Upcoming Issues Neuropathic Cancer Pain Pain in the Developing World Postoperative Pain Management Chronic Pain after Surgery or Injury

The fi rst publication that identifi ed injury and surgery as major risk factors for chronic pain appeared in 1998.1 This paper reported that around 40% of 5130 chronic pain patients in 10 pain clinics in the United Kingdom had developed their chronic pain problem after surgery or trauma. This fi nding has led to a dramatic increase in interest in this subject; searches on PubMed for key words such as chronic or persistent postsurgical pain now reveal hundreds of publications on this topic. While most of these papers analyze pain after surgery,2,3 the original publication also suggested trauma as another major precursor of chronic pain.1 This suggestion has been confi rmed by subsequent studies4; in principle, every chronic pain has been acute pain at some stage.5 The problem is not limited to major surgery or major trauma, as even minor operations such as herniotomy can have signifi cant consequences with regard to development of chronic pain; a recent editorial on this topic states that “chronic pain is the most common and serious long-term problem after repair of an inguinal hernia.”6 The consequences of chronic postsurgical or post-traumatic pain are signifi cant, not only in terms of suffering and reduced quality of life for the individual patient but also with regard to the subsequent costs to the health care and social support systems of our societies.4,7