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 .
Pain and physical function are similar following axillary, muscle-sparing vs posterolateral thoracotomy.
STUDY OBJECTIVES We set out to determine whether there is a difference in postoperative pain and recovery after the patient undergoes the axillary muscle-sparing incision ( ie  ,  muscle-sparing thoracotomy [ MT ] ) vs the modified posterolateral incision ( ie  ,  posterolateral thoracotomy [ PT ] ) .  DESIGN Analysis of a data base originally collected to determine the effect of the timing of epidural analgesia on long-term outcome after thoracotomy . SETTING The Hospital of the University of Pennsylvania . PATIENTS Patients presenting for lobectomy , segmentectomy , or bilobectomy . MEASUREMENTS Pain , physical activity , and the extent that pain interfered with activities following major thoracotomy were prospect ively assessed with st and ard question naires ( ie , the brief pain inventory and the Medical Outcomes Study 36-item short form ) 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 Eighty-two subjects underwent MT and 38 subjects underwent PT  during the 16-month accrual period . There were no significant differences in demographics . Pain reported during hospitalization and after hospital discharge did not differ with respect to incision type ( p > or = 0.17 ) . Postoperative physical activity levels were significantly less than those reported preoperatively , with a trend toward better functioning in the MT groups after 8 weeks . Incision type did not predict complications , morbidity , or mortality . CONCLUSIONS When comparing patients who had undergone vertical , axillary , wholly MT to those who had undergone modified serratus muscle-sparing PT , postoperative differences in pain were not apparent . One should not anticipate reduced pain or more rapid overall recovery following MT , at least when epidural analgesia is used aggressively for perioperative pain control
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 .