Classifying Postherniorrhaphy Pain Syndromes Following Elective Inguinal Hernia Repair

Abstract

Background Chronic postherniorrhaphy pain is diverse in origin. The aim of our study was to classify postherniorrhaphy pain syndromes following elective inguinal hernia repair. Patients and methods All patients with an elective inguinal hernia repair performed between January 2000 and August 2005 received a questionnaire evaluating chronic inguinal pain (visual analog scale, VAS 0–10). Patients with moderate to severe pain complaints (VAS score ≥ 3) were invited for an interview and an outpatient department physical examination. Results A total of 2,164 cases underwent an elective hernia repair and received the questionnaire; 1,766 individuals responded (response rate: 81.6%). Moderate to severe pain was present in 211 patients (11.9%). Follow‐up was performed in 148 patients. Three separate groups of diagnoses were identified. Group I: neuropathic pain (n = 72) indicating inguinal nerve damage; group II: non‐neuropathic pain (n = 40) due to an array of diagnoses including periostitis (n = 18) and recurrent hernia (n = 13); and group III: a tender spermatic cord and/or a tight feeling in the lower abdomen (n = 43). Conclusions Chronic pain following elective hernia repair is common and diverse in etiology but may allow for a classification contributing to the development of tailored treatment regimens.

International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery

“…Although preoperative pain may be related to the risk of developing chronic pain, there are no signs of preoperative sensory dysfunction in patients with or without pain [3]. Also, it should be emphasized that symptoms and signs in suspected neuropathic pain are very unspecific [56], and previous suggested classification of post-herniorrhaphy pain syndromes [40] requires further documentation of validity and further discussion of the consequences for the choice of treatment. Obviously, a groin hernia repair with a mesh implant can lead to chronic nociceptive pain due to the continuous inflammation around the mesh.…”

Three-month results of the effect of Ultrapro or Prolene mesh on post-operative pain and well-being following endoscopic totally extraperitoneal hernia repair (TULP trial)

“…However, the study population will be followed for 3 years and data regarding pain and quality of life issues at 1, 2 and 3 years after surgery are expected. In the present study, chronic relevant pain, according to the classification published by Loos et al [30] present 3 months post-operatively, was reported by 2.0 % of patients after lightweight mesh and 0.9 % of patients after heavyweight mesh use. A comparable study of Chowbey et al [21] showed similar results, reporting moderate to severe pain in 2.1 % patients after lightweight mesh and 1.9 % after heavyweight mesh.…”

“…The definition of the International Association for the Study of Pain (IASP) was used, and chronic post-operative pain was defined as persistent pain at the site of the operation 3 months after the primary surgery that differed from the pain before the operation [30]. In accordance with the literature, pain intensity was categorized as follows: NRS 1-3 = mild pain; NRS 4-6 = moderate pain; and NRS 7-10 = severe pain.…”

“…In accordance with the literature, pain intensity was categorized as follows: NRS 1-3 = mild pain; NRS 4-6 = moderate pain; and NRS 7-10 = severe pain. Moderate to severe pain (NRS 4-10) was considered clinically relevant and therefore used as the definition of pain in the present study [30].…”

“…In case of unclear inguinal pain or complaints suggestive of a recurrent hernia, ultrasound of the groin or MRI scan was performed. For the registration of pain symptoms, a standardized clinical evaluation form was used (Inguinal Pain Form by Loos [30] translated in Dutch).…”