Bekrater-Bodmann R, Diers M, Diers M, Reinhard I, Frank J, Wüst S, Seltzer Z, Flor H, Rietschel M. Concordance of phantom and residual limb pain phenotypes in double amputees: evidence for the contribution of distinct and common individual factors. J Pain 2015;16:1377–85.CrossrefWeb of SciencePubMedGoogle Scholar

  • [21]

    Attal N, Masselin-Dubois A, Martinez V, Jayr C, Albi A, Fermanian J, Bouhassira D, Baudic S. Does cognitive functioning predict chronic pain? Results from a prospective surgical cohort. Brain 2014;137:904–17.CrossrefPubMedWeb of ScienceGoogle Scholar

  • [22]

    Schreiber KL, Kehlet H, Belfer I, Edwards RR. Predicting, preventing and managing persistent pain after breast cancer surgery: the importance of psychosocial factors. Pain Manag 2014;4:445–59.CrossrefPubMedGoogle Scholar

  • [23]

    Hoofwijk DM, van Reij RR, Rutten BP, Kenis G, Buhre WF, Joosten EA. Genetic polymorphisms and their association with the prevalence and severity of chronic postsurgical pain: a systematic review. Br J Anaesth 2016;11:708–19.Web of ScienceGoogle Scholar

  • [24]

    Bayman EO, Parekh KR, Keech J, Selte A, Brennan TJ. A prospective study of chronic pain after thoracic surgery. Anesthesiology 2017;126;938–95.PubMedWeb of ScienceCrossrefGoogle Scholar

  • [25]

    Haroutiunian S, Nikolajsen L, Finnerup NB, Jensen TS. The neuropathic component in persistent postsurgical pain: a systematic literature review. Pain 2013;154:95–102.CrossrefWeb of ScienceGoogle Scholar

  • [26]

    Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, Hansson P, Hughes R, Nurmikko T, Serra J. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 2008;70:1630–5.CrossrefGoogle Scholar

  • [27]

    Wildgaard K, Ringsted TK, Hansen HJ, Petersen RH, Werner MU, Kehlet H. Quantitative sensory testing of persistent pain after video-assisted thoracic surgery lobectomy. Br J Anaesth 2012;108:126–33.CrossrefPubMedWeb of ScienceGoogle Scholar

  • [28]

    Kristensen AD, Pedersen TA, Hjortdal VE, Hjortdal VE, Jensen TS, Nikolajsen L. Chronic pain in adults after thoracotomy in childhood or youth. Br J Anaesth 2010;104:75–9.PubMedWeb of ScienceCrossrefGoogle Scholar

  • [29]

    Montes A, Sabate S, Roca G, Canet J. Preoperative prediction of chronic postsurgical pain after thoracotomy: need for adequately sized population-based samples. Anesthesiology 2018;128:224.PubMedCrossrefGoogle Scholar

About the article

Received: 2018-08-09

Revised: 2018-10-24

Accepted: 2018-10-29

Published Online: 2018-12-22


Authors’ statements

Research funding: Authors state no funding involved.

Conflict of interest: Authors state no conflict of interest.

Informed consent: Informed consent has been obtained from all individuals included in this study.

Ethical approval: The research complies with all relevant national regulations, institutional policies and was performed in accordance with the tenets of the Helsinki Declaration. The study was waivered by the Regional Ethics Committee and approved by the Danish Data Protection Agency.


Citation Information: Scandinavian Journal of Pain, 20180126, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1515/sjpain-2018-0126.

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©2018 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston. All rights reserved..Get Permission

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