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 .
Thoracotomy and thoracoscopy: postoperative pulmonary function, pain and chest wall complaints.
OBJECTIVE Two different surgical accesses combined with st and ard pain management procedures are compared regarding early and intermediate pulmonary function and pain relief . METHODS In a prospect i ve study , 15 consecutive patients undergoing video-thoracoscopy for pulmonary wedge resection ( group 1 ) were matched to 15 patients undergoing st and ard postero-lateral thoracotomy for lobectomy ( group 2 ) according to age , gender and preoperative pulmonary function . Postoperative pain control consisted of patient controlled analgesia in group 1 and epidural analgesia in group 2 .  Pain intensity was scored from 0 - 4 . The predicted postoperative pulmonary function ( FVC and FEV 1 ) after lobectomies was calculated from the preoperative value according to the extent of resection . A clinical measurement was obtained after a mean follow-up time of 4.2 months . RESULTS The ratios of postoperative measured to predicted values of FVC and FEV1 for group 1 compared with group 2 were 0.64 + /- 0.15 and 0.65 + /- 0.14 compared with 0.60 + /- 0.19 and 0.59 + /- 0.13 , resp . ( both n.s . ) at the first day postoperative ; 0.92 + /- 0.18 and 0.95 /- 0.17 compared with 0.76 + /- 0.20 ( P < 0.05 ) and 0.83 + /- 0.23 ( n.s . ) , resp . at hospital discharge ; 0.98 + /- 0.10 and 0.94 + /- 0.14 compared with 1.01 + /- 0.17 ( n.s . ) and 1.10 + /- 0.17 ( P < 0.05 ) , resp . at follow-up . Pain intensity score one day after surgery ranged from 0.4 ( resting position ) to 1.6 ( coughing ) for group 1 , and from 0.3 to 1.2 for group 2 . Thirty-six percent of the thoracoscopy patients and 33 % of the thoracotomy group complained of persistent pain or discomfort on the site of the operation after 3 - 18 months . CONCLUSION Post-thoracotomy pain can be effectively controlled with epidural analgesia and pain intensity is no higher than in patients after thoracoscopy who are managed with patient controlled analgesia . FVC is slightly more decreased after thoracotomy during the early postoperative period . FVC and FEV 1 approach the predicted values after four months in both groups . The rate of persistent pain is similar after thoracoscopy and thoracotomy
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 .