Thoracotomy is one of the most painful surgical approaches. Combination of traumatic incision, features of chest innervation and respiratory movements in postoperative period makes pain control especially difficult after thoracotomy. In early stages, inadequate analgesia is associated with respiratory complications, delayed activation and infectious complications. Moreover, poorly controlled postoperative pain is associated with chronic postthoracotomy pain syndrome. Understanding the complex nociceptive pathways and neuropathic mechanisms of chronic postthoracotomy pain syndrome arouses interest in research of modern therapeutic strategies and further prospects for prevention. Most authors prefer multimodal analgesic approach, but there is no clear algorithm for various procedures. This report is devoted to modern methods of prevention and treatment of pain syndrome in thoracic surgery.