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 .
Has postoperative pain been eradicated?
Recent evidence suggests that surgical trauma induces a process of central nervous system sensitisation that contributes to and enhances postoperative pain . These changes are also thought to be the underlying cause of much chronic pain . Central sensitisation is generated not only during surgery , but also postoperatively as a result of the inflammatory response to the damaged tissue . This knowledge provides a rational basis for pro-active , pre-emptive and postoperative analgesic strategies to reduce the neuronal barrage associated with tissue damage . Reduction or elimination of postoperative pain is therefore possible . We advocate the use of continuous extrapleural intercostal nerve block for postoperative analgesia in patients undergoing thoracotomy .  When this is begun pre-emptively ( by precutaneous , pre-incisional paravertebral block ) it is combined with an opiate and a non-steroidal anti-inflammatory drug premedication . In a r and omised study of 56 patients , pain scores of less than 0.5 cm on a 10 cm scale were produced , postoperative lung function was preserved and glucose and cortisol responses were significantly unchanged from preoperative values . Evidence that effective perioperative analgesia reduces the incidence of chronic post-thoracotomy chest wall pain was found in a retrospective study of 1000 consecutive thoracotomies . The endpoints of a zero pain score , complete preservation of preoperative lung function and prevention of the stress response to trauma are currently achievable and should be provided for virtually all patients undergoing chest surgery . Pre-empting pain must be the goal for all those involved in the postoperative care of patients
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 .