Chronic pain after groin hernia repair: pain characteristics and impact on quality of life

David Bande, Luis Moltó, Jose Antonio Pereira, Antonio Montes, David Bande, Luis Moltó, Jose Antonio Pereira, Antonio Montes

Abstract

Background: Chronic postsurgical pain (CPSP) after hernia repair research has mainly relied on unconfirmed self-reporting. We aimed to describe confirmed CPSP incidence, management, and quality of life (QoL) in a 2-year prospective study.

Methods: Multicenter study (GENDOLCAT) of 3890 patients undergoing 4 common surgical procedures in 23 hospitals to develop a risk model for CPSP; 2352 men underwent open hernia repair. Patients with pain were identified by telephone at 1 and 3 months and referred to the hospital 4 months after surgery for a physical examination to confirm CPSP. Three validated tools were used: the Brief Pain Inventory (BPI) for severity, analgesic use, and interference with activities; the SF-12 questionnaire for QoL (validated Spanish version), and the Douleur Neuropathique 4 (DN4). Patients with CPSP were called again at 1 and 2 years.

Results: In 1761 patients who underwent hernia repair and were eligible for physical examination for CPSP, the incidence of confirmed pain at 4 months was 13.6% (patient-reported pain, 6.2% at 1 year and 4.0% at 2 years). Neuropathic pain was diagnosed in 38.5% of the CPSP patients at 4 months. The incidences of neuropathic CPSP in patients with mesh or non-mesh repairs were similar (38.6 and 33.3%, respectively). SF-12 physical component scores changed little in all patients, whether or not they developed CPSP. The SF-12 mental component decreased significantly in all patients, but the decrease was clinically significant only in CPSP patients. CPSP interfered with activities (18%), work (15.6%), walking (15%) and mood (10.2%). At 2 years 52.1% of CPSP patients had moderate/intense pain and 28.2% took analgesics.

Conclusion: CPSP affects QoL-related activities, and although it diminishes over the course of 2 years after surgery, many patients continue to have moderate/intense pain and take analgesics. CPSP and neuropathic pain rates seem to be similar after mesh and non-mesh repair. BPI and SF-12 mental component scores detect effects on QoL.

Trial registration: ClinicalTrials.gov NCT01510496.

Keywords: Chronic pain; Hernia repair; Quality o life.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart showing patients recruited when scheduled for groin hernia repair, those lost before the telephone interviews, and the group of 239 patients initially diagnosed with CPSP based on physical examination and followed for 2 years. aIn order not to overestimate the frequency of CPSP, incidence rates were calculated on a cohort of 1761 patients we intended to follow: from the 2352 patients recruited, 17 were excluded as having been inappropriately enrolled, 312 were lost before phone calling started at 1 month, an additional 254 could not be reached by phone before the diagnostic examination at 4 months, and 8 deaths had occurred. The timeline shows median (10–90th percentile) times in months when data collection occurred, counting from the day of surgery
Fig. 2
Fig. 2
Locations of diagnosed CPSP at 4 months in 239 patients

References

    1. Montes A, Roca G, Sabate S, Lao JI, Navarro A, Cantillo J, Canet J, GENDOLCAT Study Group Genetic and clinical factors associated with chronic postsurgical pain after hernia repair, hysterectomy, and thoracotomy: a two-year multicenter cohort study. Anesthesiology. 2015;122:1123–1141. doi: 10.1097/ALN.0000000000000611.
    1. Johansen A, Romundstad L, Nielsen CS, Schirmer H, Stubhaug A. Persistent postsurgical pain in a general population: prevalence and predictors in the Tromso study. Pain. 2012;153:1390–1396. doi: 10.1016/j.pain.2012.02.018.
    1. Kingsworth A, LeBlanc K. Hernias: inguinal and incisional. Lancet. 2003;362:1561–1571. doi: 10.1016/S0140-6736(03)14746-0.
    1. Nienhuijs S, Staal E, Strobbe L, Rosman C, Groenewoud H, Bleichrodt R. Chronic pain after mesh repair of inguinal hernia: a systematic review. Am J Surg. 2007;194:394–400. doi: 10.1016/j.amjsurg.2007.02.012.
    1. Poobalan AS, Bruce J, Smith WC, King PM, Krukowski ZH, Chambers WA. A review of chronic pain after inguinal herniorrhaphy. Clin J Pain. 2003;19:48–54. doi: 10.1097/00002508-200301000-00006.
    1. Aasvang E, Kehlet H. Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth. 2005;95:69–76. doi: 10.1093/bja/aei019.
    1. Kalliomäki ML, Meyerson J, Gunnarsson U, Gordh T, Sandblom G. Long-term pain after inguinal hernia repair in a population-based cohort; risk factors and interference with daily activities. Eur J Pain. 2008;12:214–225. doi: 10.1016/j.ejpain.2007.05.006.
    1. Fränneby U, Sandblom G, Nordin P, Nyrén O, Gunnarsson U. Risk factors for long-term pain after hernia surgery. Ann Surg. 2006;244:212–219. doi: 10.1097/01.sla.0000218081.53940.01.
    1. Rutkow IM, Robbins AW. Mesh plug hernia repair: a follow-up report. Surg. 1993;117:597–598. doi: 10.1016/S0039-6060(05)80263-6.
    1. Cornell RB, Kerlakian GM. Early complications and outcomes of the current technique of transperitoneal laparoscopic herniorrhaphy and a comparison to the traditional open approach. Am J Surg. 1994;168:275–279. doi: 10.1016/S0002-9610(05)80201-6.
    1. Haroutiunian S, Nikolajsen L, Finnerup NB, Jensen TS. The neuropathic component in persistent postsurgical pain: a systematic literature review. Pain. 2013;154:95–102. doi: 10.1016/j.pain.2012.09.010.
    1. Lavand’homme P. The progression from acute to chronic pain. Curr Opin Anaesthesiol. 2011;24:545–550. doi: 10.1097/ACO.0b013e32834a4f74.
    1. Chung L, O’Dwyer PJ. Pain and its effects on physical activity and quality of life before operation in patients undergoing elective inguinal and ventral hernia repair. Am J Surg. 2014;208:406–411. doi: 10.1016/j.amjsurg.2014.02.011.
    1. Macrae WA, Davies HT. Chronic postsurgical pain. In: Crombie IK, Linton S, Croft P, Von Korff M, LeResche L, editors. Epidemiology of Pain. Seattle: IASP Press; 1999. pp. 125–142.
    1. Herrero MJ, Blanch J, Peri JM, De Pablo J, Pintor L, Bulbena A. A validation study of the hospital anxiety and depression scale (HADS) in a spanish population. Gen Hosp Psychiatry. 2003;25:277–283. doi: 10.1016/S0163-8343(03)00043-4.
    1. Schmidt S, Vilagut G, Garin O, Cunillera O, Tresserras R, Brugulat P, Mompart A, Medina A, Ferrer M, Alonso J. Reference guidelines for the 12-item short-form health survey version 2 based on the Catalan general population. Med Clin (Barc) 2012;139:613–625. doi: 10.1016/j.medcli.2011.10.024.
    1. Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, Cunin G, Fermanian J, Ginies P, Grun-Overdyking A, Jafari-Schluep H, Lantéri-Minet M, Laurent B, Mick G, Serrie A, Valade D, Vicaut E. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4) Pain. 2005;114:29–36. doi: 10.1016/j.pain.2004.12.010.
    1. Massaron S, Bona S, Fumagalli U, Valente P, Rosati R. Long-term sequelae after 1,311 primary inguinal hernia repairs. Hernia. 2008;12:57–63. doi: 10.1007/s10029-007-0277-5.
    1. O’Dwyer PJ, Kingsnorth AN, Molloy RG, Small PK, Lammers B, Horeyseck G. Randomized clinical trial assessing impact of a lightweight or heavyweight mesh on chronic pain after inguinal hernia repair. Br J Surg. 2005;92:66–70.
    1. Nienhuijs SW, Boelens OB, Strobbe LJ. Pain after anterior mesh hernia repair. J Am Coll Surg. 2005;200:885–889. doi: 10.1016/j.jamcollsurg.2005.02.005.
    1. Ergönenç T, Beyaz SG, Özocak H, Palabıyık O, Altıntoprak F. Persistent postherniorrhaphy pain following inguinal hernia repair: a cross-sectional study of prevalence, pain characteristics, and effects on quality of life. Int J Surg. 2017;46:126–132. doi: 10.1016/j.ijsu.2017.08.588.
    1. Richebé P, Capdevila X, Rivat C. Persistent postsurgical pain. Pathophysiology and preventive pharmacologic considerations. Anesthesiology. 2018;129(3):590–607. doi: 10.1097/ALN.0000000000002238.
    1. Champault G, Torcivia A, Paolino L, Chaddad W, Lacaine F, Barrat C. A self-adhering mesh for inguinal hernia repair: preliminary results of a prospective, multicenter study. Hernia. 2011;15:635–641. doi: 10.1007/s10029-011-0843-8.
    1. Bignell M, Partridge G, Mahon D, Rhodes M. Prospective randomized trial of laparoscopic (transabdominal preperitoneal-TAPP) versus open (mesh) repair for bilateral and recurrent inguinal hernia: incidence of chronic groin pain and impact in quality of life: results of 10 years follow-up. Hernia. 2012;16:635–640. doi: 10.1007/s10029-012-0940-3.
    1. Mier N, Helm M, Kastenmeier AS, Gould JC, Goldblatt MI. Preoperative pain in patient with an inguinal hernia predicts long-term quality of life. Surgery. 2018;163:578–581. doi: 10.1016/j.surg.2017.09.055.
    1. Heniford BT, Walters AL, Lincourt AE, Novitsky YW, Hope WW, Kercher KW. Comparison of generic versus specific quality-of-life scales for mesh hernia repairs. J Am Coll Surg. 2008;206:638–644. doi: 10.1016/j.jamcollsurg.2007.11.025.
    1. Fränneby U, Gunnarsson U, Andersson M, Heuman R, Nordin P, Nyrén O, Sandblom G. Validation of an inguinal pain questionnaire for assessment of chronic pain after groin hernia repair. Br J Surg. 2008;95:488–493. doi: 10.1002/bjs.6014.
    1. Molegraaf M, Lange J, Wijsmuller A. Uniformity of chronic pain assessment after inguinal hernia repair: a critical review of the literature. Eur Surg Res. 2017;58:1–9. doi: 10.1159/000448706.
    1. Kehlet H. Chronic pain after groin hernia repair. Br J Surg. 2008;95:135–136. doi: 10.1002/bjs.6111.
    1. Canet J, Sabaté S, Gomar C, Castillo J, Villalonga A, Roldán J, Grupo ANESCAT. Anesthesia practice in Catalonia, Spain: background, objectives, and design of the ANESCAT 2003 survey. Med Clin (Barc) 2006;126(Suppl 2):3–12. doi: 10.1157/13088795.
    1. Filardo G, Roffi A, Merli G, Marcacci T, Berti Ceroni F, Raboni D, Kon E, Marcacci M. Patients control preferences and results in knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2017;25(2):552–558. doi: 10.1007/s00167-016-4405-6.
    1. Singer JP, Katz PP, Soong A, Shrestha P, Huang D, Ho J, Mindo M, Greenland JR, Hays SR, Golden J, Kukreja J, Kleinhenz ME, Shah RJ, Blanc PD. Effect of lung transplantation on health-related quality of life in the era of the lung allocation score: a U.S. prospective cohort study. Am J Transplant. 2017;17(5):1334–1345. doi: 10.1111/ajt.14081.
    1. McHugh ML. The chi-square test of independence. Biochem Med (Zagreb) 2013;23(2):143–149. doi: 10.11613/BM.2013.018.
    1. Aasvang EK, Kehlet H. Persistent sensory dysfunction in pain-free herniotomy. Acta Anaesthesiol Scand. 2010;54(3):291–298. doi: 10.1111/j.1399-6576.2009.02137.x.
    1. Bjurström MF, Álvarez R, Nicol AL, Olmstead R, Amid PK, Chen DC. Quantitative validation of sensory mapping in persistent postherniorrhaphy inguinal pain patients undergoing triple neurectomy. Hernia. 2017;21(2):207–214. doi: 10.1007/s10029-017-1580-4.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever