Post Thoracotomy Pain Syndrome

Post-thoracotomy pain is one of the most severe and long lasting complications after surgery (1-4) which acutely contributes to limit normal respiratory activity impairing the sputum clearance and reducing ventilatory function (5). Along with limb amputation, thoracotomy is the surgical procedure with the highest risk of severe and long lasting acute postoperative pain (6). Moreover, a chronic post thoracotomy pain syndrome (PTPS) may delay the long term rehabilitation, worsening the quality of life because of the associated neuropathic pain even without recurrences of the primary disease (7). Lung cancer still remains the first cause of death for cancer (8) and prompt pulmonary surgery may be the only effective therapeutic strategy. Consequently, an increasing rate of thoracic surgery will be progressively associated with a higher PTPS incidence in the future. The syndrome was firstly described in 1944 during the II world war when American surgeons reported persistent intercostal pain in soldiers submitted to thoracotomy (9). Until the end of the nineties, pain treatment was mainly based on intravenous opioids and the incidence of PTPS was about 61% one year after surgery (10).