Chronic pain after thoracic surgery: mechanisms, risk factors, and limitations of current preventive strategies-a narrative review.

Authors

Yang Gu, Ji Liu, Zongmei Wen, Xin Lv, Xuefei Hu

Published in

Journal of thoracic disease. Volume 18. Issue 8. Pages 975. Aug 31, 2026. Epub Aug 28, 2026.

Abstract

Despite advances in surgical techniques and perioperative analgesia, chronic pain after thoracic surgery (CPTS) is a common and clinically significant complication. Its continued prevalence suggests that current preventive strategies remain insufficient. This narrative review aimed to synthesize current evidence on the mechanisms, risk factors, and limitations of existing preventive strategies for CPTS, with a focus on the transition from acute to chronic pain.
PubMed, Embase, and Web of Science were searched from database inception to March 2026 for English-language evidence on thoracic surgery, chronic postsurgical pain, risk factors, mechanisms, and perioperative interventions. Thoracic-specific systematic reviews, randomized trials, and prospective studies were prioritized and narratively synthesized; mechanistically informative and selected non-thoracic translational evidence was included where directly relevant.
CPTS is a multifactorial condition involving peripheral nerve injury, neuroinflammation, central sensitization, psychological vulnerability, and the evolving postoperative pain trajectory. Preoperative pain and severe acute postoperative pain are among the most reproducible clinical signals, whereas demographic and procedure-related predictors are less consistent. Multimodal and regional analgesia improve acute recovery, but evidence for CPTS prevention remains inconsistent, partly because brief perioperative interventions may not address prolonged or heterogeneous mechanisms. Early persistent pain may therefore provide a clinically relevant window for reassessment and selective escalation of care.
No single intervention reliably prevents CPTS. Standard procedure-specific multimodal care should be combined with longitudinal risk assessment, attention to dynamic pain trajectories, and selective psychological or transitional pain support. Future trials should test externally validated, risk-stratified care pathways rather than isolated short-duration interventions.

PMID:
42724526
Bibliographic data and abstract were imported from PubMed on 11 Sep 2026.

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