This is the title of a French article discussing the problem recently.
I have written about handling post hernia surgery problems before here:
Post Hernia Surgery Pain Protocol and Other Options
and had a list of studies:
Here is a more recent French protocol:
Rev Med Suisse. 2010 Jun 23;6(254):1288-91.
[Pain after inguinal hernia repair: what to do?]
[Article in French]
Abrazhda D, Hübner M, Foletti A, Demartines N, Vuilleumier H.
free article here (good luck with that)
- Problem is easily understood when one sees all the nerve that surround the hernia area (dashed area):
- These nerves will be often damaged by surgery or implantation of mesh and clips
- 10% of cases no matter what technique used though some think less likely with laparoscopic.
- They suggest to not do surgery unless you have too – hernia dangerously stuck(incarcerated) in only 1/400 cases
- pain longer than 3 month is chronic
- If the pain is more down near the pubic bone, it could be the stitch attachment to pubic bone where local steroid injection might help
- I was important to differentiate nociceptive (tissue) pains versus neuropathic (nerve) pain:
- Nociceptive: – tissue damage associated with an inflammatory response – groin pain, constant, worse with exertion, with a taut, duller quality
- Neuropathic – Nerve damage neuroma pain – Triggering point location, episodic pain, worse with walking and sitting; burning and stabbing quality, pain to light touch (allodynia), tinels sign – tingling radiation with tapping. [I would have thought numbness in area would have been a case too]
If Pain is Nociceptive:
If Pain Is Neuropathic:
- neurectomy nerve ilioinguinal and iliohypogastric
- proximal stumps are redirected and buried in the internal oblique muscle to prevent the later development of painful neuromas.
- “Resection systematic genital branch of genitofemoral nerve, advocated by some authors, remains controversial. Indeed, this nerve is small and travels near the spermatic vessels.” Wound issues may arise and it is not worth it – given it is not been proven to be the genesis of pain. “The revision surgery with neurectomy provides relief of pain symptoms in 90% of cases.” – they referenced 3 studies.
- In a series of Neurectomy studies, 60% – 100% had good results. ||
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Another study:
Madura 2005 – Total pain relief was attained in 72% of patients, partial relief in 25%, and no relief in 3%.
Within next year or so should come out a study comparing injection therapy and neurectomy for post hernia pain – I may give more guidance:
ernia. 2010 Jul 17. [Epub ahead of print]
A randomised controlled trial of injection therapy versus neurectomy for post-herniorrhaphy inguinal neuralgia: rationale and study design.
Loos MJ, Verhagen T, Scheltinga MR, Roumen RM. abstract here
Even newer techniques are coming online including:
spinal cord stimulation:
Spinal Cord Stimulation – Good Control of Post Hernia Pains
and peripheral field stimulation (only good if localized to one area):
mentioned here:
Post Hernia Surgery Pain Protocol and Other Options
Comment – It comes down to people having the appropriate nerve blocks; if qualify, having any necessary surgery; and if need be, having access to someone doing neurostimulation.
What experience have people had in this regard?
Good information people who have the surgery will have different experiences some has to do with not rehab recovery time correctly, some doctor rushing them back to work too soon and some from just bad surgery.
Below is a link to a Saudi study on a new surgical technique. This study reports zero groin pain and no recurrence when this technique is used.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2702909/
FYI I found this study by putting the following into google:
“inguinal hernia” “suture removal”
Zero recurrence and zero groin pain – can’t get much better than that. I hope this is helpful and promotes some productive discussion. It seems that we should be using this in the United States.
anotehr reference:
Saudi J Gastroenterol. 2008 July; 14(3): 122–127.
doi: 10.4103/1319-3767.41730
It has been 17 months since my hernia surgery done with mesh and still have pain, a nerve blocker for pain have been done with no relief any advise that can be given to me, I don’t want to go through the rest of my life with this or how long do I have to suffer.
How about a steriod injection would this help?
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steroid injections in posthernia surgery cases has only been recently investigated – but not reported – I have written the researcher and asked for comments.
admin
I had a double ingurnial hernia op nearly 4 years ago. . I had instant agony from the left side. No one really listened to me. 12 months on I had a hernia gram and a steroid injection which made it all worse. After. 15 months of agony., they opened me up to find the mesh had popped. Although, they re stitched the mesh in, I’m still in lots of pain. 3 years after the original op, I had a 3rd operation. (Keyhole for the first time) to look at what’s happening. I also had something called the lloyd release procedure. (Check it out). For 4 weeks I was almost pain free and all the bowel symptoms I was having settled down. But sadly, 3 months on and I’m back to square one again? I had a steroid injection a week ago and it actually feels worse now. When will this misery ever end? Will it ever end?
I’m happy to find this page. Although, it’s a horrible situation lots of us have found ourselves in, I feel slightly better knowing I’m not alone.
6 years ago (2009)I was referred to a consultant by my GP after I had concerns regarding a “lump” on the left side of my groin. On examination, I was told by the consultant ,after examining the right side of my groin,that I needed surgery for Hernia there as well as the left side,even though there was no visible sign of any lump on the right side. within 3 months both left and right sides where operated on.I was 63 years old at the time. There was a gap of around 3 months between left and right hernia surgery. 6 months passed and was now suffering real pain and tenderness in both left and right testicles. After talking to my GP about this chronic pain He referred me back
After 6 years of Chronic pain after L and R ingurnial hernia surgery.And countless appointments with consultants and Health professionals over a period of 5 years,To no relief whatsoever,After 3 appointments with”Pain Management People”. I have been asked to have Cortisone Injections in my groin? To see of this treatment helps! Am I clutching at straws to go along with this, As I was under the impression that this treatment was for Joint inflammation and not nerve damage, Which I believe ,after speaking as l say to numerous Health profesionals is probably not possibly the cause after 6 years of chronic pain. I was 64 Years of age when I had the surgery.
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There are primarily two nerve that get damaged most by hernia surgery – ilioinguinal, and the genitofemoral nerves. The genitofemoral radiates into testicle:
http://painmuse.org/wp-content/uploads/genitofemoraln.png
Injecting that nerve with steroid sometimes helps:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1599523/pdf/brmedj00069-0024a.pdf
Genitofemoral Neuropathy
“A depot preparation of methylprednisolone (1 ml) was injected just lateral to the femoral artery and just below the inguinal ligament. This relieved the hyperpathia within 24 hours…” However, it can take up to 3-4 injections to be sure how much benefit can be achieved…