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Myofascial Pain in Patients With Postthoracotomy Pain Syndrome
  1. Hiroshi Hamada, M.D., Ph.D.,
  2. Katsuyuki Moriwaki, M.D., Ph.D.,
  3. Kazuhisa Shiroyama, M.D.,
  4. Hiroyuki Tanaka, M.D.,
  5. Masashi Kawamoto, M.D., Ph.D. and
  6. Osafumi Yuge, M.D., Ph.D.
  1. From the Department of Anesthesiology and Critical Care Medicine, Hiroshima University School of Medicine, Hiroshima, Japan.
  1. Reprint requests: Hiroshi Hamada, M.D., Ph.D., Chugoku Rosai General Hospital, Department of Anesthesiology, 1-5-1 Hiro-Tagaya, Kure, Hiroshima, 737-0193 Japan. E-mail: s-daimao{at}


Objective Postthoracotomy pain syndrome is generally considered to be neuropathic pain due to intercostal nerve injury. However, nonneuropathic pain can also occur following thoracic surgery. We present a series of cases with postthoracotomy pain syndrome in which myofascial pain was thought to be a causative component of postthoracotomy pain syndrome.

Case Report Twenty-seven patients (17 men and 10 women) were treated with trigger point injections, intercostal nerve blocks, and/or epidural blocks. Clinical criteria were used to diagnose the myofascial pain. A visual analogue scale was used, and sensory disturbances were recorded before and after treatment. A trigger point in a taut muscular band within the scapular region, which we diagnosed as myofascial pain, was observed in 67% of the patients. The existence of this trigger point significantly increased the rate of success for the treatments.

Conclusions Postthoracotomy pain may result, at least in part, from a nonneuropathic origin (myofascial pain). It is recommended that each patient be examined in detail to determine whether there is a trigger point in a taut muscular band within the scapular region. If found, this point is suggested as a good area for anesthetic injection.

  • Postthoracotomy pain
  • Myofascial pain
  • Trigger point injection
  • Intercostal nerve block

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  • Supported in part by the Second Term Comprehensive 10 Year Strategy for Cancer Control of the Japanese Ministry of Health and Welfare.