What is Post-Thoracotomy Pain?

A thoracotomy is a type of surgery that is carried out on a person’s chest, and is often used during the treatment of lung cancer. Thoracotomy is considered the most painful of surgical procedures; pain after the procedure is very severe, and can affect more than 50% of patients. Post-thoracotomy pain syndrome (or PTPS) is defined as pain that recurs or persists along a thoracotomy incision at least two months following the surgical procedure. In general, it is burning and stabbing pain with dysesthesia and thus shares many features of neuropathic pain.

What are the Causes?

Post-thoracotomy pain (also known as intercostal neuralgia) is caused by inflammation, damage or compression to the intercostal nerves, which lie between each of the twelve ribs. Other causes include inflammation of the intercostal nerves associated with an outbreak of shingles, tumor, or radiation for the treatment of some cancers. Post-thoracotomy pain is typically felt in the back and chest region following surgery in the chest. Following a thoracotomy, half of all patients may experience persistent pain, and as much as 30 percent of patients may continue to experience the pain for four to five years after the surgery or even permanently.

Post-thoracotomy pain syndrome (PTPS) is most likely felt to be a combination of damage to the intercostal nerves that unfortunately, may not be avoidable, as well as damage to the muscles between the ribs.

What are the Symptoms?

Post-thoracotomy pain is often described as pain that wraps around your chest, and can sometimes be described as a band radiating from the back of the body to the front chest or upper abdomen. The pain may be described as burning, spasm-like, aching, gnawing and stabbing.  The pain may worsen with sudden chest movements such as laughing, coughing or taking deep breaths with exertion. For patients who had a thoracotomy surgery, they may experience pain that radiates along the rib cage or just experience persistent pain along the incision site. The description of the pain is similar, and it may be severe and debilitating.

What are the Treatments?

A variety of treatments are available depending on your particular symptoms, and your pain management specialist at CSPP will develop a treatment plan with you after conducting a physical examination. Your customized treatment plan may involve a combination of medications and injection therapy.

You may be prescribed a combination of medications, including:

  • Nerve-stabilizing medications (anti-convulsants)
  • Anti-depressants that also work to stabilize the nerve
  • Non-steroidal anti-inflammatories
  • Topical patches and creams.

In addition, your specialist at CSPP may also suggest a nerve block to help alleviate some of the pain. If the pain persists despite the initial treatment options, your specialist may suggest a spinal cord stimulator trial or a peripheral nerve stimulator trial.