While surgery and surgical procedures have become specialized and involve as little tissue damage as possible, they nonetheless involve the cutting, removing and suturing of skin, muscles, nerves and other structures. Therefore some surgical procedures can cause chronic pain due to the trauma of the procedure. Post thoracotomy pain is an example of pain associated with the surgical procedure. Doctors define post thoracotomy pain as pain that returns or persists around the surgical incision for at least two months after the surgery. The pain is generally located along the chest wall. Patients who have post thoracotomy pain describe it as achy-like, burning or sharp. Pain can result from entrapped nerve fibers in the area of the scar tissue.
Sometimes a neuroma or painful lump of nerve tissue can form at the tip of a nerve in the chest wall where it has been cut during surgery. Pain from the muscles in the chest or shoulder may contribute to post thoracotomy pain syndrome as well. If the thoracotomy was performed to remove a tumor involving the lining of the chest or the chest wall, continued pain may indicate tumor recurrence.
Diagnosis
Doctors will use a physical examination to confirm a painful area near the surgical scar and to map the area of irritation. A CT scan of the chest sometimes helps determine if a tumor has reoccurred. Doctors may use a kind of nerve block or injection of anesthetic medications around a neuroma or nerve in the chest wall to help confirm the diagnosis.
Treatment
Some patients benefit from oral non-steroidal anti-inflammatory medications with the addition of pain medicine. Long-term relief is often obtained from the use of nerve blocks given into a neuroma, local anesthetics and anti-inflammatory medications. Other nerve block treatments can be given along the path of the various nerves in the chest, which contribute to the pain after thoracotomy surgery. Sometimes nerve stimulation procedures are used to help relieve pain along the chest wall. Physical therapy exercises may be utilized to regain the ability to perform normal daily activities.