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Pain in intensive care after sternotomy is predictive for chronic thoracic pain


Chronic thoracic pain after sternotomy has an overall incidence of 28–38%. It has been suggested that excessive and persistent postoperative pain may be a precursor to chronic pain. The aim of this study was to determine the incidence of chronic poststernotomy pain, the use of analgetics to minimize this pain and its effect on daily function and sleeping. We investigated whether unacceptable acute pain after sternotomy is an independent predictor for the occurrence of chronic thoracic pain.


A cohort study of 146 patients (older than 18 years) submitted to intensive care after cardiac surgery through sternotomy in the period 28 June 2006–18 August 2006 was performed. From all patients, the pain was measured using the Numeric Rating Scale (NRS ranging from 0 to 10). One or more pain measurements of a NRS >4 during the first postoperative week was considered unacceptable acute pain. After 10–12 months the patients were contacted by telephone and questioned about thoracic pain in the 2 weeks prior to the interview. The main outcome variable was unacceptable chronic thoracic pain. Multivariable logistic regression was used to control for potential confounders and to calculate the adjusted odds ratio of unacceptable chronic thoracic pain for patients who experienced unacceptable acute pain.


From a total of 146 patients we contacted 120 (82.2%) by telephone. The incidence of chronic thoracic pain was n = 42 (35%). Of the patients with chronic pain most patients, n = 31 (73%), rated this pain as unacceptable. Of the patients with chronic thoracic pain, disturbed sleeping was mentioned by 16 (38%) patients, use of analgetics for thoracic pain by 15 (36%) patients and disturbed daily function by six (14%) patients. Almost all of these patients rated their chronic pain unacceptable. The adjusted odds ratio of unacceptable chronic thoracic pain for patients who experienced unacceptable acute pain was 4.6 (95% CI: 1.26–16.4).


The results of this study confirmed that chronic pain is an important complication after sternotomy. Unacceptable acute pain is a strong predictor for the development of chronic thoracic pain.


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Janssen-Sanders, L., Gulik, L., Bruins, P. et al. Pain in intensive care after sternotomy is predictive for chronic thoracic pain. Crit Care 12 (Suppl 2), P510 (2008).

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