A survey of post‐sternotomy chronic pain following cardiac surgery

Abstract

Introduction: Persistent chest wall pain following cardiac surgery, termed Post CABG Pain Syndrome (PCPS) in 1989 [1], has an incidence of up to 56% and is an important postoperative complication. Our patients are not forewarned for PCPS. We undertook a survey of 100 CABG patients in order to determine the incidence of PCPS in our population. Method. We obtained local ethics committee approval for this structured questionnaire. One hundred consecutive CABG patients were contacted by telephone eight to ten months after their operation. PCPS was defined using previously published criteria [1]. The pain was qualified in terms of its site, nature, severity, neuropathic component, need for analgesics and effect on sleep and activities of daily living. The data was analysed using Fisher's exact test with Bonferroni correction for multiple comparisons and unpaired Student's t-test. A separate questionnaire established the cardiac surgeons' perceived incidence of PCPS. Results. Completed data sets were available for 79 patients. 46% of patients met the criteria for a diagnosis of PCPS. Analysis revealed statistically significant higher mean pain scores on ICU (P=0.012), the ward (P=0.046) and on discharge (P=0.024) in the patients with PCPS. Subgroup analysis of other previously reported risk factors for PCPS failed to reach statistical significance. The cardiac surgeons estimated the incidence of PCPS to be 0.01 - 5%. Discussion. This study reveals a high incidence (46%) of PCPS in our population. Our data shows that increased post-operative pain is a risk factor for developing PCPS. Limitations of this study include selection bias and small sample size. We conclude that PCPS is a significant complication for which patients should be forewarned. We intend to further investigate the link between increased post-operative pain and PCPS.