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

Introduction

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.

Methods

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.

Results

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).

Conclusion

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.

References

  1. 1.

    Lahtinen P, Kokki H, Hynynen M: Pain after cardiac surgery: a prospective cohort study of 1-year incidence and intensity. Anesthesiology 2006, 105: 794-800. 10.1097/00000542-200610000-00026

    PubMed  Article  Google Scholar 

  2. 2.

    Bruce J, Drury N, Poobalan AS, et al.: The prevalence of chronic chest and leg pain following cardiac surgery: a historical cohort study. Pain 2003, 104: 265-273. 10.1016/S0304-3959(03)00017-4

    PubMed  CAS  Article  Google Scholar 

  3. 3.

    Ho SC, Royse CF, Royse AG, et al.: Persistent pain after cardiac surgery: an audit of high thoracic epidural and primary opioid analgesia therapies. Anesth Analg 2002, 95: 820-823. 10.1097/00000539-200210000-00006

    PubMed  CAS  Google Scholar 

  4. 4.

    Meyerson J, Thelin S, Gordh T, Karlsten R: The incidence of chronic post-sternotomy pain after cardiac surgery – a prospective study. Anaesthesiol Scand 2001, 45: 940-944. 10.1034/j.1399-6576.2001.450804.x

    CAS  Article  Google Scholar 

  5. 5.

    Kalso E, Mennander S, Tasmuth T, Nilsson E: Chronic post-sternotomy pain. Acta Anaesthesiol Scand 2001, 45: 935-939. 10.1034/j.1399-6576.2001.450803.x

    PubMed  CAS  Article  Google Scholar 

  6. 6.

    Mueller XM, Tinguely F, Tevaearai HT, et al.: Pain location, distribution, and intensity after cardiac surgery. Chest 2000, 118: 391-396. 10.1378/chest.118.2.391

    PubMed  CAS  Article  Google Scholar 

  7. 7.

    Pluijms WA, Steegers MAH, Verhagen AFTM, Wilder-Smith OHG: Chronic post-thoracotomy pain: a retrospective study. Acta Anesth Scand 2006, 50: 804-808. 10.1111/j.1399-6576.2006.01065.x

    CAS  Article  Google Scholar 

  8. 8.

    Gotoda Y, Kambara N, Sakai T, et al.: The morbidity, time course and predictive factors for persistent post-thoracotomy pain. Eur J Pain 2001, 5: 89-96. 10.1053/eujp.2001.0225

    PubMed  CAS  Article  Google Scholar 

  9. 9.

    Norgaard MA, Andersen TC, Lavrsen MJ, Borgeskov S: The outcome of sternal wire removal on persistent anterior chest wall pain after median sternotomy. Eur J Cardiothorac Surg 2006, 29: 920-924. 10.1016/j.ejcts.2006.02.013

    PubMed  Article  Google Scholar 

  10. 10.

    Fine PG, Karwande SV: Sternal wire-induced persistent chest pain: a possible hypersensitivity reaction. Ann Thorac Surg 1990, 49: 135-136.

    PubMed  CAS  Article  Google Scholar 

  11. 11.

    Perkins FM, Kehlet H: Chronic pain as an outcome of surgery. A review of predictive factors. Anasthesiology 2000, 93: 1123-1133. 10.1097/00000542-200010000-00038

    CAS  Article  Google Scholar 

  12. 12.

    Cohen AJ, Moore P, Jones C, et al.: Effect of internal mammary harvest on postoperative pain and pulmonary function. Ann Thorac Surg 1993, 56: 1107-1109. 10.1016/0003-4975(95)90025-X

    PubMed  CAS  Article  Google Scholar 

  13. 13.

    Katz J, Jackson M, Kavanagh BP, Sandler AN: Acute pain after thoracic surgery predicts long-term post-thoracotomy pain. Clin J Pain 1996, 12: 50-55. 10.1097/00002508-199603000-00009

    PubMed  CAS  Article  Google Scholar 

  14. 14.

    Woolf CJ, Salter MW: Neural plasticity: increasing the gain in pain. Science 2000, 288: 1765-1769. 10.1126/science.288.5472.1765

    PubMed  CAS  Article  Google Scholar 

  15. 15.

    Zalon LM: Nurses' assessment of postoperative patients in pain. Pain 1993, 54: 329-34. 10.1016/0304-3959(93)90033-L

    PubMed  CAS  Article  Google Scholar 

  16. 16.

    Macrae WA: Chronic pain after sternotomy. Acta Anaesthesiol Scand 2001, 45: 927-928. 10.1034/j.1399-6576.2001.450801.x

    PubMed  CAS  Article  Google Scholar 

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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, P510 (2008). https://doi.org/10.1186/cc6731

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Keywords

  • Outcome Variable
  • Chronic Pain
  • Independent Predictor
  • Emergency Medicine
  • Postoperative Pain