The following is a portrait of a typical hernia mesh pain patient. A hernia mesh pain patient reading this might say "Oh, that is me!". Actually it is no patient in particular, it is many patients.
Jane Doe is a 50 year old female who comes to see me with a 3 year history of severe chronic pain in the right groin and other areas and and other symptoms such as severe chronic fatigue, achy joints and swollen glands. She had a right inguinal hernia repair with mesh 3 years ago.
On exam prior to surgery she had a small right inguinal hernia. The hernia mesh pain started immediately after surgery. In the recovery room after surgery she knew something was wrong. The pain was much more than she expected. Her surgeon reassured her that her pain was normal post operative pain and that it would soon get better.
She saw her surgeon for follow up in his office a week later. She complained that her pain was not getting better and that she had used up all of the pain pills he had given her. He examined her. There were no signs of infection, bleeding or other complications. Again he reassured her, gave her another pain prescription and asked to return in one month.
A month later she returns with the same pain. On exam her wound is well healed, is very sensitive to light touch, pin prick causes extreme pain and there are no signs of a hernia recurrence or wound infection. He does not give her another prescription but instructs her to take over the counter pain medicine. He tells her he sees nothing wrong, orders a ct-scan and asks her to come back in another month.
Ct-scan report is normal post operative changes. Another month passes and her pain is unchanged. Her surgeon says sometimes it can take months for the pain to resolve, this is not unusual. He says she needs more time to heal and for now needs pain management. She is getting very anxious. He refers her to pain management.
The pain doctor evaluates her and diagnoses her with chronic pain of uncertain cause. He prescribes a narcotic pain medication and another med called Neurontin. This makes the pain a little better but the Neurontin makes her very sleepy all of the time.
The pain doctor orders an ultrasound and mri, both of which return normal results. He suggests injection of steroid and local anesthetic into the wound. This gives modest temporary relief.
He then suggests a nerve block trial. This gives partial relief. After this a nerve ablation procedure is preformed. This gives modest relief lasting only two months.
One year after her hernia surgery her pain and disability are getting worse. In her frustration she returns to the one doctor who she knows will listen, her primary care. He listens to all her complaints, takes a history and examines her. He refers her to various specialists who preform colonoscopy, nerve conduction studies, hip x-rays, blood work and and other studies. Still no good diagnosis or treatment plan.
She knows deep down that the mesh is the problem and it needs to come out. She starts looking for a surgeon to do this. She is told by multiple surgeons that it is impossible to safely remove mesh and even if it was removed her hernia would certainly come back. She is also told that there is nothing wrong with her mesh and hernia repair. One surgeon recommends exploratory surgery with possible revision of the repair by application of more mesh.
The diagnosis of hernia mesh pain is a clinical diagnosis based on history of mesh hernia surgery, complains of pain centered where the mesh is and onset of pain anytime after mesh hernia surgery even as much as twenty years later. The diagnosis is not made by any medical imaging or any other laboratory test. Medical imaging is worthless unless because of medical suspicion some other cause of pain needs to be ruled out, such as hip joint disease, ovarian disease and other conditions.
Chronic post surgical pain is defined by pain specialist societies as pain that lasts beyond the completion of healing. An arbitrary definition is defined by many practioners as pain lasting more than three months, 6 months or 1 year. I do not subscribe to any of these arbitrary definitions.
The time of onset of hernia mesh pain varies widely, from immediately after surgery to 20 years after surgery. 50% say their hernia mesh pain started immediately after surgery. Of the patients with hernia mesh pain 80% say their pain started between immediately to 6 months after surgery. 20% develop their hernia mesh surgery after 6 months.
Men have 3 times more hernias than women but a women come to me for mesh removal at a ratio of men to women at 2 - 1. There are a lot of possible reasons for this. Women may be more likely to develop pain, they may be less tolerant of pain(which I doubt) or they may just take better care of themselves.
Hernia mesh pain patients commonly have pain in multiple areas such as the other side, the rectum, the abdomen and down a leg. This is caused by the Widening of the Pain Field component of Central Pain Sensitization(see button at bottom of this page). Light touch causing pain is a phenomenon called Allodynia. Mild painful stimulus causing extreme pain is called Hyperesthesia.
Severe chronic fatigue, achy joints and swollen glands are three symptoms which are enough symptom criterion( there are other criterion) to make the diagnosis of syndrome. There are other symptoms which are part of the A.S.I.A. syndrome.
Pain at one month after surgery is a bad sign but there is still a chance the pain will get better in time. Pain lasting three months after surgery is very unlikely to get better no matter how long you wait.
The only reliable permanent cure for hernia mesh pain is mesh removal. All other treatments are either temporary or have intolerable side effects.
Exploratory surgery for the hernia mesh pain patient is a bad idea. At best it is worthless and a waste of time. Diagnosis of hernia mesh pain is a clinical diagnosis not based on gross pathology or even microscopic pathology. All mesh microscopically shows chronic inflammation whether or not the there is hernia mesh pain. Also a terrible idea is to postulate there is an occult hernia and treating it by revising the repair by adding more mesh. This compounds the pain problem and makes it much more difficult to treat by mesh explanation. Also removing old mesh and replacing it with new mesh does not work. New mesh is not free of the pain problem.
Severe hernia mesh pain is devastating. Patients commonly lose everything including employment, insurance, home, personal relationships, recreational activities and any enjoyment of life. Some patients never get out of bed, Some patients commit suicide which is a tragedy.
Central Pain SensitizationSubmit a comment or question by email for posting on the Invitational forum. All email addresses are discarded and will not be shared. Please do not change subject line. kevincpetersen@gmail.com