In the past ten years there has been recognition that chronic post-surgical pain is a significant problem. This is a complex area of research and although the quality of studies has improved many difficulties remain. Several recent publications have examined risk factors. Severe acute postoperative pain emerges as a factor that we may be able to influence. There is a need for education of the medical profession and the general public, so that effective measures are introduced and unnecessary and inappropriate operations minimized.

The possibility that the pain is continuing from a preexisting problem must be explored and exclusion attempted. (There is an obvious grey area here in that surgery may simply exacerbate a pre-existent condition, but attributing escalating pain to the surgery is clearly not

Surgery and trauma are recognised as important causes of chronic pain, although their overall contribution has not been systematically studied. This paper reports on the contribution of surgery and trauma to chronic pain among 5130 patients attending 10 outpatient clinics located throughout North Britain. Surgery contributed to pain in 22.5% of patients, and was particularly associated with the development of pain in the abdomen and with anal, perineal and genital pain. Trauma was a cause of pain in 18.7% of patients, and was most common in pain in the upper limb, the spine and the lower limb. Patients with chronic pain associated with trauma are on average younger than those with chronic post-surgical pain. Further, and unusually for pain conditions, the trauma patients show an excess of males over females. These findings indicate that it can be unhelpful for pain classification systems to combine surgery and trauma in a single category. The results also point to areas for potentially fruitful research into the aetiology of chronic pain. In particular, studies are needed to identify the operative procedures associated with the development of pain so that preventive measures can be implemented.

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