Post-thoracotomy pain syndrome has been, and I anticipate will be, a continuing major problem for thoracic surgeons. Standard treatment by rest, analgesia, physiotherapy and nerve-root injection often provides little relief. Recently, I had two patients with severe post-thoracotomy pain syndrome who I treated in this way, but with little success. Both were unable to return to work and required ongoing treatment with narcotic drugs. As I monitored their progress it became obvious that a scoliosis had developed concave to the operated side associated with a great deal of spasm in the paraspinal muscles. Because there have been many reports recently in the chiropractic literature of chest pain relieved by manipulation of the costovertebral joints, I approached a doctor of chiropractic about these two patients. He elected to treat the patients both by direct joint manipulation and by attempting to open up the posterior facets by flexing the patients over a rolling drum. The results were dramatic: both patients no longer required narcotic drugs to relieve their pain. One, who had been incapacitated for 2 years, was completely relieved of pain and had only slight numbness in the distribution of the involved nerve root and was able to return to work. The other had pain relief estimated to be more than 80% and no longer required major analgesics.
In most patients, post-thoracotomy pain will eventually resolve, and in both of my patients, who had protracted pain, the condition may have been about to improve spontaneously. Certainly the results have very little scientific significance. The magnitude of the problems that both of these patients faced, however, seemed so monumental and the relief that they obtained from the chiropractor’s treatments was so dramatic that I believe it is worth communicating with readers of the journal this approach as an alternative to be considered in patients with serious post-thoracotomy pain syndrome. Perhaps with a wider patient base and experience this may prove to be a beneficial method of treating these patients whose condition is so difficult, if not impossible, to manage by the current standard treatment.