Steegers Monique A H, Snik Daphne M, Verhagen Ad F, van der Drift Miep A, Wilder-Smith Oliver H G
Pain and Nociception Research Group, Department of Anaesthesiology, Pain and Palliative Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
J Pain. 2008 Oct;9(10):955-61. doi: 10.1016/j.jpain.2008.05.009. Epub 2008 Jul 16.
Chronic pain is a common complication after thoracic surgery. The cause of chronic post-thoracotomy pain is often suggested to be intercostal nerve damage. Thus chronic pain after thoracic surgery should have an important neuropathic component. The present study investigated the prevalence of the neuropathic component in chronic pain after thoracic surgery. Furthermore, we looked for predictive factors for prevalence and intensity of chronic pain. We contacted 243 patients who underwent a video-assisted thoracoscopy (VATS) or thoracotomy in the period between January 2004 and September 2006 by mail. Patients retrospectively received a questionnaire with the Dutch version of the PainDETECT Questionnaire, a validated screening tool for neuropathic pain. Results were analyzed from 204 patients (144 thoracotomies, 60 VATS). The prevalence of chronic pain was 40% after thoracotomy and 47% after VATS. Definite chronic neuropathic pain was present in 23% of the patients with chronic pain, with an additional 30% having probable neuropathic pain. Greater probability of neuropathic pain (ie, a higher total score of the PainDETECT) correlated with more intense chronic pain. Predictive factors for chronic pain were younger age (P = .01), radiotherapy (P = .043), pleurectomy (P = .04) and more extensive surgery (P < .001).
Up to half the chronic pain after thoracic surgery is not associated with a neuropathic component, which has not been reported to date. More extensive surgery and pleurectomy are predictive factors for chronic pain after thoracic surgery, suggesting a visceral component apart from nerve injury.
慢性疼痛是胸外科手术后常见的并发症。开胸术后慢性疼痛的原因通常被认为是肋间神经损伤。因此，胸外科手术后的慢性疼痛应具有重要的神经病理性成分。本研究调查了胸外科手术后慢性疼痛中神经病理性成分的发生率。此外，我们还寻找了慢性疼痛发生率和强度的预测因素。我们通过邮件联系了2004年1月至2006年9月期间接受电视辅助胸腔镜手术（VATS）或开胸手术的243例患者。患者回顾性地收到一份包含荷兰语版疼痛检测问卷的问卷，这是一种经过验证的神经性疼痛筛查工具。对204例患者（144例开胸手术，60例VATS）的结果进行了分析。开胸术后慢性疼痛的发生率为40%，VATS术后为47%。23%的慢性疼痛患者存在明确的慢性神经性疼痛，另有30%可能存在神经性疼痛。神经性疼痛的可能性越大（即疼痛检测问卷总分越高），慢性疼痛越强烈。慢性疼痛的预测因素为年龄较小（P = 0.01）、放疗（P = 0.043）、胸膜切除术（P = 0.04）和手术范围更广（P < 0.001）。
胸外科手术后高达一半的慢性疼痛与神经病理性成分无关，这一点迄今为止尚未见报道。手术范围更广和胸膜切除术是胸外科手术后慢性疼痛的预测因素，提示除神经损伤外还存在内脏成分。
