Chronic Pain After Lung Resection: Risk Factors, Neuropathic Pain, and Quality of Life

Silvia Fiorelli; Luigi Cioffi; Cecilia Menna; Mohsen Ibrahim; Roberto A De Blasi; Erino A Rendina; Monica Rocco; Domenico Massullo

doi:10.1016/j.jpainsymman.2020.03.012

Chronic Pain After Lung Resection: Risk Factors, Neuropathic Pain, and Quality of Life

J Pain Symptom Manage. 2020 Aug;60(2):326-335. doi: 10.1016/j.jpainsymman.2020.03.012. Epub 2020 Mar 24.

Authors

Silvia Fiorelli¹, Luigi Cioffi², Cecilia Menna³, Mohsen Ibrahim³, Roberto A De Blasi², Erino A Rendina³, Monica Rocco², Domenico Massullo²

Affiliations

¹ Department of Clinical and Surgical Translational Medicine, Anesthesia and Intensive Care Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy. Electronic address: silvia.fiorelli@uniroma1.it.
² Department of Clinical and Surgical Translational Medicine, Anesthesia and Intensive Care Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
³ Department of Clinical and Surgical Translational Medicine, Thoracic Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.

PMID: 32220584
DOI: 10.1016/j.jpainsymman.2020.03.012

Abstract

Context: Chronic postsurgical pain (CPSP) can occur frequently after thoracic surgery.

Objectives: This retrospective study aimed to determine CPSP prevalence, risk factors, neuropathic pain (NP) occurrence, and its impact on quality of life.

Methods: About 200 patients who underwent lung resection via minithoracotomy or thoracoscopy between January 2017 and December 2017 were assessed 4-12 months postoperatively via phone interview for chronic pain by a 0-10 Numeric Rating Scale, for NP using the Douleur Neuropathique 4 test, and for quality of life using a Short Form-36 (SF-36) Health Survey (Italian version).

Results: CPSP incidence was 35% (n = 70 of 200; 95% CI 41-28) of which 31.5% (n = 22 of 70; 95% CI 41-21) was with NP. Only 10% of patients with CPSP reported severe chronic pain. According to univariate analysis, CPSP was associated to moderate and severe acute postoperative pain (P < 0.001), open surgery (P = 0.001), and female gender (P = 0.044). According to multivariable analysis, independent risk factors for CPSP development included moderate-to-severe acute postoperative pain occurrence (odds ratio 32.61; 95% CI 13.37-79.54; P < 0.001) and open surgery (odds ratio 6.78; 95% CI, 2.18-21.03; P = 0.001). NP incidence was higher in female patients (16% in women and 6% in men, respectively; P = 0.040). A significant decrease in all SF-36 Health Survey domain scores was recorded for patients with CPSP and NP (P < 0.001).

Conclusion: More than one of three patients who underwent lung resection could develop CPSP, frequently showing neuropathic component. Female gender reported a higher CPSP and NP incidence. Moderate-to-severe acute postoperative pain occurrence and open surgery seem to be independent risk factors for CPSP. Chronic pain and NP have a negative impact on quality of life, decreasing the SF-36 scores of all domains.

Keywords: Pain; chronic postsurgical pain; neuropathic pain; quality of life; thoracic surgery.

MeSH terms

Chronic Pain* / epidemiology
Female
Humans
Lung
Male
Neuralgia* / epidemiology
Neuralgia* / etiology
Pain Measurement
Pain, Postoperative / epidemiology
Prospective Studies
Quality of Life
Retrospective Studies
Risk Factors