Chronic postthoracotomy pain and health-related quality of life

Abstract

Background: Pain after thoracotomy is common. The objective of this study was to assess whether pain 3 months postthoracotomy negatively impacts quality of life.

Methods: One hundred ten patients were prospectively assessed using the Medical Outcomes Study 36-Item Short Form Health Survey before and 3 months after elective thoracotomy. Pain and medication use were evaluated by questionnaire. Patients experiencing pain at 3 months were compared with patients who did not have postthoracotomy pain.

Results: Seventy-five patients (68%) had pain 3 months postthoracotomy; 12 patients (11%) rated their average pain greater than 3 (out of 10). Eighteen (16%) patients required opioid analgesics. The pain group reported lower SF-36 scores in physical functioning (p = 0.049), bodily pain (p = 0.0002), and vitality (p = 0.044). There were no other significant differences in any SF-36 scale between the pain and non-pain groups.

Conclusions: Pain is commonly reported at 3 months after elective thoracotomy but is generally mild, shows improvement with time, and does not usually require opioid analgesics. Patients who experience postthoracotomy pain at 3 months are at risk for significantly decreased physical functioning and vitality, but are not at risk for significantly decreased social, emotional, or mental health functioning compared with patients who do not experience postthoracotomy pain at 3 months.

Figure 1

Mean pre-operative and 3-month SF-36 scale scores in patients with and without post-thoracotomy at 3 months. ^a In patients with post-thoracotomy pain at 3 months, the SD for the preoperative scores in each SF-36 scale and the magnitude of change in SF-36 scores is presented (effect size was analyzed using Cohen’s d - see Statistical Analysis). Available benchmarks describe effect size values of 0.20–0.49 as small, 0.50–0.79 as moderate, and effect size values ≥0.80 as large. *Paired t-test p<0.05.