Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Oct 9;21(1):70-80.
doi: 10.1515/sjpain-2020-0104. Print 2021 Jan 27.

Trajectories in severe persistent pain after groin hernia repair: a retrospective analysis

Elisabeth Kjær Jensen  1 , Emmanuel Bäckryd  2 , Jørgen Hilden  3 , Mads U Werner  1
Affiliations
Free article

Trajectories in severe persistent pain after groin hernia repair: a retrospective analysis

Elisabeth Kjær Jensen et al. Scand J Pain. .
Free article

Abstract

Objectives: Severe persistent post-surgical pain (PPSP) remains a significant healthcare problem. In the third most common surgical procedure in the U.K., groin hernia repair, including 85,000 surgeries, estimated 1,500-3,000 patients will annually develop severe PPSP. While the trajectory of PPSP is generally considered a continuation of the acute post-surgery pain, recent data suggest the condition may develop with a delayed onset. This study evaluated pain-trajectories in a consecutive cohort referred from groin hernia repair-surgeons to a tertiary PPSP-center. Potential explanatory variables based on individual psychometric, sensory, and surgical profiles were analyzed.

Methods: Patients completed graphs on pain trajectories and questionnaires on neuropathic pain, pain-related functional assessments, and psychometrics. Surgical records and quantitative sensory testing profiles were obtained. Pain trajectories were normalized, and pre- and post-surgical segments were analyzed by a normalized area-under-the-curve (AUC) technique. Principal component analysis (PCA) was applied to the explanatory variables. Significant PCA-components were further examined using multiple logistic regression models.

Results: In 95 patients, the AUC identified groups of post-surgical pain trajectories (p<0.0001): group I (n=48), acute high-intensity pain progressing to PPSP; group II (n=28), delayed onset of PPSP; group III (n=7), repeat-surgery gradually inducing PPSP. Data from groups IV (n=3) and V (n=9) were not included in the statistical analysis due to small sample size and data heterogeneity, respectively. The PCA/logistic analyses indicated that neuropathic pain scores, composite pain scores, and pain-related functional assessments were explanatory variables for groups I and II.

Conclusions: Pain trajectories in PPSP after groin hernia repair are heterogeneous but can be classified into meaningful groups. Examination of pain trajectories, mirroring the transition from acute to severe persistent post-surgical pain, has the potential of uncovering clinically relevant pathophysiological mechanisms.

Keywords: chronic pain; groin; herniorrhaphy; physiopathology; postoperative.

PubMed Disclaimer

References

    1. Chapman, CR, Vierck, CJ. The transition of acute postoperative pain to chronic pain: an integrative overview of research on mechanisms. J Pain 2016;18:359.e1–e38. https://doi.org/10.1016/j.jpain.2016.11.004.
    1. Schug, SA, Lavand’homme, P, Barke, A, Korwisi, B, Rief, W, Treede, RD. IASP taskforce for the classification of chronic pain. The IASP classification of chronic pain for ICD-11: chronic postsurgical or posttraumatic pain. Pain 2019;160:45–52. https://doi.org/10.1097/j.pain.0000000000001413.
    1. Werner, MU, Kongsgaard, UE. I. Defining persistent post-surgical pain: is an update required?. Br J Anaesth 2014;113:1–4. https://doi.org/10.1093/bja/aeu012.
    1. Werner, MU. Management of persistent postsurgical inguinal pain. Langenbeck’s Arch Surg 2014;399:559–69. https://doi.org/10.1007/s00423-014-1211-9.
    1. Reinpold, WM, Nehls, J, Eggert, A. Nerve management and chronic pain after open inguinal hernia repair: a prospective two phase study. Ann Surg 2011;254:163–8. https://doi.org/10.1097/sla.0b013e31821d4a2d.

LinkOut - more resources