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Aims and objectives. To examine the relationship between patient satisfaction and the incidence of severe and enduring pain through a health board wide hospital satisfaction questionnaire. Background. The incidence and management of acute postoperative pain and its relationship to patient satisfaction have been of great interest to clinicians over the last 20 years. Evidence suggests that despite many moves to address this problem with the advent of acute pain nurse specialists and dedicated pain teams, severe and enduring pain continues to be a problem. However, patients appear to report high satisfaction levels. Design. The study design was a postal questionnaire the results of which were analysed statistically. Methods. The postal questionnaire was sent to patients who had been discharged from acute hospitals in one health board in the previous two weeks. A total of three large acute hospitals were included. The data were analysed to produce descriptive statistics for all patients on the pain questions and then for patients with severe and enduring pain on the variables of age, gender, ethnic group, responses to pain questions and type of admission. Results. Twenty-six percent of patients reported having pain all or most of the time. Patients suffering from severe and enduring pain were younger females. Conclusion. Acute postoperative pain continues to be a problem, although patients continue reporting moderate satisfaction levels. Relevance to clinical practice. Acute postoperative pain is an ongoing issue for postsurgical patients. It is crucial to understand and recognise issues that can adversely contribute to increased pain severity. [ABSTRACT FROM AUTHOR]