Post Thoracic Pain Syndrome

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March 24, 2015 at 11:34 pm  #1269008    

k2rruss55

Hello:

8 months after having a lobectomy for an upper right 1A Adenocarcinoma, I started experiencing pain around the incision area. After many tests to confirm that the cancer had not returned, I was finally referred to a pain management doctor who diagnosed me with Post Thoracic Pain Syndrome. He gave me a nerve block for areas around 3 ribs. The pain subsided for a day or two, but is now coming back.

I was curious if anyone else had this same issue. If so, any information you can provide would be very helpful.

Thank you.

Karen

March 25, 2015 at 4:27 am  #1269011    
JimC Forum Moderator
JimC Forum Moderator

Hi Karen,

Welcome to GRACE. I am sorry that you are experiencing this pain, and I hope you can find a solution soon.

GRACE’s Dr. Pinder had this to say about Post Thoracic Pain Syndrome:

“Although not common, post-thoracotomy pain syndrome can be an extremely frustrating condition to experience. The hypersensitivity of the nerves is a real challenge. Because it is due to nerve damage, narcotic pain medications are not tremendously helpful, and people end up fighting the side effects of the narcotics without real pain relief.

When one of my patients has chronic post-thoracotomy pain, I tend to start gabapentin with a slowly increasing titration. Although this is more commonly recognized as an (older) seizure medication, it has effects on nerve pain, although we don’t really understand the mechanism. Medications like this (or amitriptyline, another medication that can help nerve pain) don’t work immediately on pain, and I warn patients that they will not notice instant effects. However, after taking it for several weeks, one tends to look back over time and realize that the pain is diminished compared to where it was previously. Some people need to take the medications long term, but in many we will treat for 6 months or a year, and then start tapering back off the medication to see how things go.

Sometimes topical lidocaine patches can be helpful for a local effect.

Many times, some hyper-stimulation of the nerve (like you have found, tight clothing, applying heat; or also firmly rubbing the area or even capsaicin cream) will help it to calm down a bit. I’m not clear whether this helps over the long term or if just the underlying healing process does that.

For very difficult pain situations, I have referred people to a pain management specialist to consider an injection at the area to block the damaged nerve. This is much more of a last resort.

(continued in the next post)


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

March 25, 2015 at 4:29 am  #1269012    
JimC Forum Moderator
JimC Forum Moderator

(continued)

There are always options to consider for treatment of pain, although sometimes the side effects might be more bothersome than the pain itself. These issues must be carefully weighed in each unique situation.
http://cancergrace.org/forums/index.php?topic=8202.0

You may also find this page helpful: http://www.gotpaindocs.com/post_thoractmy_pn.htm

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

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