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

• Published in: BMC surgery Vol. 20; no. 1; pp. 1 - 147
• Main Authors: Bande, David, Moltó, Luis, Pereira, Jose Antonio, Montes, Antonio
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 06.07.2020; BioMed Central; BMC
• Subjects: Analgesics; Analysis; Anesthesia; Chronic pain; Data collection; Finite element method; Health risk assessment; Hernia; Hernia repair; Hernias; Hospitals; Internet resources; Interviews; Medical research; Mood; Neuralgia; Pain; Pain management; Patients; Quality o life; Quality of life; Questionnaires; Researchers; Risk assessment; Studies; Surgery; Spain
• ISSN: 1471-2482; 1471-2482
• DOI: 10.1186/s12893-020-00805-9

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.