Chronic Postoperative Hernia Pain

Causes of Pain Lasting for Longer Than Three Months

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One of the more frustrating complications of hernia surgery is the chronic postoperative pain that can sometimes occur. It is both an irony and aggravation given that the surgery was meant to relieve pain, not add to it.

Luckily, in all but a few cases, the pain is not permanent and will eventually resolve on its own. How long it takes depends largely on a person's age, the type of surgery used, the location and size of the herniation, and the general health of the individual.

Understanding Post-Herniorraphy Neuralgia

Chronic postoperative hernia pain, also known as post-herniorrhaphy neuralgia, is defined as a nerve-related pain which persists for more than three months and is unrelated to any other cause.

It is not all that uncommon a condition, particularly for those who have undergone inguinal (groin) hernia surgery. Depending on which study you refer to, the incidence can be as low as nine percent or as high as 62 percent. In some cases, the pain can be so severe as to interfere with walking, sitting, or even sleep.

The pain is typically caused when nerves become damaged or trapped in sutures, staples, or surgical mesh. The resulting pain is referred to as neuropathy and can manifest with shooting pains and/or a burning, tingling, aching, or pins-and-needles sensation.

The pain may also be somatic, meaning that is related to the skin, muscles, or tissue rather than the nerves.

If any of these are foreshortened during surgery, it can result in an uncomfortable tugging, aching, or pulling sensation, generally with movement. Time and exercise are usually the best way to overcome pain of this sort. It is rarely long-lasting.

Risk of Postoperative Hernia Neuralgia

The risk of developing chronic postoperative neuralgia following hernia surgery can vary but may include:

  • Younger age
  • Being female (although no one is quite certain why)
  • Having had surgery within the past three years
  • Undergoing surgery to repair a previous hernia surgery
  • The involvement of the Iliohypogastric nerve which supplies sensations to the buttocks and abdominal area
  • The repair of an anterior (nearer to the midline) hernia
  • Infection or other postoperative complications
  • Pre-existing neuropathy

Of these, age appears to be the single biggest factor. In fact, one study found that 58 percent of people under 40 had persistent, postoperative hernia pain compared to only 14 percent over 60. This is likely due to the fact that younger people are more active than older people.

Treating Postoperative Hernia Neuralgia

Chronic postoperative hernia pain is usually treated conservatively with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen or naproxen. Severe pain may require prescription opioid medications.

If these fail to provide relief, the doctor may recommend radiofrequency ablation in which an electrical current produced by radio waves is used sever a nerve pathway, thereby decreasing pain signals from that specific area.

A less invasive version of this is called a nerve block and involves the use of an anesthetic injection to temporarily cut off pain signals.

A Word From Verywell

While chronic postoperative pain can interfere with your wellbeing and quality of life, it is important to remember that it is rarely a permanent condition. In around 30 percent of cases, the pain will go away on its own within six months. After five years, fewer than three percent of patients remain affected.

While medications can relieve many of the symptoms, exercise can improve circulation and flexibility, both of which can help reduce pain over the long term. Sitting still will not. Moreover, shedding those extra pounds can help relieve weight-related stress, particularly in the groin or pelvic area.

In the end, good lifestyle choices will not only make you healthier, it can improve your mood and provide you the means to better cope with persistent pain.

Sources:

Hakeem, A. and Shanmugam, V. " Current trends in the diagnosis and management of post-herniorraphy chronic groin pain." World J Gastrointest Surg. 2011; 3(6):73-81. DOI: 10.4240/wjgs.v3.i6.73.

Somaiah, A. and Spence, R.. "Chronic Pain After Hernia Surgery – An Informed Consent Issue." Ulster Med J. 2007; 76(3):136-40.PMCID: PMC2075594