Post Thoracotomy Pain Syndrome (PTPS) is defined as pain that occurs or persists in the area
of the thoracotomy incision for at least 2 months following the initial procedure. The true
incidence of PTPS is hard to define as literature reports a wide range of occurrence from 5%
to 90%. Thoracotomy is associated with a high risk of severe chronic postoperative pain.
Presenting symptoms include both neuropathic pain in the area of the incision, as well as
myofascial pain commonly in the ipsilateral scapula and shoulder.
Pain management can be challenging in these patients. Multiple treatments have been
described including conservative treatments with oral nonsteroidal anti-inflammatory drugs
(NSAIDs); topically applied, peripherally acting drugs; neuromodulating agents; physical
therapy; transcutaneous electrical nerve stimulation as well as more invasive treatments
including intercostal nerve blocks, trigger point steroid injections, epidural steroid injections,
radiofrequency nerve ablation, cryoablation, and one case report of spinal cord stimulation.
Unfortunately, a portion of these patients will have persistent pain in spite of multiple treatment
modalities, and in some cases will experience worsening of pain.
This case report describes the novel utility and complete resolution of symptoms with spinal
cord stimulation (SCS) in treatment of a patient with persistent PTPS.
In the operating room, a percutaneous octet electrode lead was placed using sterile technique
under fluoroscopic guidance and loss-of-resistance technique. The octet electrode lead was
subsequently advanced with the aid of fluoroscopy to the level of the T3 superior endplate
just right of midline. The patient’s pain distribution was captured optimally with stimulation
at this level. With the assistance of a neurosurgeon, the lead was anchored, tunneled, and
connected to a generator, which was implanted over the right iliac crest. The patient tolerated
the procedure well with no complications.
We report the successful use of SCS as well as complete resolution of symptoms at 4 months
follow-up, in a patient with persistent PTPS, which was resistant to other modalities.
In conclusion, studies designed to evaluate the effectiveness of SCS for PTPS may be warranted.
Key words: post thoracotomy pain syndrome, PTPS, chronic pain, spinal cord stimulation,
thoracic pain, neuropathic pain, transcranial magnetic stimulation
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