Chronic post-thoracotomy pain-What is new in pathogenic mechanisms and strategies for prevention?

Recently, the development of persistent postsurgical pain states has received much attention. As a model for understanding persistent postsurgical pain, thoracotomy and its minimal invasive counterpart, video-assisted thoracic surgery, have been investigated. The present article presents recent developments in pathophysiology of post-thoracotomy pain syndrome (PTPS) in regards to pre-, intra-, and postoperative factors. Although the literature is abundant with trials on PTPS, inadequate and inconsistent inclusion of relevant pre-, intra-, and postoperative factors is still problematic. Future trials delineating pain areas and assessing sensory dysfunction support the importance of nerve injury, but other factors are insufficiently investigated. Finally, there is a need for validated detailed procedure-specific questionnaires to assess the function and psychosocial consequences of PTPS.