Objectives: Surgical patients who regain consciousness while under general anesthesia may develop symptoms of Posttraumatic Stress Disorder (PTSD). One common PTSD symptom is the experiencing ofabnormal perceptions during which the patient feels as ifthe trauma is recurring. The objective of this report is to document the re-occurrence of pain as part of the PTSD sequelae.Results: We present two patients who developed PTSD following an episode of awareness under anesthesia. In both cases, posttraumatic sequelae persisted for years and included pain symptoms that resembled, in quality and location, pain experienced during surgery. In addition to their similarity to the original pain, these pain symptoms were triggered by stimuli associated with the traumatic situation, suggesting that they were flashbacks to the episode of awareness under anesthesia.Discussion: The similarity between the patients' pain symptoms and pain experienced during trauma, the triggering by traumatic cues, and the associated emotional arousal and avoidance suggest the involvement of a somatosensory memory mechanism.Key Words: posttraumatic stress disorder, pain memory, somatosensory memory, surgery, awareness under anesthesia, flashbacks S urgical patients who regain consciousness while under general anesthesia frequently find themselves powerless to alert the anesthesiologist or surgeon to their plight, due to the use of muscle relaxants. l -4 These patients may subsequently develop PTSD,5 a psychiatric condition characterized by symptoms ofre-experiencing, avoidance, emotional numbing, and hyperarousa1. 6 In a recent review of the link between awareness under anesthesia and PTSD, Osterman and van der Kolk l noted that inescapable stress is particularly conducive to the development of PTSD symptoms. One characteristic symptom ofPTSD is "acting or feeling as if the traumatic event were recurring."6 Patients with PTSD often report flashbacks, in which actual sensations related to their trauma are re-experienced.7 Mellman and Davis 8 noted that visual flashbacks are most common but abnormal perceptions occur in other modalities, often triggered by heightened arousal or sensory cues. They report on a combat veteran who re-experienced "pain like a shrapnel wound" as part of combat-related posttraumatic sequelae, indicating that pain may occur as a sensory flashback to trauma. The re-occurrence ofpain as a sensory memory has been well documented in the amputee population,9 but, with a few exceptions,1O has been otherwise virtually ignored. The object of the present clinical note is to report two patients who became aware during surgery while under general anesthesia. The patients subsequently developed PTSD symptoms that included pain similar in quality and location to the pain they experienced when they awoke during surgery. Consent was obtained from both patients to be interviewed and to have their history published. Both patients were interviewed using two standardized measures, the Clinician Administered PTSD Scale ll (CAPS) and the Traumat...