Pathophysiology and Management of Chest Wall Pain after Surgical and Non-Surgical Local Therapies for Lung Cancer

John Nikitas, MD; Jane Yanagawa, MD; Sandra Sacks, MD; Edward K. Hui, MD; Alan Lee, MD; Jie Deng, MD, PhD; Fereidoun Abtin, MD; Robert Suh, MD; Jay M. Lee, MD; Paul Toste, MD; Bryan M. Burt, MD; Sha’Shonda L. Revels, MD; Robert B. Cameron, MD; Drew Moghanaki, MD, MPH

JTO Clinical and Research Reports (Jul 2024)

Pathophysiology and Management of Chest Wall Pain after Surgical and Non-Surgical Local Therapies for Lung Cancer

John Nikitas, MD,
Jane Yanagawa, MD,
Sandra Sacks, MD,
Edward K. Hui, MD,
Alan Lee, MD,
Jie Deng, MD, PhD,
Fereidoun Abtin, MD,
Robert Suh, MD,
Jay M. Lee, MD,
Paul Toste, MD,
Bryan M. Burt, MD,
Sha’Shonda L. Revels, MD,
Robert B. Cameron, MD,
Drew Moghanaki, MD, MPH

Affiliations

John Nikitas, MD: Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
Jane Yanagawa, MD: Division of Thoracic Surgery, University of California, Los Angeles, Los Angeles, California
Sandra Sacks, MD: Department of Anesthesiology, University of California, Los Angeles, Los Angeles, California
Edward K. Hui, MD: Center for East-West Medicine, University of California, Los Angeles, Los Angeles, California
Alan Lee, MD: Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
Jie Deng, MD, PhD: Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California
Fereidoun Abtin, MD: Thoracic Imaging and Intervention, Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, California
Robert Suh, MD: Thoracic Imaging and Intervention, Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, California
Jay M. Lee, MD: Division of Thoracic Surgery, University of California, Los Angeles, Los Angeles, California
Paul Toste, MD: Division of Thoracic Surgery, University of California, Los Angeles, Los Angeles, California
Bryan M. Burt, MD: Division of Thoracic Surgery, University of California, Los Angeles, Los Angeles, California
Sha’Shonda L. Revels, MD: Division of Thoracic Surgery, University of California, Los Angeles, Los Angeles, California
Robert B. Cameron, MD: Division of Thoracic Surgery, University of California, Los Angeles, Los Angeles, California
Drew Moghanaki, MD, MPH: Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California; Radiation Oncology Service, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California; Corresponding author. Address for correspondence: Drew Moghanaki, MD, MPH, 200 Medical Plaza Driveway, Suite #B265, Medical Plaza, Los Angeles, CA 90095.

Journal volume & issue: Vol. 5, no. 7
p. 100690

Abstract

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Chest wall pain syndromes can emerge following local therapies for lung cancer and can adversely affect patients’ quality-of-life. This can occur after lung surgery, radiation therapy, or percutaneous image-guided thermal ablation. This review describes the multifactorial pathophysiology of chest wall pain syndromes that develop following surgical and non-surgical local therapies for lung cancer and summarizes evidence-based management strategies for inflammatory, neuropathic, myofascial, and osseous pain. It discusses a step-wise approach to treating chest wall pain that begins with non-opioid oral analgesics and includes additional pharmacologic treatments as clinically indicated, such as anticonvulsants, serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, and various topical treatments. For myofascial pain, physical medicine techniques, such as acupuncture, trigger point injections, deep tissue massage, and intercostal myofascial release can also offer pain relief. For severe or refractory cases, opioid analgesics, intercostal nerve blocks, or intercostal nerve ablations may be indicated. Fortunately, palliation of treatment-related chest wall pain syndromes can be managed by most clinical providers, regardless of the type of local therapy utilized for a patient’s lung cancer treatment. In cases where a patient’s pain fails to respond to initial medical management, clinicians can consider referring to a pain specialist who can tailor a more specific pharmacologic approach or perform a procedural intervention to relieve pain.

Published in JTO Clinical and Research Reports

ISSN: 2666-3643 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.journals.elsevier.com/jto-clinical-and-research-reports/

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Abstract

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