Chronic Pain After Lung Cancer Surgery: Treatment Options

Postpneumonectomy Syndrome and Post-Thoracotomy Pain Syndrome

woman experiencing chronic chest pain after lung cancer surgery
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Chronic, long-term pain after lung cancer surgery such as a lobectomy is far too common, with around 50 percent of people experiencing symptoms of pain with movement, burning nerve pain, and shortness of breath. Treatment options can include pain medications, nerve blocks, silicone implants, spinal cord stimulation, or alternative therapies. Coping with this pain (that's been coined post-thoractomy pain syndrome or postpneumonectomy syndrome) can be challenging, but fortunately, this is an area of active research with several clinical trials currently in progress.

Chronic Pain Syndromes After Lung Surgery

People may have chronic pain after any type of lung surgery, but two syndromes have been coined based on common symptoms.

Postpneumonectomy syndrome is a complication that can occur months to years following a pneumonectomy for lung cancer or other conditions. It is more common following a left pneumonectomy than a right pneumonectomy and occurs more frequently in younger people.

Post-thoracotomy pain syndrome (PTPS) is another phrase used to describe this severe pain and includes pain after other lung cancer surgeries such as lobectomy as well. The syndrome occurs when the remaining lung and structures in the middle area of the chest (the mediastinum) are displaced, and fill the empty area that is left after a lung or part of a lung is removed. 

Significance and Importance

It's thought that 50 percent of people who have surgery for lung cancer experience chronic pain to the degree that it interferes with quality of life. It is probably under-reported and is seriously under-treated among those who have survived lung cancer. Postpneumonectomy syndrome can have a significant impact on a lung cancer survivors well-being, and indirectly through this, on their recovery.

Symptoms

Chronic pain after lung cancer surgery can take a number of different forms, but for most people, the pain and other symptoms are very frustrating.

Pain may occur anywhere in the chest, and does not necessarily reflect on the precise location where the surgery was performed. Some people experience chronic shoulder pain as well. Pain may be present both with activity and at rest, and many people note a worsening of the pain with arm movements. The pain may be achy or dull, but is often described as burning, tingling, and difficult to describe. This type of pain, called neuropathic pain, was found to be present in half of people who had chronic pain after lung surgery, and is not only difficult to describe but can be particularly disabling and challenging to treat. A

Some people also not progressive shortness of breath associated with the pain, but this may be overlooked as an expected symptom after a reduction in lung mass.

Causes of Post Lung Surgery Pain

There are several mechanisms related to thoracic (chest) surgery that can be responsible for pain, both alone, or in combination, including:

  • Compression of the intercostal nerves (nerves that run between the ribs)
  • The trauma of surgery
  • Scar tissue which rubs with each breath
  • Fractured and compressed ribs
  • Inflammation of the chest muscles
  • Atrophy of chest muscles

Treatments

A number of different treatments have been tried for post-thoracotomy syndrome, and it's likely that a combination of treatments, rather than one treatment alone, is the best option.

Medications

Sometimes opioids are needed to get the pain under control, but unfortunately, thoracic surgery has been found to lead to long-term opioid use far too often. Anti-inflammatory medications may help some people, but are relatively ineffective with nerve pain. Anti-seizure drugs such as gabapentin may be helpful for some people who have neuropathic pain.

Silicone Implants

The use of silicone implants (similar to breast implants) that are placed in the chest to fill the space left over following the removal of a lung, has given some people significant relief from long-term pain after lung surgery.

Nerve Blocks

A number of studies have looked at different types of nerve blocks to control pain, with some success.

Spinal Cord Stimulation

Recently spinal cord stimulation has also been found to be effective for controlling pain for some people.

Alternative Therapies

Some of the alternative cancer treatments such as massage therapy and acupuncture may help with pain control and with coping with the aftermath of cancer treatment.

Coping

For a long time, people weren't expected to live for a long time after lung cancer surgery, and management of quality of life issues such as chronic chest pain was put on the back burner. Fortunately, survivorship issues, such as persistent pain and other long-term effects of cancer treatment are now being addressed, and the field of cancer rehabilitation taking shape to help people live their best life following treatment.

If you're coping with chronic pain after lung cancer surgery, talk to your doctor. Some cancer centers have pain management specialists who are trained in ways of helping people cope with neuropathic type pain.

The Future

With new procedures such as video-assisted thoracoscopic surgery (VATS) replacing some open thoracotomy procedures, the incidence of postpneumonectomy syndrome will hopefully decrease in the future. For those who are living with the syndrome today, there is hope as well, and active research is ongoing looking for ways to help people cope with this annoying after effect of lung cancer surgery.

Examples: Josh was becoming more short of breath a year after his pneumonectomy for lung cancer, and his doctor diagnosed him with postpneumonectomy syndrome.

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