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Post-thoracotomy pain syndrome (PTPS) develops after a thoracotomy (open or laparoscopic) and is one of the most often reported chronic postsurgical pain syndromes.

Pain is transmitted to the central nervous system via thinly myelinated Aδ and unmyelinated C-fibers. The former convey the sensation of sharp, lancinating “first” pain, whereas the latter conduct the dull, longer-lasting “second” pain. Aδ-fibers predominantly respond to mechanical stimuli (Type I or “high-threshold mechanoreceptor”) or to noxious heat (Type II). Conversely, the C-fibers are polymodal, the same fiber responding to mechanical, thermal and chemical stimuli. Both Aδ- and C-fibers terminate in the superficial dorsal horn, mainly in Rexed Laminae I and II, although some Aδ-fibers also terminate in the deeper lamina V. In the periphery, the distal endings terminate freely in the tissues. These free nerve endings express a variety of signal transducing molecules, one of the most extensively investigated being the transient receptor potential ion channel TRPV1, also known as the capsaicin receptor [1].

Phantom Limb Pain (PLP) is the feeling of pain in a limb, portion of a limb, or organ after its amputation. PLP can also occur after nerve avulsions or spinal cord injuries. Around 80 % of people who undergo amputation experience some degree of PLP.

Spinal cord stimulation (SCS) is a treatment option for severe neuropathic pain not responsive to more conservative treatments. Common indications include FBSS, CRPS types 1 and 2, and painful radiculopathies. Other indications include but are not limited to painful peripheral vascular disease, post-herpetic neuralgia, and axial low back pain. Careful patient selection is paramount; contraindications include but are not limited to certain severe psychological comorbidities, active infection, and an inability to pause anticoagulants for the procedure. Prior to implantation of the impulse generator, the patient must first undergo a trial with a percutaneous or surgically placed lead and show at least a 50 % improvement in pain or functional status.

The intercostal nerve block (ICN) is used in acute and chronic pain conditions of the thorax and the upper abdomen. It can be performed for analgesia in cases of rib fractures or in chronic pain conditions such as postmastectomy and post-thoracotomy pain.

Background Inadequately treated postoperative pain can lead to longer healing processes, longer hospital stays and the development of chronic pain. In a 900-bed university hospital in Switzerland pain scores were assessed systematically. The study's primary aim was to define whether the routine pain assessment on the ward is accurate and reproducible. Subsequently the obtained data were used for a benchmark analysis to determine the hospitals performance in pain assessment quality compared with similar centers. Methods During a 3-month period PAIN OUT questionnaires were used for patients’ interviews. Patients were included randomly according to the daily surgical schedule. Pain scores were assessed routinely by nursing staff on the wards and compared to PAIN OUT data. The ascertained data was analyzed by descriptive statistics as well as the Wilcoxon test for non parametric values using IBM SPSS. Results 658 patients were included in the study. Comparing routine pain measurements with PAIN OUT results revealed that within the first 24 hours on the ward pain scores were significantly lower than measured with PAIN OUT questionnaires. This difference increased with increasing pain scores. The quality of pain management of the hospital in which this study was performed ranged around the fiftieth percentile when compared to similar centers. Conclusion The cross sectional data comparison of pain assessment by the ward staff and by interviews with the PAIN OUT questionnaire showed a large gap of underrated pain. The benchmark analysis with the method of PAIN OUT suggests a decent pain management among reference groups. This article is protected by copyright. All rights reserved.