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      Is chronic post-herniorrhaphy pain always chronic? A literature review

      Journal of Pain Research

      Dove Medical Press

      hernia, pain, chronic post-surgery pain, neuropathic pain, halvation time

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          Abstract

          Introduction

          Chronic post-surgery pain (CPSP) has gained increased recognition as a major factor influencing health-related quality-of-life following most surgical procedures, in particular following surgery for benign conditions. The natural course of CPSP, however, is not well-known.

          Methods

          A literature review was undertaken, searching for studies with repeated estimates of post-herniorrhaphy pain. The hypothetical halvation time was calculated from the repeat estimates.

          Results

          Eight studies fulfilling the criteria were identified. With one exception, the extrapolated halvation times ranged from 1.3 to 9.2 years.

          Discussion

          Even if CPSP is generally very treatment-resistant, in many cases it eventually dissipates with time. Further studies are required to evaluate the prevalence of pain beyond the first decade.

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          Most cited references 29

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          The short-form McGill Pain Questionnaire.

           R Melzack (1987)
          A short form of the McGill Pain Questionnaire (SF-MPQ) has been developed. The main component of the SF-MPQ consists of 15 descriptors (11 sensory; 4 affective) which are rated on an intensity scale as 0 = none, 1 = mild, 2 = moderate or 3 = severe. Three pain scores are derived from the sum of the intensity rank values of the words chosen for sensory, affective and total descriptors. The SF-MPQ also includes the Present Pain Intensity (PPI) index of the standard MPQ and a visual analogue scale (VAS). The SF-MPQ scores obtained from patients in post-surgical and obstetrical wards and physiotherapy and dental departments were compared to the scores obtained with the standard MPQ. The correlations were consistently high and significant. The SF-MPQ was also shown to be sufficiently sensitive to demonstrate differences due to treatment at statistical levels comparable to those obtained with the standard form. The SF-MPQ shows promise as a useful tool in situations in which the standard MPQ takes too long to administer, yet qualitative information is desired and the PPI and VAS are inadequate.
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            International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery.

            To provide uniform terminology and definition of post-herniorrhaphy groin chronic pain. To give guidelines to the scientific community concerning the prevention and the treatment of chronic groin and testicular pain. A group of nine experts in hernia surgery was created in 2007. The group set up six clinical questions and continued to work on the answers, according to evidence-based literature. In 2008, an International Consensus Conference was held in Rome with the working group, with an audience of 200 participants, with a view to reaching a consensus for each question. A consensus was reached regarding a definition of chronic groin pain. The recommendation was to identify and preserve all three inguinal nerves during open inguinal hernia repair to reduce the risk of chronic groin pain. Likewise, elective resection of a suspected injured nerve was recommended. There was no recommendation for a procedure on the resected nerve ending and no recommendation for using glue during hernia repair. Surgical treatment (including all three nerves) should be suggested for patients who do not respond to no-surgery pain-management treatment; it is advisable to wait at least 1 year from the previous herniorraphy. The consensus reached on some open questions in the field of post-herniorrhaphy chronic pain may help to better analyze and compare studies, avoid sending erroneous messages to the scientific community, and provide some guidelines for the prevention and treatment of post-herniorraphy chronic pain.
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              Risk factors for long-term pain after hernia surgery.

              To estimate the prevalence of residual pain 2 to 3 years after hernia surgery, to identify factors associated with its occurrence, and to assess the consequences for the patient. Iatrogenic chronic pain is a neglected problem that may totally annul the benefits from hernia repair. From the population-based Swedish Hernia Register 3000 patients aged 15 to 85 years were sampled from the 9280 patients registered as having undergone a primary groin hernia operation in the year 2000. Of these, the 2853 patients still alive in 2003 were requested to fill in a postal questionnaire. After 2 reminders, 2456 patients (86%), 2299 men and 157 women responded. In response to a question about "worst perceived pain last week," 758 patients (31%) reported pain to some extent. In 144 cases (6%), the pain interfered with daily activities. Age below median, a high level of pain before the operation, and occurrence of any postoperative complication were found to significantly and independently predict long-term pain in multivariate logistic analysis when "worst pain last week" was used as outcome variable. The same variables, along with a repair technique using anterior approach, were found to predict long-term pain with "pain right now" as outcome variable. Pain that is at least partly disabling appears to occur more often than recurrences. The prevalence of long-term pain can be reduced by preventing postoperative complications. The impact of repair technique on the risk of long-term pain shown in our study should be further assessed in randomized controlled trials.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2015
                22 May 2015
                : 8
                : 241-245
                Affiliations
                Department of Clinical Science, Intervention and Technology, Karolinska Institute, Huddinge, Sweden
                Author notes
                Correspondence: Gabriel Sandblom, Gastrocentrum, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden, Tel +46 8 585 800 00, Email gabriel.sandblom@ 123456ki.se
                Article
                jpr-8-241
                10.2147/JPR.S82708
                4447176
                © 2015 Sandblom. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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