Post-thoracotomy pain syndrome
Current Approaches to Pain Management, NOVA Science Publishers Inc. , ss.207-221, 2025
- Yayın Türü: Kitapta Bölüm / Araştırma Kitabı
- Basım Tarihi: 2025
- Yayınevi: NOVA Science Publishers Inc.
- Sayfa Sayıları: ss.207-221
- Anahtar Kelimeler: Neuropathic pain, Post thoracotomy pain syndrome, Thoracotomy
- Maltepe Üniversitesi Adresli: Evet
Özet
Post-thoracotomy pain syndrome (PTPS) is defined as pain persisting for at least 3 months or recurring after thoracic surgery. Its prevalence varies between 25% and 80%. Pain typically has a neuropathic characteristic but can also coexist with somatic pain. The development of PTPS involves neuroplasticity and neuro-humoral processes, leading to chronicization. Surgical incision, lung parenchyma or pleural damage, direct intercostal nerve injury, nerve compression due to retractor use, costovertebral dislocation, and thoracic tube and drains can lead to pain. Tissue damage triggers glutamatergic stimulation, leading to increased intracellular calcium release and activation of alternative pathways, ultimately causing pain. The chronicization of pain involves neuroplasticity occurring in the nervous system due to neuro-humoral processes, decreased inhibition in the spinal cord, increased sensitivity of peripheral sensory neurons, inflammation, and the failure of the nervous system to return to its previous state of damage. Acute postoperative pain responds well to proper treatment, and early intervention in PTPS yields favorable outcomes. Inadequate control of acute pain leads to prolonged hyperexcitability and complicates pain management. The risk factors contributing to the development of Post-Thoracotomy Pain Syndrome (PTPS) are categorized based on preoperative (age, gender, genetic polymorphism, opioid usage, sociocultural characteristics, psychosocial factors, and preoperative pain), perioperative (surgical techniques, muscle, and nerve-preserving methods, rib resection, thoracic tube, and drains), and postoperative factors (acute pain management, chemotherapy, radiotherapy). Notably, acute pain has been underscored as the most significant risk factor in the onset of PTPS. In conclusion, PTPS is a complex syndrome requiring comprehensive prevention and management strategies. Personalized approaches, considering the type and intensity of pain, comorbidities, and patient-specific factors, are crucial for effective treatment.