Evaluation of Intercostal Neuralgia in Patients With Chest Tube Insertion After Traumatic Rib Fracture

NCT ID: NCT07308587

Last Updated: 2025-12-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Total Enrollment

100 participants

Study Classification

OBSERVATIONAL

Study Start Date

2026-01-01

Study Completion Date

2026-12-31

Brief Summary

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Traumatic rib fractures are common injuries following blunt chest trauma, often requiring chest tube insertion to manage complications such as pneumothorax or haemothorax. However, chest tube placement can lead to intercostal nerve injury, resulting in intercostal neuralgia-a debilitating condition characterized by chronic, neuropathic pain along the intercostal nerves. Despite its clinical significance, the incidence, risk factors, and long-term outcomes of intercostal neuralgia in this patient population remain poorly understood.

Chronic pain following thoracic trauma, including intercostal neuralgia, has been shown to significantly impair quality of life and functional outcomes, leading to prolonged disability and increased healthcare utilization. Current literature highlights the need for better understanding and management of this condition, particularly in patients undergoing invasive procedures such as chest tube insertion. This study aims to prospectively evaluate the development of intercostal neuralgia in patients with chest tube insertion following traumatic rib fractures.

Detailed Description

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Intercostal neuralgia is defined as pain along the intercostal nerve distribution with neuropathic features. Chronic intercostal neuralgia is defined as having intercostal neuralgia symptoms for \>3 months.

Intercostal neuralgia pain will be specifically differentiated from persistent rib fracture pain through the presence of neuropathic pain at the level of the chest tube/pigtail that is reproducible with brushing/light touch to the chest tube scar site.

The following data will be collected:

Baseline:

* Demographic information (age, sex, ethnicity, comorbidities).
* Pain assessment using numerical rating scale at rest and with deep inspiration
* Pre-existing chronic pain conditions (e.g., fibromyalgia, chronic regional pain syndrome) and history of prior thoracic surgery or chest tube insertion.
* Injury characteristics (mechanism of injury including presence of foreign bodies and additional penetrating injuries, number and location of rib fractures, associated injuries including vertebral body fractures, sternal fracture, transverse process fracture).
* Chest tube / pigtail details (size, insertion site, duration of placement).
* Spirometry testing including forced vital capacity (FVC) and forced expiratory volume (FEV1) at time of enrolment of study

Additional information to be collected following hospital stay:

* Analgesic use including dose of opioids, use of regional anesthesia techniques, and adjunct analgesic medications while in hospital
* Length of hospital stay
* Presence and duration of mechanical ventilation
* Number of surgeries

Follow ups: 1 (± 3 days) and 3 months (± 1 week) via telephone

* Pain assessment using the numerical rating scale at rest and with deep inspiration
* S-LANSS for neuropathic pain
* EQ-5D-5L for health related quality of life
* PROMIS sleep disturbance 6a for sleep
* Medication use (analgesics, neuropathic pain medications)

Patients who are found to have intercostal neuralgia at 3 month follow up assessment can be referred to the pain clinic and choose to be sent for formal ultrasound to identify and characterize findings to indicate the presence of neuroma (a non-cancerous tumor or growth of nerve tissue), degree of scarring, or any other pain generating causes, if agreed. Participants' preferences regarding the disclosure of neuroma, including their right to know or not to know, will be respected (as described in the consent form).

Conditions

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Intercostal Nerve Injury

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Chest tube inserted

Patients with acute traumatic rib fracture/chest injury requiring chest tube insertion

Chest tube insertion

Intervention Type PROCEDURE

Insertion of chest tube

Interventions

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Chest tube insertion

Insertion of chest tube

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Adults (≥18 years) with traumatic rib fractures requiring chest tube insertion
* Chest tube or pigtail insertion performed during their initial hospitalization for trauma

Exclusion Criteria

* Patients with traumatic brain injury
* Patients with spinal cord injury
* Inability to complete follow-up assessments (e.g., language barriers, lack of telephone access)


* Patients with traumatic brain injury
* Patients with spinal cord injury
* Inability to complete follow-up assessments (e.g., language barriers, lack of telephone access)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Sunnybrook Health Sciences Centre

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Central Contacts

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Howard Meng, MD

Role: CONTACT

Phone: 416-480-4864

Email: [email protected]

Lilia Kauistov, PhD

Role: CONTACT

Phone: 416-480-4864

Email: [email protected]

References

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Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma. 2000 Jun;48(6):1040-6; discussion 1046-7. doi: 10.1097/00005373-200006000-00007.

Reference Type RESULT
PMID: 10866248 (View on PubMed)

Karmakar MK, Ho AM. Acute pain management of patients with multiple fractured ribs. J Trauma. 2003 Mar;54(3):615-25. doi: 10.1097/01.TA.0000053197.40145.62.

Reference Type RESULT
PMID: 12634549 (View on PubMed)

Bailey RC. Complications of tube thoracostomy in trauma. J Accid Emerg Med. 2000 Mar;17(2):111-4. doi: 10.1136/emj.17.2.111.

Reference Type RESULT
PMID: 10718232 (View on PubMed)

Fabricant L, Ham B, Mullins R, Mayberry J. Prolonged pain and disability are common after rib fractures. Am J Surg. 2013 May;205(5):511-5; discusssion 515-6. doi: 10.1016/j.amjsurg.2012.12.007.

Reference Type RESULT
PMID: 23592156 (View on PubMed)

Blyth FM, March LM, Brnabic AJ, Cousins MJ. Chronic pain and frequent use of health care. Pain. 2004 Sep;111(1-2):51-8. doi: 10.1016/j.pain.2004.05.020.

Reference Type RESULT
PMID: 15327808 (View on PubMed)

Other Identifiers

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SUN 6775

Identifier Type: -

Identifier Source: org_study_id