The role of regional anaesthesia and analgesia in the prevention of chronic postsurgical pain: there is no Holy Grail

Chronic postsurgical pain is an increasingly common and debilitating problem, with a median incidence of 20–30% at 6–12 months postoperatively. The aetiology of chronic postsurgical pain is generally considered multifactorial, encompassing patient, anaesthetic and surgical risk factors. Poorly treated peri-operative acute pain is a recognised risk factor for chronic postsurgical pain based on observational studies.This is an area of active investigation with relatively few risk factors identified to date, and many unanswered questions remain about the mechanisms behind the transition from acute to chronic pain, how to reliably and accurately predict those at risk and what we can do to prevent it.