The Overlooked Role of External Chest Supports in Managing Poststernotomy Pain Syndrome (PSPS).

Poststernotomy pain syndrome (PSPS) is a common issue for many patients recovering
from heart surgery. Defined as pain lasting more than three months, PSPS affects between 10% and 67% of patients. These numbers may be underestimated because many patients, grateful to have survived the surgery, often downplay their pain, considering it a normal part of recovery. This can lead to delayed diagnosis and treatment, contributing to the wide variation in reported pain incidence. 

The pain can be intermittent or constant, depending on the individual.
Factors like deep breathing, coughing, movement, tight clothing, stress,
and even weather changes can worsen the pain.
If this pain isn’t properly diagnosed and treated, it can seriously impact
a person’s quality of life, affecting their mood, daily activities, sleep,
and overall well-being.

What Causes Poststernotomy Pain?

The exact cause of chronic poststernotomy pain isn’t fully understood,
but several surgical factors may contribute:

• Internal Mammary Artery (IMA) Harvest: This procedure was initially linked
  to long-term pain due to tissue and nerve damage, but newer techniques may have reduced this risk. However, studies show mixed results.
• Bilateral IMA Harvest: Harvesting arteries from both sides of the chest can lead
  to more incision pain and infections, which are linked to chronic pain.
  Removing the IMA along with nearby tissue (muscle and veins) increases
  the risk of mediastinitis, which is associated with chronic pain.
  Skeletonized grafts (without surrounding tissue) reduce this risk.
• Urgent/Emergent Surgeries: Emergency surgeries have a higher risk
  of chronic pain, likely due to increased tissue trauma.
• Rib Fractures: Rib fractures occur in up to 5% of cases and can cause chest pain
  that mimics heart issues. Fractures and related nerve injuries can lead
  to chronic pain.
• Sternal Retractors: Devices used to hold the chest open during surgery
  can cause fractures and nerve damage, increasing the risk of long-term pain.
• Incisional Damage: Injuries to muscles and the sternum from the incision
  can lead to chronic pain.
• Sternal Wires/Plates: Irritation from the wires or plates used to close
  the sternum may contribute to long-term pain.
• Resternotomy: Repeated surgeries during the same hospital stay can cause additional tissue trauma and increase the risk of chronic pain.
• Sternal Wound Infections and Nonunion: Infections and poor healing
  of the sternum (e.g., pseudoarthrosis, nonunion) are strongly linked
  to chronic pain due to prolonged inflammation and instability.
  
  

Patient Factors Contributing
to Long-Term Pain

Certain patient-related factors increase the risk of developing long-term pain after heart surgery:

• Gender: Women are more likely to experience chronic chest pain within the first year post-surgery.
• Chest Size & Obesity: People with larger chest circumferences or those who are overweight/obese are more likely to report chronic pain.
  
  
  
  
• Age: Both younger patients and those over 75 tend to experience more chronic pain.
• Hypothyroidism: This condition increases the risk of chronic pain,
  possibly due to nerve-related issues.
• Mood Disorders: Depression and anxiety elevate the risk of chronic pain,
  likely due to changes in brain chemistry.
• Socioeconomic Status: Those with lower income or other financial challenges are more likely to experience chronic pain.
• Pre-surgery Pain & Opioid Use: Patients who had pre-existing pain or were using opioids before surgery are at higher risk for chronic pain.
• Genetics: Some individuals may be genetically predisposed to experiencing more pain, making them more likely to develop chronic pain after surgery.

Understanding the factors that contribute to chronic pain underscores the importance of early and effective pain management to prevent long-term suffering.

Managing Poststernotomy Pain Early

Severe pain after surgery can affect the nervous system, causing the loss of neurons
that typically help control pain. Prolonged pain can also lead the body to release chemicals
that increase pain sensitivity. When the nervous system becomes overly sensitive
(secondary hyperalgesia), it can turn short-term pain into long-term pain. Unfortunately, opioids and other common pain medications don’t work well once this stage begins.

Managing pain effectively right after surgery is crucial in preventing long-term pain.
Even less intense pain, if not properly treated, can lead to chronic pain.
Good pain control not only helps reduce the risk of long-term pain but also lowers the chance of other complications, such as heart issues, pneumonia, and blood clots.

How Is Post-Surgical Pain Managed?

Chronic pain often requires a combination of treatments. Common medications
include anti-inflammatory drugs (NSAIDs), opioids, antidepressants, anticonvulsants,
muscle relaxants, and topical treatments. However, about half of patients with chronic poststernotomy pain report that their medications don’t fully relieve their symptoms, especially those with more severe pain.

In addition to medication, invasive treatments like nerve blocks, spinal cord stimulators,
and injections of steroids or anesthetics may help with severe post-surgery pain.

These procedures are typically used when other treatments fail, but their effectiveness in heart surgery recovery is mostly supported by individual reports rather than large studies.

Preventing infections, using careful surgical techniques, and managing pain early on are key strategies to reduce the risk of chronic pain. Although better management of acute pain could lower the risk of long-term pain, more solid evidence is needed to confirm this approach. Overall, more studies are required to find the best ways to prevent and treat chronic poststernotomy pain.

Has Every Method for Managing Poststernotomy Pain Been Explored?

Multimodal pain management, along with reducing opioid use, is designed to improve patient outcomes and speed up recovery. Non-drug approaches such as early mobilization, nutrition support, and physical therapy are now standard in proper post-surgical recovery.

However, a simple tool like an external chest support remains an overlooked
and underutilized resource in cardiac recovery. These supports are rarely mentioned
in scientific literature, despite their ability to address key aspects of recovery, such as pain control, physical stability, and psychological benefits—without relying on medications.

How External Chest Supports Help

• Pain Relief and Comfort: Different designs of chest supports exist, but not all provide effective pain relief and comfort for sore muscles and ribs. The QualiBreath sternum and thorax support, made from firm, elastic material, conforms to various body sizes and provides pain relief, similar to an elastic bandage on a bruised muscle.
  It also includes handles that patients can grasp to minimize pain during activities like coughing or sneezing.
  Numerous patient testimonials and studies show that patients who used QualiBreath experienced better pain control. This reduction in pain is important, as it may help prevent  acute pain from developing into chronic pain.
• Psychological Benefits: Beyond physical pain relief, chest supports provide psychological comfort. Patients describe feeling “held together” when wearing QualiBreath, which helps reduce anxiety—a known risk factor for chronic post-surgery pain. By addressing both the physical and emotional aspects of recovery, QualiBreath offers a dual benefit.
  
  

  ERAS Protocols: A Missed Opportunity

  Enhanced Recovery After Surgery (ERAS) protocols promote interventions like early mobilization, multimodal pain management, and physiotherapy. However, ERAS protocols seem to miss the opportunity to incorporate external chest supports,
  which can play a vital role in improving recovery after heart surgery.

  Patients recovering from sternotomies often experience significant pain that hinders
  their ability to engage in key recovery activities, such as walking, coughing, or deep breathing. Comfortable chest supports, like QualiBreath, can improve patient compliance with these activities, promoting better outcomes in line with ERAS guidelines.

  Studies show that compliance with ERAS protocols leads to shorter hospital stays,
  fewer complications, and a lower risk of chronic pain. Adding QualiBreath to ERAS protocols may significantly increase compliance and  enhance patient participation
  in recovery activities, leading to better long-term outcomes.

  
  

  A Call for External Chest Supports in Poststernotomy Recovery

  Patients recovering from cardiac surgery deserve every available resource to ensure
  a smooth recovery, both physically and emotionally. External chest supports like QualiBreath offer a simple, cost-effective, and non-invasive solution that not only addresses pain but also empowers patients by improving mobility and reducing anxiety. By integrating these supports into care protocols, including ERAS programs,
  we can help patients recover more effectively.

  We encourage researchers, clinicians, and healthcare organizations to consider integrating external chest supports into formal studies. Collaborating on studies
  that include QualiBreath would offer valuable insights into its role in reducing postoperative pain, improving patient outcomes, and lowering opioid reliance.

  With the current opioid crisis and increasing focus on non-pharmacological interventions, the time is now to explore the full potential of external chest supports
  in reducing poststernotomy pain and improving patient outcomes.

  Patient Testimonials: Real-Life Success with QualiBreath

  Here are some testimonials from patients around the world who have experienced
  the benefits of using QualiBreath during their recovery:

  F. Cleworth from East Yorkshire, United Kingdom
  "The best thing to help with my recovery. I am now undergoing a recovery from
  a sternum repair after my first operation failed. I feel that if I had been given the support vest the first time, I would not have had to have it redone. I can say that the QualiBreath support vest has been one of the best things to help with my recovery."

  R.G. from Wisconsin, USA
  "QualiBreath works great. I am having problems with my breastbone healing properly.
  I tried another brace/binder, but it was uncomfortable and didn’t fit correctly,
  and was only available in limited sizes. My new QualiBreath works great.
  It provides comfortable support, fits well, and I can wear it all day.
  I know it will help me heal as I should have."

  J.M. from Malaga, Spain
  "Your vest helps me sleep at night. It’s God-sent.”