Postpneumonectomy Syndrome and Post-Thoracotomy Pain Syndrome

Chronic Pain After Thoractomy and Its Impact on Lung Cancer

What are postpneumonectomy syndrome and post-thoracotomy pain syndrome?.

Definition: Postpneumonectomy Syndrome and Post Thoracotomy Pain Syndrome

Postpneumonectomy syndrome is a complication that can occur months to years following a pneumonectomy for lung cancer or other conditions. It is more common following a left pneumonectomy than a right pneumonectomy and occurs more frequently in younger people.

Post-thoracotomy pain syndrome (PTPS) is another phrase used to describe this severe pain and includes pain after other lung cancer surgeries such as lobectomy as well.

The syndrome occurs when the remaining lung and structures in the middle area of the chest (the mediastinum) are displaced, and fill the empty area that is left after a lung, or part of a lung, is removed. 

Significance and Importance

It's thought that 50 percent of post surgery patients with lung cancer experience post-pneumonectomy syndrome or post-thoracotomy pain syndrome to a degree in which it interferes with quality of life. It is probably under-reported and is seriously under-treated among those who have survived lung cancer. 

Postpneumonectomy syndrome can have a significant impact on a lung cancer survivors well-being, and indirectly through this, on her recovery.


Symptoms often include progressive shortness of breath. Because many people have some shortness of breath following a pneumonectomy, this symptom can be easily overlooked. Many people note pain with arm movements as well.

The pain is often "neuropathic pain" a type of pain which is difficult to describe but persistent and disabling.

Why Does Post-Pneumonectomy or Post Thoracotomy Pain Syndrome Occur?

There are several mechanisms that can be responsible for pain, alone, or in combination, including:

  • Compression of the intercostal nerves (nerves that run between the ribs)
  • The trauma of surgery
  • Scar tissue which rubs with each breath
  • Fractured and compressed ribs
  • Inflammation of the chest muscles
  • Atrophy of chest muscles


A number of different treatments have been tried for post-thoracotomy syndrome, and it's likely that a combination of treatments, rather than one treatment alone, is the best option. That said, treatment involving the use of silicone implants (similar to breast implants) that are placed in the chest to fill the space left over following removal of a lung, has given some people significant relief. Recently spinal cord stimulation has also been found to be effective.


If you're coping with post-pneumonectomy or post-thoracotomy syndrome talk to your doctor. Some cancer centers have pain management specialists who are trained in ways of helping people cope with neuropathic type pain. People have also found benefit in some of the mind/body therapies such as massage therapy, qigong, and acupuncture.

The Future

With new procedures such as video-assisted thoracoscopic surgery (VATS) replacing some open thoracotomy procedures, the incidence of post-pneumonectomy syndrome will hopefully decrease in the future.

For those who are living with the syndrome today there is hope as well, and active research is ongoing looking for ways to help people cope with this annoying after effect of lung cancer surgery.

Examples: Josh was becoming more short of breath a year after his pneumonectomy for lung cancer, and his doctor diagnosed him with postpneumonectomy syndrome.


Gerner, P. Post-thoractomy Pain Management Problems. Anesthesiology Clinics. 2008. 26(2):355-vii.

Jung, J., Cho, J., Kim, H. et al. Management of post-pneumonectomy syndrome using tissue expanders. Thoracic Cancer. 2016. 7(1):88-93.

Hopkins, K., and M. Rosenzweig. Post-thoracotomy pain syndrome: assessment and intervention. Clinical Journal of Oncology Nursing. 2012. 16(4):365-70.

Wininger, K., Bester, M., and K. Deshpande. Spinal cord stimulation to treat postthoractomy neuralgia: non small-cell lung cancer: a case report. Pain Management Nursing. 2012. 13(1):52-9.

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