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What is Post-thoracotomy Pain?
Pain in any part of the body is always distressing and a nuisance. Post-thoracotomy pain refers to pain that occurs following a surgical procedure on the chest wall called a thoracotomy.
A thoracotomy is a surgical procedure that is carried out to deal with medical conditions that affect the chest, such as tumors or cancer. The procedure involves making a deep incision in the chest wall that penetrates the skin, muscles and ligaments along with the requirement of resecting the ribs. Access is thus obtained to the structures within the lung so that surgery can be carried out.
Post-thoracotomy pain is a severe form of pain that can cause tremendous amount of distress to patients following a thoracotomy. As a result, patients can have a number of problems, such as difficulty coughing out infected secretions, development of pneumonia, and a general difficulty in managing any form of activities because breathing is painful.
What causes Post-thoracotomy Pain?
There are two main types of post-thoracotomy pain: acute and chronic. Acute post-thoracotomy pain refers to pain that occurs immediately after surgery. It can cause difficulty in breathing and coughing. Chronic post-thoracotomy pain refers to persistent pain at the site of surgical incision that lasts at least two months following a thoracotomy procedure.
The most common reason why post-thoracotomy pain may occur is damage to the intercostal nerves. These are the nerves that run in between the ribs and supply the muscles, called intercostal muscles, that connect the ribs. While care is always taken to prevent any damage to the intercostal nerves, unfortunately it can still occur due to mechanical injury that can be precipitated by rib resection. Pain usually occurs at the site of skin incision and damage of the intercostal nerve.
As was previously mentioned, a thoracotomy may be conducted to remove a tumor within the lung. A recurrence of this tumor can result in pain. Finally, post-thoracotomy pain may occur due to damage that occurred inadvertently to surrounding muscles during the surgical procedure. While there are clearly a few causes of post-thoracotomy pain, there still remains debate as to what the exact cause for it is.
Symptoms and Diagnosis
The most common symptom of post-thoracotomy pain is pain at the site of surgery. Upon examination, the patient will complain of tenderness at the site of incision and occasionally may complain of altered sensation at the site.
How is Post-thoracotomy Pain treated?
The decision as to what treatment is best is decided by the doctor based on the patient's presentation and their response to symptomatic treatment.
- Symptomatic treatment This refers to the application of hot or cold packs at the area of the incision to help relieve pain.
- Painkillers This is probably the first-line of treatment that the doctor may recommend. Commonly used drugs include paracetamol and non-steroidal anti-inflammatory drugs. On occasion, stronger painkillers may be required and the doctor will decide this on a case-by-case basis.
- Antidepressant medications such as tricyclic antidepressants are known to be extremely strong painkillers and may be offered to the patient.
- Specialist treatments These include injecting the painful area with a combination of a local anesthetic along with a steroid compound. This numbs the area and reduces the inflammation.