Table of ContentsView AllTable of ContentsSyndromesSymptomsCausesTreatmentCoping

Table of ContentsView All

View All

Table of Contents

Syndromes

Symptoms

Causes

Treatment

Coping

The life-saving lung cancer surgery that removes malignant tumors can, in some instances, cause debilitating chest pain, breathing discomfort, burning sensations, and pain with movement. Not all people who undergo surgery fornon-small cell lung cancerdevelop this post-operative problem, but it is common with lobectomy and pneumonectomy. Thankfully, the discomfort is typically manageable and should eventually pass.

Rawpixel/Getty Images

A man sitting on his bed with pain in his chest and lungs

If you find yourself suffering from chronic pain after lung surgery, you should discuss it with your healthcare provider immediately so you can begin treatments that can help you deal with the pain while ensuring you stay on the road toward remission.

Chronic Pain Syndromes

Pain after lung surgery is associated with an open-chest lung resection, a procedure that involves surgically opening the chest and pulling back the ribs to either remove tissue from one lung or an entire lung. This is usually done in an effort to removestage 1,stage 2, orstage 3Acancerous tumors, but may also be used to treattuberculosis, severeCOPD, or trauma to the chest.

Depending on what type of lung resection surgery you undergo, you may be at risk of developing either postpneumonectomy syndrome or post-thoracotomy pain syndrome. A 2014 meta-analysis included a total of 2,793 patients and found that the incidence of post-chest surgery pain syndrome at three and six months after thoracotomy was approximately 50% and had not decreased significantly since the 1990s.

Postpneumonectomy Syndrome

A pneumonectomy is the removal of one entire lung. In rare cases, within a few weeks to as long as several years after surgery, patients who undergo this procedure may develop postpneumonectomy syndrome (PPS).

Children have a greater risk of developing PPS. It’s also more frequent following the removal of the left lung versus the right.

Post-Thoracotomy Pain Syndrome

Athoracotomyis any surgery in which your healthcare provider opens the chest to access the heart, the lungs, esophagus, or other thoracic organs.

Post-thoracotomy pain syndrome (PTPS) is specifically associated withlobectomyoperations in which healthcare providers remove lung cancer tumors along with one of the five lobes that make up your lungs (your right lung has three lobes; your left lung has two).

Your healthcare provider will probably order several tests to diagnose PPS. These can includecomputed tomography (CT) scans,pulmonary function tests (PFTs), andbronchoscopy.

A CT scan might be used to rule out tumor recurrence, but to confirm a PTPS diagnosis, nerve blockers or anesthetic medications will be administered to test if your pain responds to those therapies.

Long-term pain after lobectomy surgery is more common than after a pneumonectomy. But whichever type of problem you suffer from, the discomfort may taper off. Studies show that 50% to 70% of people who undergo lung resection feel pain for two or more months after surgery; that number drops to 40% after one year.

Symptoms of Post-Lung Surgery Pain

Chronic pain after lung cancer surgery can take a number of different forms. The pain is mild in most cases, though it can still be inconvenient. About 50% of people report that the pain interferes with their daily life.

These can cause a variety of sensations:

Pain may be present both with activity and at rest, and many people note a worsening of the pain with arm movements.

The process of opening up the chest and pushing back the rib cage is invasive. Added to that, your healthcare provider needs to remove tissue in the chest, which disrupts the natural placement of the organs and body systems. The post-operative healing process itself can also lead to late-onset pain.

A combination of factors that can contribute to chronic pain include:

A number of different treatments are currently used to help manage pain after a lung resection. Your healthcare providers will likely recommend a combination of treatments to combat the pain rather than one treatment alone. This multi-modal approach has been seen to be more successful because it targets multiple sites that can cause pain.

Oral Medications

The oral medications most commonly prescribed for PPS and PTPS arenon-steroid anti-inflammatory drugs(NSAIDs) andopioids. These may be used together or alone.

Opiods

Opiods pose a range of side effects. Minor ones include sleepiness, constipation, and nausea. They may also cause issues that interfere with everyday life, including confusion. More serious side effects may include shallow breathing, slowed heart rate, and loss of consciousness.

Serious complications could be fatal. These should be reported to a healthcare provider immediately.

Two of the most notable downsides to these drugs are:

How to Take Painkillers Safely and Avoid Addiction

NSAIDs

NSAIDS are frequently used in place of opioids because they offer several advantages for lung cancer patients suffering from post-surgery pain, including:

Before Using MedicationsNSAIDs can result in kidney damage (​acute renal failure), which is a significant risk for older adults and those with renal disorders. An estimated 2.5 million people experience NSAID-related kidney problems each year. Discuss the risks with your healthcare provider before beginning a regular regimen of NSAIDs.Opioid addiction is a significant problem that affects people of every walk of life. Talk with your healthcare provider about how to properly use painkillers before you begin taking them to ensure you don’t become addicted.

Before Using Medications

NSAIDs can result in kidney damage (​acute renal failure), which is a significant risk for older adults and those with renal disorders. An estimated 2.5 million people experience NSAID-related kidney problems each year. Discuss the risks with your healthcare provider before beginning a regular regimen of NSAIDs.Opioid addiction is a significant problem that affects people of every walk of life. Talk with your healthcare provider about how to properly use painkillers before you begin taking them to ensure you don’t become addicted.

NSAIDs can result in kidney damage (​acute renal failure), which is a significant risk for older adults and those with renal disorders. An estimated 2.5 million people experience NSAID-related kidney problems each year. Discuss the risks with your healthcare provider before beginning a regular regimen of NSAIDs.

Opioid addiction is a significant problem that affects people of every walk of life. Talk with your healthcare provider about how to properly use painkillers before you begin taking them to ensure you don’t become addicted.

Silicone Implants

These tissue expanders have been shown to relieve symptoms when placed in the chest after a patient begins to experience pain.

Nerve Blocks

Anintercostal nerveblock is an injection of medication into the intercostal nerve region (located under each rib) that has proven to be successful in relieving chest pain related to lung surgery.

Healthcare providers apply a local anesthetic and then inject either steroid medication or ananalgesic(pain medication) into the area where you’re feeling discomfort. This can bring down inflammation and ease chronic pain.

You may have some relief immediately after receiving the first injection, but it usually takes a few days for the full effects to begin to be felt. You may need to continue to have regular injections several months apart to remain pain-free.

Nerve Blocks for Chronic Pain: What to Expect

For previous generations, a poor prognosis for lung cancer meant that few people who were treated for the disease lived long enough to worry about complications such as chronic postoperative pain.

Today, if there’s any silver lining to experiencing such pain it is that it is an indication that treatment advances have made it possible to live a longer life with the disease—long enough for this complication to occur.

Focus on the fact that this is good news, and that as cancer treatments continue to advance, there will be better options to manage your pain. This perspective is part of assuming apositive, hopeful attitudethat will help you heal and enjoy life every day.

Also consider meeting with apain management specialistwho can talk you through all your treatment options, both pharmaceutical and non-pharmaceutical, so you feel confident that you’re doing all you can to ease your symptoms.

You may also want to look intoalternative cancer treatmentssuch as massage therapy and acupuncture, which can help with pain as well as the physical and emotional aftermath of cancer treatment.

A Word From Verywell

With new, less-invasive procedures that allow surgeons to remove cancer without fully opening up the chest cavity (such as video-assisted thoracoscopic surgery), the incidence of PPS and PTPS syndrome will hopefully decrease.

9 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Essaleh W, Stanzel F, Welter S.A postpneumonectomy syndrome with congenital pectus excavatum using Ravitch’s procedure and silicone breast implants.Int J Surg Case Rep. 2020;72:27-31. doi:10.1016%2Fj.ijscr.2020.05.044Gerner P.Postthoracotomy pain management problems.Anesthesiol Clin. 2008;26(2):355-67, vii. doi:10.1016%2Fj.anclin.2008.01.007Dziedzic D, Orlowski T.The role of VATS in lung cancer surgery: Current status and prospects for development.Minim Invasive Surg. 2015;2015:938430. doi:10.1155%2F2015%2F938430Mesbah A, Yeung J, Gao F.Pain after thoracotomy.BJA Education.2016;16(1)1-7. doi:10.1093/bjaceaccp/mkv005Kelsheimer B, Williams C, Kelsheimer C.New emerging modalities to treat post-thoracotomy pain syndrome: A review.Mo Med. 2019;116(1):41-44.Debeaumont D, Bota S, Baste JM, et al.Postpneumonectomy compression of the mitral annulus: Rare vascular complication in sportive patient.Case Rep Pulmonol. 2016;2016:9575894. doi:10.1155%2F2016%2F9575894Bayman EO, Parekh KR, Keech J, Selte A, Brennan TJ.A prospective study of chronic pain after thoracic surgery.Anesthesiology. 2017;126(5):938–951. doi:10.1097/ALN.0000000000001576American Society of Anesthesiologists.What are opioids?Jung JJ, Cho JH, Kim HK, et al.Management of post-pneumonectomy syndrome using tissue expanders.Thorac Cancer. 2016;7(1):88-93. doi:10.1111%2F1759-7714.12282Additional ReadingHopkins, K., and M. Rosenzweig.Post-Thoracotomy Pain Syndrome: Assessment and Intervention.Clinical Journal of Oncology Nursing. 2012. 16(4):365-70.Steegers, M., Snik, D., Verhagen. A.Only Half of the Chronic Pain After Thoracic Surgery Shows a Neuropathic Component.The Journal of Pain. 2008. 9(10):955-961.

9 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Essaleh W, Stanzel F, Welter S.A postpneumonectomy syndrome with congenital pectus excavatum using Ravitch’s procedure and silicone breast implants.Int J Surg Case Rep. 2020;72:27-31. doi:10.1016%2Fj.ijscr.2020.05.044Gerner P.Postthoracotomy pain management problems.Anesthesiol Clin. 2008;26(2):355-67, vii. doi:10.1016%2Fj.anclin.2008.01.007Dziedzic D, Orlowski T.The role of VATS in lung cancer surgery: Current status and prospects for development.Minim Invasive Surg. 2015;2015:938430. doi:10.1155%2F2015%2F938430Mesbah A, Yeung J, Gao F.Pain after thoracotomy.BJA Education.2016;16(1)1-7. doi:10.1093/bjaceaccp/mkv005Kelsheimer B, Williams C, Kelsheimer C.New emerging modalities to treat post-thoracotomy pain syndrome: A review.Mo Med. 2019;116(1):41-44.Debeaumont D, Bota S, Baste JM, et al.Postpneumonectomy compression of the mitral annulus: Rare vascular complication in sportive patient.Case Rep Pulmonol. 2016;2016:9575894. doi:10.1155%2F2016%2F9575894Bayman EO, Parekh KR, Keech J, Selte A, Brennan TJ.A prospective study of chronic pain after thoracic surgery.Anesthesiology. 2017;126(5):938–951. doi:10.1097/ALN.0000000000001576American Society of Anesthesiologists.What are opioids?Jung JJ, Cho JH, Kim HK, et al.Management of post-pneumonectomy syndrome using tissue expanders.Thorac Cancer. 2016;7(1):88-93. doi:10.1111%2F1759-7714.12282Additional ReadingHopkins, K., and M. Rosenzweig.Post-Thoracotomy Pain Syndrome: Assessment and Intervention.Clinical Journal of Oncology Nursing. 2012. 16(4):365-70.Steegers, M., Snik, D., Verhagen. A.Only Half of the Chronic Pain After Thoracic Surgery Shows a Neuropathic Component.The Journal of Pain. 2008. 9(10):955-961.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Essaleh W, Stanzel F, Welter S.A postpneumonectomy syndrome with congenital pectus excavatum using Ravitch’s procedure and silicone breast implants.Int J Surg Case Rep. 2020;72:27-31. doi:10.1016%2Fj.ijscr.2020.05.044Gerner P.Postthoracotomy pain management problems.Anesthesiol Clin. 2008;26(2):355-67, vii. doi:10.1016%2Fj.anclin.2008.01.007Dziedzic D, Orlowski T.The role of VATS in lung cancer surgery: Current status and prospects for development.Minim Invasive Surg. 2015;2015:938430. doi:10.1155%2F2015%2F938430Mesbah A, Yeung J, Gao F.Pain after thoracotomy.BJA Education.2016;16(1)1-7. doi:10.1093/bjaceaccp/mkv005Kelsheimer B, Williams C, Kelsheimer C.New emerging modalities to treat post-thoracotomy pain syndrome: A review.Mo Med. 2019;116(1):41-44.Debeaumont D, Bota S, Baste JM, et al.Postpneumonectomy compression of the mitral annulus: Rare vascular complication in sportive patient.Case Rep Pulmonol. 2016;2016:9575894. doi:10.1155%2F2016%2F9575894Bayman EO, Parekh KR, Keech J, Selte A, Brennan TJ.A prospective study of chronic pain after thoracic surgery.Anesthesiology. 2017;126(5):938–951. doi:10.1097/ALN.0000000000001576American Society of Anesthesiologists.What are opioids?Jung JJ, Cho JH, Kim HK, et al.Management of post-pneumonectomy syndrome using tissue expanders.Thorac Cancer. 2016;7(1):88-93. doi:10.1111%2F1759-7714.12282

Essaleh W, Stanzel F, Welter S.A postpneumonectomy syndrome with congenital pectus excavatum using Ravitch’s procedure and silicone breast implants.Int J Surg Case Rep. 2020;72:27-31. doi:10.1016%2Fj.ijscr.2020.05.044

Gerner P.Postthoracotomy pain management problems.Anesthesiol Clin. 2008;26(2):355-67, vii. doi:10.1016%2Fj.anclin.2008.01.007

Dziedzic D, Orlowski T.The role of VATS in lung cancer surgery: Current status and prospects for development.Minim Invasive Surg. 2015;2015:938430. doi:10.1155%2F2015%2F938430

Mesbah A, Yeung J, Gao F.Pain after thoracotomy.BJA Education.2016;16(1)1-7. doi:10.1093/bjaceaccp/mkv005

Kelsheimer B, Williams C, Kelsheimer C.New emerging modalities to treat post-thoracotomy pain syndrome: A review.Mo Med. 2019;116(1):41-44.

Debeaumont D, Bota S, Baste JM, et al.Postpneumonectomy compression of the mitral annulus: Rare vascular complication in sportive patient.Case Rep Pulmonol. 2016;2016:9575894. doi:10.1155%2F2016%2F9575894

Bayman EO, Parekh KR, Keech J, Selte A, Brennan TJ.A prospective study of chronic pain after thoracic surgery.Anesthesiology. 2017;126(5):938–951. doi:10.1097/ALN.0000000000001576

American Society of Anesthesiologists.What are opioids?

Jung JJ, Cho JH, Kim HK, et al.Management of post-pneumonectomy syndrome using tissue expanders.Thorac Cancer. 2016;7(1):88-93. doi:10.1111%2F1759-7714.12282

Hopkins, K., and M. Rosenzweig.Post-Thoracotomy Pain Syndrome: Assessment and Intervention.Clinical Journal of Oncology Nursing. 2012. 16(4):365-70.Steegers, M., Snik, D., Verhagen. A.Only Half of the Chronic Pain After Thoracic Surgery Shows a Neuropathic Component.The Journal of Pain. 2008. 9(10):955-961.

Hopkins, K., and M. Rosenzweig.Post-Thoracotomy Pain Syndrome: Assessment and Intervention.Clinical Journal of Oncology Nursing. 2012. 16(4):365-70.

Steegers, M., Snik, D., Verhagen. A.Only Half of the Chronic Pain After Thoracic Surgery Shows a Neuropathic Component.The Journal of Pain. 2008. 9(10):955-961.

Meet Our Medical Expert Board

Share Feedback

Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit

Was this page helpful?

Thanks for your feedback!

What is your feedback?OtherHelpfulReport an ErrorSubmit

What is your feedback?