Chronic Pain after Inguinal Hernia Surgery
The concept of chronic pain after a hernia repair, especially an inguinal hernia repair, while being very real, is a topic of much debate. This debate centers around two big questions that are still largely unanswered. 1) what is the actual incidence of chronic pain after hernia repair? Various studies have offered wildly differing rates and 2) What is the true cause of chronic pain after a hernia repair?
Let’s explore the possible causes of chronic pain after hernia repair…
First, it is important to define chronic pain, which is the incidence of continuous pain three or more months after surgery. There are various levels of chronic pain from mild to severe, however chronic pain is difficult to quantify it because every individual has a different tolerance.
Knowing that chronic pain that is one of the most common complications after hernia surgery, we can be relatively confident that the primary cause of this pain is damage or irritation to nerves in the abdominal area. We do know that a methodical identification of the main nerve trunks in the groin is associated with a decrease in the number of traumatic nerve injuries during surgery.
- The placement of mesh and the method of attaching the mesh to the abdominal wall can contribute to irritation or damage to nerves. While it stands to reason that both factors could play a role, clinical studies have yet to prove this to be the case. As such, hernia repair with mesh remains the gold standard in care.
- Interestingly, relatively younger patients tend to have a greater incidence of chronic pain after their surgical procedure versus older patients.
- How pain is addressed after surgery can also affect the incidence of chronic pain. Aggressive management of surgical pain is key to longer-term comfort.
- Open hernia repairs are associated with a greater chance of chronic pain than laparoscopic repairs.
- The degree of pain that a patient was experiencing before surgery is also indicative of the risk of chronic pain after surgery. More pain before means increased risk of pain after, generally speaking.
Treating Chronic Pain
While chronic pain is a common complication after surgery, it is also very treatable. Therefore, patients should be aware of their pain levels and not be ashamed to address this with their doctor should an elevated level of pain continue longer-term. Most patients will find that their chronic pain will resolve, albeit slowly, over the course of time. Others will see that their pain diminishes to the point of being hardly noticeable. A minority of patients will experience continued chronic pain that can be severe and debilitating despite conservative and medical treatments. These patients may require a follow-up surgical procedure to adjust or remove the mesh or its attachments to the abdominal wall. Please note that reoperation is uncommon and represents a last resort when all other pain management measures have been exhausted.
How We Address the Issue of Chronic Pain
- The incidence of chronic pain is very clearly related to the severity of the hernia and the complexity of the hernia repair. Therefore, we suggest that patients with symptomatic hernias address them, via surgical means, as soon as possible.
- Because of the number of nerve that runs through the abdomen, we use all practical precautions to ensure that we do not irritate, pinch or damage any of these nerves during the procedure.
- Surgical experience is also related to chronic pain complications. The more experienced the surgeon, the lower the risk of developing complications including chronic pain. Our surgeons are not only highly experienced, but also highly skilled at inguinal hernia repair.
The bottom line is that a discussion about chronic pain is certainly warranted. While it is not completely avoidable, patient should understand the risk factors for it and what they can do to minimize the chance of developing a chronic pain issue. While we do not advocate watchful waiting for the sole purpose of avoiding postoperative complications, we do find it important that the patient understand the degree to which chronic pain may affect them after surgery.