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The aim of OxPPOPS is to identify the incidence and predictive factors for the development of persistent pain after surgery. We have just finished recruiting a cohort of patients having planned caesarean sections.

Protocol to identifying risk factors associated with the development of persistent pain after surgery
Protocol to identifying risk factors associated with the development of persistent pain after surgery


Chronic pain is a worldwide problem affecting 20% of the adult population at a cost of 200 billion Euros per annum. It has a major impact on quality of life, as many of the drugs used in its treatment are ineffective. Post-operative pain persisting for three or more months after surgery is an increasingly recognised source of chronic pain with approximately 20% of patients attending chronic pain clinics having pain relating to previous surgery. Several mechanisms for the development of chronic pain have been identified including patient psychological factors, anaesthetic techniques, the surgical procedure and post-operative analgesic management.


The Oxford Persisting Post-Operative Pain Study (OxPPOPS) aims to identify the incidence of persistent pain and its impact on quality of life one year after surgery. By collecting longitudinal data on all aspects of the patient and their treatment, we aim to identify the predictive factors involved in the transition from the expected acute (and healthy) pain after surgery to long-term chronic pain that serves no purpose. Confirmation of the factors involved and knowledge of their interactions will enable us to develop interventions in ‘at-risk’ patients that will ultimately reduce the incidence of persistent post-operative pain.

OxPPOPS is a successful multi-disciplinary collaboration between the University of Oxford and the NHS, recruiting from centres across the Oxford University Hospitals Trust. Data collection on OxPPOPS began in August 2009 with a successful pilot study on inguinal hernia repair. In June 2011, OxPPOPS began recruiting women undergoing elective caesarean section in the Maternity unit of the John Radcliffe Hospital. As nearly a quarter of women give birth by caesarean section, it is now one of the most frequently performed operations in the UK.

Our preliminary results show that around 12% of women suffer from pain one year after caesarean section and, given the large number of women undergoing surgery, this represents a significant problem. OxPPOPS-Caesarean recruited 728 patients and long term follow up completed in May 2015.