However , intercostal nerve injury seems to be the most important pathogenic factor .
Chronic pain complaints after thoracic surgery represent a significant clinical problem in 25 - 60 % of patients .
Results from thoracic and other surgical procedures suggest multiple pathogenic mechanisms that include pre- , intra- , and postoperative factors .
This review attempts to analyse the methodology and systematic s of the studies on the  post-thoracotomy pain syndrome ( PTPS ) after lung cancer surgery in adults , in order to clarify the relative role of possible pathogenic factors and to define future strategies for prevention .
Women Suffer More Short and Long-term Pain Than Men After Major Thoracotomy
Objectives Prolonged activation of pain centers is a proposed cause of chronic pain syndromes . Women are at particular risk for chronic pain as they tend to more readily detect pain and to attenuate it less than men . We set out to determine whether sex affected pain and recovery after major surgery by analyzing data originally collected to determine the effect of the timing of epidural analgesia on long-term outcome after thoracotomy . Methods Patients presenting for lobectomy , segmentectomy , or bilobectomy , but not pneumonectomy or chest wall resection , were enrolled .  Pain , physical activity , and the extent that pain interfered with activities after surgery were prospect ively assessed with st and ard question naires ( Brief Pain Inventory and physical component score of SF-36 ) on postoperative days 1 to 5 , and at postoperative weeks 4 , 8 , 12 , 24 , 36 , and 48 by a blinded research assistant . Perioperative care was st and ardized and included patient-controlled thoracic epidural analgesia until thoracostomy tube removal . Results Fifty eight men and 62 women were enrolled . Women reported more pain than men throughout the entire study period , and they had a higher rate of nonsteroidal anti-inflammatory drug use , but not opioid use . This increased pain was not explained by incision type , surgeon , tumor type , or tumor stage . Older patients reported less pain after discharge than younger patients . Postoperative physical activity levels were significantly less than those reported preoperatively , but did not differ by sex . Discussion Women have a distinctly different pain experience than men after thoracic surgery and probably require novel and /or multimodal analgesic regimens to improve their comfort
However , intercostal nerve injury seems to be the most important pathogenic factor .
Chronic pain complaints after thoracic surgery represent a significant clinical problem in 25 - 60 % of patients .
Results from thoracic and other surgical procedures suggest multiple pathogenic mechanisms that include pre- , intra- , and postoperative factors .
This review attempts to analyse the methodology and systematic s of the studies on the  post-thoracotomy pain syndrome ( PTPS ) after lung cancer surgery in adults , in order to clarify the relative role of possible pathogenic factors and to define future strategies for prevention .