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 .
Intercostal muscle flap reduces the pain of thoracotomy: a prospective randomized trial.
BACKGROUND Thoracotomy is associated with significant pain and morbidity . METHODS We performed a prospect i ve r and omized trial over 4 months . Patients were r and omized to a st and ard posterior-lateral thoracotomy or an identical procedure , except an intercostal muscle was harvested from the lower rib ( to protect the intercostal nerve ) before chest retraction . To ensure an equal distribution among both groups , patients were stratified by race , sex , and type of pulmonary resection . All patients received similar pain management . Pain was assessed by using multiple pain scores during hospitalization and after discharge . Outcomes assessed were pain scores , spirometric values , analgesic use , and activity level . RESULTS There were 114 patients . The median time for intercostal muscle harvesting was 3.7 minutes . The numeric pain scores were lower for the intercostal muscle group on postoperative days 1 and 2 and at weeks 1 , 2 , 3 , 4 , 8 , and 12 ( P < .05 for all ) . In addition , patients in the intercostal muscle group had a smaller decrease in spirometric values , were less likely to be using analgesics , and were more likely to have returned to normal activity . CONCLUSIONS The harvesting of an intercostal muscle flap before chest retraction decreases the pain of thoracotomy and leads to a lower decrease in spirometry . In addition , patients have less pain at 1 , 2 , 3 , 4 , 8 , and 12 weeks postoperatively and are less likely to be using narcotics . Finally , it offers a pedicled muscle flap that takes little time to harvest and is able to buttress all bronchi after lobectomy
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 .