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Multicenter Study
. 2020 Jul 6;20(1):147.
doi: 10.1186/s12893-020-00805-9.

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

David Bande  1 , Luis Moltó  2 , Jose Antonio Pereira  3 , Antonio Montes  2
Affiliations
Multicenter Study

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

David Bande et al. BMC Surg. .

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.

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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
See this image and copyright information in PMC

References

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