Poststernotomy neuralgia: a new pain syndrome.

Three points of interest arise out of Drs. Defalque and Bromley’s article (1). First, all patients were men; presumably most were from a Veterans Administration Hospital, although the study began at Indiana University Medical Center. One wonders whether or not men have a lower pain threshold. Alternatively, the patient pool may have been all male. Second, there was a 1to 6-month delay in onset of this pain syndrome. Does this mean that the patients were preoccupied by other postoperative concerns in the interval and pain was not an issue? My impression is that neuroma pain in other scars becomes a problem soon after the wound heals. Third, has this syndrome gone unrecognized and remains unrecognized (or at least not a problem) in my hospital’s large cardiac surgery service of over 1000 patients per year? One of the senior cardiac surgeons here believed that such discomfort is not a problem with us, although he could imagine that it might be among some patients with low pain thresholds. A second surgeon suggested a mechanism by which it might occur: spreading of the sternal retractor can, if applied strongly, buckle the costal cartilages. This is especially true with mammary artery grafts: 61% of the authors’ patients had left internal mammary grafts and 63% had left sternal pain. Even so, this surgeon also agreed it was not a problem. Finally, as director of our Anesthesia Pain Control SerDonald P. Todd, MD Director, Anesthesia Pain Control Service Massachusetts General Hospital Boston, M A 02114