Of all surgical procedures requiring a sternotomy, coronary bypass surgery is certainly the most common one. During coronary bypass surgery, a median sternotomy is performed by making a vertical incision in the middle of the sternum (breastbone), in order to open the chest cavity and access coronary arteries. Although this procedure has a great success rate nowadays, there is still certain risk of side effects.
Besides other, more severe side effects related to coronary arteries and grafts, people often complain about postoperative pain located in the chest wall. During the first few weeks after surgery, sternal pain represents a normal reaction to tissue damage done during the sternotomy, but with wound healing and scar formation, this pain should decrease and eventually disappear. Sometimes, postoperative pain can persist for six months or even for years after surgery. This is labeled as chronic post-sternotomy pain.
Chronic Post-sternotomy Pain
Studies have shown that the frequency of post-sternotomy pain lasting for more than six months after coronary bypass surgery is about 37 percent. Additionally, three to five percent of patients have severe, disabling post-sternotomy pain during the first year after surgery. Patients often describe this pain as pricking, aching (continuous dull pain), lancinating (sharp, stabbing), and allodynic (painful to touch). Tingling sensations have also been noticed in arms and shoulders.
Causes of Chronic Post-sternotomy Pain
Ischemic pain caused by narrowed coronary arteries should be eliminated after coronary bypass surgery. However, it is possible for the blood flow through the coronary arteries to remain insufficient after surgery, thus causing ischemic pain. In order to exclude that possibility, all patients experiencing persistent post-bypass surgery pain should undergo a stress test and other examinations the cardiologist deems necessary.
Analgesics overuse. Studies have shown that increased use of analgesics (pain relievers) during the first few weeks after surgery was related to a higher incidence of chronic postoperative pain. A possible explanation is that analgesics may be weakening a person's pain control systems, but the exact cause of this phenomenon is still unknown.
Wound infection. Patients with postoperative complications such as wound infection have a prolonged recovery period which may contribute to the development of chronic postoperative pain. Infection can lead to the improper healing of the sternal wound, thus causing dehiscence (separation along the wound suture), which also produces pain, especially during movements. To investigate all the abnormalities of bone structures including the sternum, a chest X-ray is required.
Neuropathic pain. If all the above causes are eliminated, the pain is often labeled as neuropathical. This type of chronic pain appears due to nerve damage caused by the incision or postoperative complications, such as wound infection. Neuropathic pain is treated in specialized pain clinics.
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