The frequency of chronic pain after inguinal hernia repair was found to be as high as 54%, much more than previously reported. Quality of life of these patients is affected. Chronic pain is reported less often after laparoscopic and mesh repairs. Recurrent hernia repair, preoperative pain, day case surgery, delayed onset of symptoms, and high pain scores in the first week after surgery, however, were identified to be risk factors for the development of chronic pain. Definition of chronic pain was not explicit in the majority of the reviewed studies. Accurate evaluation of the frequency of chronic pain will require standardization of definition and methods of assessment. Prospective studies are required to define the role of risk factors identified in this review.

On behalf of the Recovery Study Group. Psychological, surgical and sociodemographic predictors of pain outcomes after breast cancer surgery: a population-based cohort study, PAIN (2013), doi: http://dx.doi.org/10. 1016/j.pain.2013.09.028 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. 25Two multiple logistic regression models were then developed to predict chronic pain status 26(presence or absence of chronic pain) at 4 and 9 months after controlling for other variables. 27Included variables were specified a priori by the Study Group, based upon previous (Table 3). The pattern of symptoms, in terms of location and frequency, 10was relatively stable rather than dynamic, when compared across follow-up time points. By 9 11 months postoperatively, more than half of women felt that their symptoms were unchanged, 12rather than improving over time (Table 3). Regarding symptom attribution, breast surgery 13 was reported to be the cause of symptoms for 94% women with chronic pain at 4 months 14 and 89% of women at 9 months after surgery. 16Pain intensity and character 17Most women reported chronic pain of mild intensity (Table 4) (Table 7). Decreased psychological robustness, type of axillary 5 surgery and more severe acute postoperative pain at rest increased the risk of experiencing 6 moderate to severe pain at 9 months postoperatively. Several risk factors were of borderline 7 statistical significance: younger age and having had multiple surgical procedures were 8 associated with greater pain intensity at 4 months, and chronic preoperative pain was 9 associated with greater pain intensity at 9 months postoperatively.This multicentre prospective cohort study investigated psychological, sociodemographic, and 3 surgical risk factors, adjusted for intraoperative nerve handling, on painful adverse outcomes 4 captured at multiple time points after resectional surgery for primary breast cancer. 6We found a high incidence of chronic pain, with two-thirds of women reporting pain-related 23The strengths of our study include being the first epidemiological study to investigate 27of intraoperative data collection forms; we achieved 97% complete data on nerve handling. 28 20We adjusted for other potential confounding factors, specified a priori, identified from existing 1 literature and from our own research [9-11; 30; 43; 50; 54]

Post mastectomy pain syndrome is a condition which can occur following breast surgery and has until recently been regarded as uncommon. Recent reports have suggested that it may affect 20% or more of women following mastectomy. The symptoms are distressing and may be difficult to treat however treatment for neuropathic pain can be successful. This paper reports a retrospective cohort of consecutive mastectomy cases over a six year period in one region of whom 511 survivors were traced and eligible for survey. A total of 408 completed a questionnaire survey which revealed that 175 (43%) had ever suffered from postmastectomy pain syndrome and 119 (29%) reported current symptoms although the majority were decreasing in intensity. A striking finding was the very high cumulative prevalence in younger women (65%) decreasing to 26% in the over 70 year group. The details of the onset, frequency and intensity of symptoms are described along with their natural history. The age effect on the frequency of the syndrome influences the marital status, employment status, housing, and educational status of those who report typical symptoms. Body weight and height are also associated with the frequency of post mastectomy pain syndrome. Relationship between the frequency of post mastectomy pain syndrome and radiotherapy, chemotherapy and the use of tamoxifen are difficult to unravel because of the combinations of pre and post operative treatments received confounded by age. The implications of a much higher frequency of post mastectomy pain are discussed with regard to management and counselling. The high frequency of the syndrome in the younger women is important and possible explanations are explored.

Our understanding of the natural history of chronic pain in the community is limited. This is partly due to the lack of a validated measure of chronic pain severity known to be responsive to change over time. The Chronic Pain Grade questionnaire has been shown to be valid and reliable for use in a general population as a self-completion questionnaire. However, its reliability and validity for use in longitudinal studies and its responsiveness to change over time has not yet been assessed. We undertook a postal survey designed to test the responsiveness and the validity of the Chronic Pain Grade questionnaire over time. A random sample of 560 chronic pain patients, aged 25 years and over was drawn from an existing cohort and stratified for age, gender and chronic pain severity. Subjects were re-surveyed by a postal self-completion questionnaire consisting of the Chronic Pain Grade and the SF-36 general health questionnaire, which is known to be responsive to change in health over time. To test whether changes in CPG scores correlated with changes in SF-36 scores, Spearman's rank correlation coefficients were calculated. A response rate of 86% was achieved for the follow-up study. The majority of SF-36 scores changed in the hypothesized directions. Changes in CPG scores were significantly correlated with changes in most of the SF-36 domains. We concluded that the CPG is a useful and valid objective instrument for measuring change in severity of chronic pain over time and could be used in longitudinal studies of chronic pain severity.

The goals of this retrospective case review were to analyze the long-term results of surgery for petrous temporal bone cholesteatomas and to propose a new classification system for these lesions. Patients with a surgically confirmed petrous temporal bone cholesteatoma were treated at Addenbrooke's Hospital, a tertiary referral center. Postoperative facial function, hearing, residual/recurrent cholesteatoma, and other complications were assessed in relation to preoperative signs, intraoperative findings, and surgical approach. Between 1983 and 2004, 43 patients were treated. There were no perioperative deaths. There was no long-term recurrence in 95.4% of the patients, possibly because of meticulous surgical technique, bipolar diathermy, and use of the laser to denature the cholesteatoma matrix that was adherent to the dura. At presentation, 95% of the patients had no socially useful hearing in the affected ear. Facial nerve function, however, was usually preserved. Both direct anastomosis and nerve grafting can improve facial nerve function from House-Brackmann grade VI to grade III if the palsy is not longstanding. Four patients had cerebrospinal fluid leakage; other complications were rare. The proposed classification facilitates surgical planning and predicts the postoperative outcome with regards to hearing.