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H E R N I A
R E P A I R
DEFINING DISCOMFORT
What Is Chronic Pain?
Chronic pain, which occurs after 15% to 35% of hernia repairs, is
defined as pain measuring 4 or
higher on a 1-to-10 scale and lasting
longer than a month after surgery. It
prohibits patients from returning to normal life routines and activities.
PAINFUL PATCH Heavyweight microporous
mesh increases risk of inflammatory response.
Somatic pain is experienced most
often. It's the result of scarification issues, previous ligament or mesh injury,
or new ligament or mesh injury caused by surgery. Neuropathic pain
involves direct nerve damage or injury, or incorporation of sensory nerves
with suture, tacks, staples or mesh. Finally, visceral pain related to hernia
repair can occur when implanted mesh compromises peritoneal tissue.
Prevention is of course the best solution to post-op chronic pain. But when
inguinodynia does occur, surgeons must first rule out other causes of the
pain. Is the patient suffering from back problems or urologic complications?
Is the patient dealing with psychological issues? Has there been recurrence
of the hernia?
Legitimate chronic post-op pain is first treated with the least invasive intervention: anti-inflammatories, ice therapy and restriction of activity. Injections
with a local anesthetic and steroid have been shown to reduce pain to tolerable levels 50% of the time.
If those attempts fail to work, pain specialists may get involved, offering
alcohol blocks, radiofrequency ablation, dorsal column stimulators that send
block pain sensations at the spinal cord and implantable morphine pumps.
The ultimate cure, of course, is re-operating to remove the affected nerves
or mesh that are the offending problems.
— Jeffrey B. Mazin, MD, FACS
