Can chronic neuropathic pain following thoracic surgery be predicted during the postoperative period?

Academic Unit of Anaesthesia, Level 8 Clinical Sciences Building, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK *Corresponding author. Tel.: +44 (0) 113 20 65282; fax: +44 (0) 113 206 4140. E-mail address : r.searle{at}leeds.ac.uk (R.D. Searle). Chronic pain following thoracic surgery is common and associated with neuropathic symptoms, however, the proportion of patients with neuropathic pain in the immediate postoperative period is unknown. We aimed to determine the proportion of patients who have neuropathic symptoms and signs immediately after, and at three months following thoracic surgery. The study was designed as a prospective observational cohort study. We identified patients with pain of predominantly neuropathic origin using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) score in the immediate postoperative period and the self-report LANSS (S-LANSS) version three months after surgery. One hundred patients undergoing video assisted thoracic surgery (VATS) or thoracotomy completed LANSS scores preoperatively and in the immediate postoperative period. Eighty-seven percent completed three months S-LANSS follow-up scores. Eight percent of patients had positive LANSS scores in the immediate postoperative period; 22% of patients had positive S-LANSS scores three months following surgery. There was a significant association between positive scores in the acute and chronic periods (relative risk (RR) 3.5, [95% confidence interval (CI) 1.7–7.2]). Identifying pain of predominantly neuropathic origin in the postoperative period with a simple pain score can help identify those at risk of developing chronic pain with these features following thoracic surgery. Key Words: Acute neuropathic pain; Chronic post-surgical pain; LANSS; Thoracotomy; Thoracic surgery