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Acute Pain after Thoracic Surgery Predicts Long-Term Post-Thoracotomy Pain
Open accessAbstract
OBJECTIVE: Long-term pain is a common sequela of thoracotomy, occurring in approximately 50% of patients 2 years after thoracic surgery. Despite this alarming statistic, little is known about the factors responsible for the transition of acute to chronic pain. The aim of the present study is to identify predictors of long-term post-thoracotomy pain. DESIGN: Follow-up was for 1.5 years for patients who had participated in a prospective, randomized, controlled trial of preemptive, multimodal analgesia. SETTING: Subjects were recruited from a tertiary care center. PATIENTS: Thirty patients who had undergone lateral thoracotomy were followed up by telephone, administered a structured interview, and classified according to long-term pain status. MAIN OUTCOME MEASURES: Present pain status was measured by a verbal rating scale (VAS). Measures obtained within the first 48 h after surgery were compared between patients with and without pain 1.5 years later. These include VAS pain scores at rest and after movement, McGill Pain Questionnaire data, patient-controlled morphine consumption (mg), and pain thresholds to pressure applied to a rib contralateral to the thoracotomy incision. RESULTS: Fifty-two percent of patients reported long-term pain. Early postoperative pain was the only factor that significantly predicted long-term pain. Pain intensity 24 h after surgery, at rest, and after movement was significantly greater among patients who developed long-term pain compared with pain-free patients. A significant predictive relationship was also found at 24 and 48 h using the McGill Pain Questionnaire. Cumulative morphine was comparable for the two groups. Pain thresholds to pressure applied to a rib contralateral to the incision did not differ significantly between the groups. CONCLUSION: Aggressive management of early postoperative pain may reduce the likelihood of long-term post-thoracotomy pain.
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“The data clearly show that the presence32 and intensity of preoperative chronic pain,6,33–35 the intensity of acute postoperative pain,6,23,32,33,36 the time spent in severe pain after surgery,6 pain intensity in the weeks after surgery,35,37,38 and pain in other body parts32,34,39 reliably predict CPSP across a range of surgical procedures.”
From Chronic postsurgical pain: From risk factor identification to multidisciplinary management at the Toronto General Hospital Transitional Pain Service (2019) · cites this paper as [23]
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Cites
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Self-citationLong-Term Postthoracotomy Pain
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Pain Control after Thoracic Surgery
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Self-citationPreoperative morphine pre-empts postoperative pain
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Self-citationMultimodal analgesia before thoracic surgery does not reduce postoperative paint †
Kavanagh, B. P., Katz, J. D., Sandler, A. N., Nierenberg, H., Roger, S., Boylan, J. F., & Laws, A. (1994) · British Journal of Anaesthesia · doi:10.1093/bja/73.2.184 · Cited by 82
Self-citationPreop analgesia for postop pain
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Persistent postsurgical pain: risk factors and prevention
Kehlet, H., Jensen, T. S., & Woolf, C. J. (2006) · The Lancet · doi:10.1016/s0140-6736(06)68700-x · Cited by 4,086
Poorly controlled postoperative pain: prevalence, consequences, and prevention
Gan, T. J. (2017) · Journal of Pain Research · doi:10.2147/jpr.s144066 · Cited by 1,594
Chronic Pain as an Outcome of Surgery
Perkins, F. M., & Kehlet, H. (2000) · Anesthesiology · doi:10.1097/00000542-200010000-00038 · Cited by 1,336
Predictors of Postoperative Pain and Analgesic Consumption: A Qualitative Systematic Review
Ip, H. Y. V., Abrishami, A., Peng, P. W. H., Wong, J., & Chung, F. (2009) · Anesthesiology · doi:10.1097/aln.0b013e3181aae87a · Cited by 1,055
Chronic post-surgical pain: 10 years on
Macrae, W. A. (2008) · British Journal of Anaesthesia · doi:10.1093/bja/aen099 · Cited by 992
Metadata
- Authors
- Katz, J., Jackson, M., Kavanagh, B. P., & Sandler, A. N.
- Affiliations
- University of Toronto (CA)
- Corresponding author
- Katz, Joel
- Jackson, Marla
- ORCID
- Katz, Joel
- Venue
- The Clinical Journal of Pain
- Published
- 1996-03
- Volume
- 12
- Issue
- 1
- Pages
- 50-55
- ISSN
- 0749-8047 (ISSN-L)
- OpenAlex
- W1964647709
- Cited by
- 915
- References
- 22
- Citations by year
- 2026: 11 · 2025: 17 · 2024: 25 · 2023: 27 · 2022: 42 · 2021: 35 · 2020: 32 · 2019: 29 · 2018: 38 · 2017: 45 · 2016: 31 · 2015: 42 · 2014: 32 · 2013: 42 · 2012: 25
- FWCI
- 15.79
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Clinical Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- YorkSpace (York University) (submittedVersion)
- Funders
- Medical Research Council Canada
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Pain Management
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- post-thoracotomy pain, chronic postoperative pain, acute postoperative pain, lateral thoracotomy, preemptive analgesia, multimodal analgesia, pain intensity, McGill Pain Questionnaire, morphine consumption, pain threshold, pressure pain threshold
- MeSH terms
- Acute Disease, Analgesics, Opioid, Anxiety, Depression, Female, Follow-Up Studies, Humans, Male, Middle Aged, Morphine, Pain, Pain Measurement, Postoperative Pain, Predictive Value of Tests, Prospective Studies, Thoracotomy
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