A Review of Chronic Post-Sternotomy Pain Syndrome.

purpose of reviewChronic post-sternotomy pain syndrome (CPSPS) is a common yet frequently underrecognized complication following cardiac and other intrathoracic procedures requiring median sternotomy. This review covers current evidence regarding the definition, epidemiology, pathophysiology, risk factors, morbidity, and contemporary management strategies for CPSPS. RECENT

findingsRecent prospective cohort studies and meta-analyses demonstrate that persistent pain after sternotomy remains prevalent despite advances in surgical and perioperative care, with some patients experiencing symptoms for several years. Data demonstrates distinct pain trajectories following cardiac surgery and emphasize the contribution of neuropathic mechanisms and central sensitization. Identified risk factors include younger age, female sex, pre-existing chronic pain, psychological distress, internal mammary artery harvesting, re-sternotomy, prolonged operative duration, and inadequate acute pain control. Regional anesthesia techniques such as thoracic epidural analgesia and thoracic paravertebral blocks can reduce acute pain and opioid consumption, with mixed evidence regarding chronic pain prevention. Other newer modalities such as erector spinae plane blocks, parasternal blocks, peripheral nerve stimulation, and cryoneurolysis show promise but require further study. CPSPS represents a multifactorial pain condition with significant long-term implications for functional recovery, quality of life, and healthcare utilization. Early identification of high-risk patients, optimization of perioperative analgesia, and adoption of multimodal, multidisciplinary management strategies are central to mitigating chronic pain development. Continued investigation into targeted preventive interventions and long-term outcomes is essential to reduce the enduring burden of post-sternotomy pain.