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 .
Muscle-sparing versus posterolateral thoracotomy: a prospective study.
OBJECTIVE Although the thoracotomy incision is guided in part by the exposure required , both cosmesis and the potential for improved recovery are important factors to be taken into account . We conducted a prospect i ve r and omized study in order to compare muscle sparing thoracotomy ( MST ) and st and ard posterolateral thoracotomy ( PLT ) for postoperative pain and physical function during and after hospitalization . MATERIAL AND METHOD One hundred patients operated from June through December 2004 were recruited in this study . Fifty patients underwent MST of 6 - 8 cm and 50 had a PLT of more than 8 cm with division of latissimus dorsi and serratus anterior muscles . Operations performed were atypical resections and lobectomies . Pneumonectomies and operations on tumors invading the chest wall or brachial plexus were excluded . Perioperative care was st and ardized concerning analgetics and physiotherapy . Postoperative pain ( quantitated by the visual analogue scale ) , preoperative and postoperative pulmonary function , shoulder strength , and range of motion were evaluated . RESULTS There was no difference in demographics , tumor stage , and type of lung resection . Patients were also matched for the number of chest tubes , length of chest tube duration , and length of hospital stay . Pain reported during hospitalization and after hospital discharge within 1 and 2 months did not differ within the two groups ( p>0.05 ) . Shoulder function was shown to decrease less in cases of MST , but physical function was not found statistically significant in comparison of the two groups ( p>0.05 ) within 1 month . Rehabilitation was also similar . CONCLUSION The rates of occurrence of acute or chronic pain and morbidity were equivalent after MST and PLT . It appears that the single advantage of MST over PLT involves the preservation of chest wall musculature in case rotational muscle flaps should be needed along with a better cosmetic result
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 .