Background: Chronic post thoracotomy pain (CPTP) was a common complication after
thoracotomy, while spontaneous muscle contraction (SMC) was very rare. Neuropathic pain
components appeared in some CPTP patients. The patients with neuropathic pain (NPP) often
suffered from more severe pain.
Objective: We presented a case of a 57 year- old Chinese male, suffering from SMC with extreme
chronic pain after thoracotomy for 2 years. The patient was treated by pulsed radiofrequency
(PRF). Then we reviewed the related progresses including recent view on NPP in CPTP, the possible
mechanism of SMC, treatments for CTPT, and peripheral nerve treatments in NPP.
Study Design: Case report and review of the literature.
Methods: The patient was diagnosed as CPTP with SMC. After the experimental intercostal nerve
block provided short-term analgesia, we performed PRF through the angulus costae on intercostal
nerves under x-ray guidance. We performed PRF for 3 times in all, at an interval of 2 weeks. Then
we had followed up the pain intensity, frequency and amplitude of SMC of this patient during the
2 years.
Results: The pain intensity decreased from 8 to 2 on the visual analogue scale (VAS). The frequency
of muscle contraction was decreased by 90%, and the amplitude was decreased by 60%. The
treatment also improved the patient’s sleep quality. These improvements were stable in 2 years’
follow-up. In our review of the literature, the SMC may be based on the pain-spasm-pain model.
Limitation: Single case report.
Conclusion: Pulsed radiofrequency provided good efficacy in CPTP with SMC in this case.
Key words: Chronic post-thoracotomy pain, pulsed radiofrequency, intercostal nerve, angulus
costae, neuropathic pain, muscle spasm
Posterior epidural migration of sequestered lumbar disc fragment causing cauda equina syndrome
