Once a patient has a thoracotomy procedure, pain from the incision may persist despite having a successful procedure. Thoracotomy procedures have numerous indications, including lung resection or spine surgery just to mention a couple. Unfortunately even if the procedure was exceptionally successful, the patient may end up with residual pain despite having had a successful resection or spine surgery. This can be extremely disabling for patients and ruin an otherwise successful surgery.
If a patient's pain from the thoracoctomy incision persists for over 2 months following the initial surgery, this is known as post-thoracotomy syndrome, or PTPS. Patients present with symptoms of neuropathic pain, along with muscular type pain in the scapular on the same side and maybe the shoulder too.
Treatments that have been described for patients with PTPS including oral NSAIDs, topically applied NSAIDs, physical therapy, neuromodulating agents like Lyrica, or TENS Unit treatment, and various injections. These injections may include trigger points, radiofrequency ablation, intercostal nerve blocks, epidural injections, or cryoablation.
One treatment that may hold some promise is spinal cord stimulation. A spinal cord stimulator is an excellent last resort for patients who have failed other treatments for their back pain and are no longer candidates for spinal surgery. Spinal cord stimulator's are finding utility in the treatment of other diagnoses as well, such as chronic pelvic pain. When it comes to PTP, it can be so disabling and patients fail other treatment options a spinal cord stimulator may be a viable option.
A spinal stimulator provides a persistent electrical stimulation in the area of where the electrical catheter is placed. It can help depolarize the pain channels that are in the region and alter how the brain senses the pain signals that are incoming. This can allow for a patient to decrease the amount of pain being experienced while at the same time having no curative effect.
A spinal cord stimulator is placed completely under the skin. The electrical catheter is placed in the area of the problem or the intercostal nerves are, and then the wire is placed under the skin and attached to a subcutaneous battery. This battery is able to be charged without being pulled out from the body, and the patient wears a belt potentially while they are sleeping that charges the battery every few days.
No large clinical studies exist in the effectiveness of spinal cord stimulator treatment for PTPS. It truly should be considered as an option for these patients, but probably not a first resort since it is an extremely expensive procedure. There are plenty of case reports and anecdotal reports backing up its effectiveness, so it should be in the option department for PTPS but once again not reached to primarily.
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