A Prospective Study of Chronic Pain after Thoracic Surgery

Abstract

Background: The goal of this study was to detect the predictors of chronic pain at 6 months after thoracic surgery from a comprehensive evaluation of demographic, psychosocial, and surgical factors.

Methods: Thoracic surgery patients were enrolled 1 week before surgery and followed up 6 months postsurgery in this prospective, observational study. Comprehensive psychosocial measurements were assessed before surgery. The presence and severity of pain were assessed at 3 and 6 months after surgery. One hundred seven patients were assessed during the first 3 days after surgery, and 99 (30 thoracotomy and 69 video-assisted thoracoscopic surgery, thoracoscopy) patients completed the 6-month follow-up. Patients with versus without chronic pain related to thoracic surgery at 6 months were compared.

Results: Both incidence (P = 0.37) and severity (P = 0.97) of surgery-related chronic pain at 6 months were similar after thoracotomy (33%; 95% CI, 17 to 53%; 3.3 ± 2.1) and thoracoscopy (25%; 95% CI, 15 to 36%; 3.3 ± 1.7). Both frequentist and Bayesian multivariate models revealed that the severity of acute pain (numerical rating scale, 0 to 10) is the measure associated with chronic pain related to thoracic surgery. Psychosocial factors and quantitative sensory testing were not predictive.

Conclusions: There was no difference in the incidence and severity of chronic pain at 6 months in patients undergoing thoracotomy versus thoracoscopy. Unlike other postsurgical pain conditions, none of the preoperative psychosocial measurements were associated with chronic pain after thoracic surgery.

Conflict of interest statement

Conflicts of Interest: The authors declare no competing interests.

Figures

Figure 1

Flowchart of patients. VATS: video-assisted thoracic surgery

Figure 2

Numerical rating scale (NRS, 0–10) for patients during the 6 months of the study separately for thoracotomy vs VATS patients. Note that those patients with zero pain scores were included in this plot. When analyzed longitudinally, the time effect was significant (p

Figure 3

Incidences of chronic pain related to thoracotomy and VATS ant 3 and 6 months after surgery. VATS: video-assisted thoracic surgery

Figure 4

Severity of pain for those patients with and without chronic pain related to thoracic surgery at 6 months after surgery. Note that those patients with zero pain scores were included in this plot. When analyzed longitudinally, both the time effect (p¥) was sedated during the first 3 days. Some (5 patients at 3 months, and 8 patients at 6 months) patients completed phone interviews at 3 and 6 months, but did not return the mail including the NRS. One-sided error bars represent standard deviation. NRS: numerical rating scale, POD: post-operative day, pre-op: pre-operative, *: p≤ 0.05, ***: p≤0.001.

Figure 5

Severity of pre-operative pain at rest (NRS, 0–10) for those patients with (red triangles) vs without (black circles) chronic pain related to thoracic surgery at 6 months. NRS: numerical rating scale