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 .
Long-term Pain and Activity during Recovery from Major Thoracotomy Using Thoracic Epidural Analgesia
Background Pain  following thoracotomy  can persist for years with an undetermined impact on quality of life . Factors hypothesized to modulate this painful experience include analgesic regimen , gender , and type of incision . Methods A total of 157 generally healthy patients of both genders scheduled for segmentectomy , lobectomy , or bilobectomy through a posterolateral or muscle-sparing incision were r and omly assigned to receive thoracic epidural analgesia initiated prior to incision or at the time of rib approximation .  Pain and activity scores were obtained 4 , 8 , 12 , 24 , 36 , and 48 weeks after surgery . Results Overall , there were no differences in pain scores between the control and intervention groups during hospitalization ( P ≥ 0.165 ) or after discharge ( P ≥ 0.098 ) . The number of patients reporting pain 1 yr following surgery ( 18 of 85 ; 21.2 % ) was not significantly different ( P = 0.122 ) from the number reporting preoperative pain ( 15 of 120 ; 12.5 % ) . During hospitalization , women reported greater pain than men ( worst pain , P = 0.007 ; average pain , P = 0.016 ) . Women experienced fewer supraventricular tachydysrhythmias ( P = 0.013 ) and were thus discharged earlier ( P = 0.002 ) . After discharge women continued to report greater discomfort than men ( P ≤ 0.016 ) , but did not differ from men in their level of physical activity ( P = 0.241 ) . Conclusions Initiation of thoracic epidural analgesia prior to incision or the use of a muscle-sparing incision did not significantly impact pain or physical activity . Although women reported significantly greater pain during hospitalization and after discharge , they experienced fewer complications , were more likely to be discharged from the hospital sooner , and were just as active after discharge as men
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 .