Chronic post-sternotomy pain

Background: Chronic postoperative pain is a well-recognised problem. The incidence of severe incapacitating pain is about 35% after various types of surgery such as thoracotomy, repair of inguinal hernias and mastectomy. Sternotomy causes considerable postoperative pain and patients with chronic post-stemotomy pain are often referred to pain clinics. Epidemiological studies on chronic post-sternotomy pain are scarce, however. The aim of this paper was to study the incidence and possible risk factors of chronic pain following sternotomy operations performed for coronary bypass grafting or thymectomy. Methods: Two groups of patients were studied for persistent pain following sternotomy operations. A questionnaire was sent in January 1997 to 71 patients with myasthenia gravis (MG) who had undergone a thymectomy during 1985-1996 and 720 patients who had had coronary bypass grafting (CABG) in 1994 were interviewed by letter. The patients were asked about the presence of pain and other symptoms in the chest, shoulders, arms or legs that they thought were connected to surgery. They were also asked about the quality of the pain and its evolvement with time. The patients' records were checked for details about surgery, anaesthesia and the state of the coronary disease. Results: The response rate was 87%. The interval between the interview and surgery varied from 6 months to 12 years in the MG group and it was 2-3 years in the CABG group. In the MG group, 27% of the patients reported chronic post-sternotomy pain, which was moderate to severe in 48% of the patients. In the CABG group, 28% of the patients still had post-sternotomy pain, which was moderate to severe in 38% of patients. Of the patients who had post-stemotomy pain, one-third reported sleep disturbances due to the pain. Conclusion: Chronic post-sternotomy pain is an important complication that may have a significant impact on the patient's everyday life. Future studies will show whether minimising complications, improving postoperative care and starting early adequate pain management will reduce the incidence of this problem.