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Chronic Pain affecting most of one side
HI all. I had inguinal hernia repair (right side) on Aug 31 2019. Have had chronic pain since then. I have tingling in my right foot up into my calf at times. Pain from my inner thigh up into my rib cage. The pain is in most of my abdmoen on my right side, even wraps around to the side. When lifting with my right arm I often experience pain down the right side of my chest. Surgeon is looking at a triple neurectomy and I am just trying to find if anyone has heard of similar type of chronic pain issues and if the triple was a good course of action (I know everyone heals differently but looking for input)
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10 Replies
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Thakn you all for your input again. It has given me a lot to think about and take to my dr . I hope they sort it out soon though cause the pain is interfering with my life so much.
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I agree with Dr Brown, many of your symptoms seem incongruous with the plan of care.
– symptoms below the knee is almost never Related to groin hernia. Have they evaluated your spine?
– if you didn’t respond with pain relief by nerve block, then triple neurectomy will not help you.
– CT scan is not adequate for groin or pelvis evaluation after prior hernia repair. It does not adequately evaluate the mesh. You need MRI. That will help determine if there are issues with the mesh placement. It may also identify new diagnoses, inflammation, hip problem, spine issue, other pelvis issues. -
I would be careful with any sort of direct injections to the groin that’s not imaging guided with an US. I wouldn’t recommend direct injections of the mesh with steroid, having had it done myself by a surgeon who regularly participates in this forum, it only added further insult to my injury and to the nearby nerves.
Without imaging, the needle can pierce or puncture a nerve or nerves, there is no way visually for the operator to know exactly where a nerve is, he or she shooting blind with the needle.
Claims that the steroid can soften the mesh is false, that doesn’t make any sense if you do a little research on what steroid compound is and the material science behind a polypropylene mesh.
The injection with steroid will actually cause even more scarring, tissue, blood vessel, and nerve injury from the multiple needle penetrations. Keep in mind it’s not a single needle insertion, but several in and around the mesh where the nerve runs along your spermatic cord.
Imagine a piece of paper wrapped around a pencil, the paper being the mesh and the pencil being your spermatic cord. Get a thumbtack poke the paper multiple times, but instead of a paper its actually mesh/soft tissue.
The trauma from the needle and the puncture will cause micro tears and an exacerbated inflammatory reaction once that cocktail of local anesthetic and steroid leaves your system to repair the damage.
This process will further alters the integrity of the mesh and your soft tissue, which is already compromised.
Sometimes less intervention is better, this diagnostic intervention is not a treatment, nor a solution, and can worsen your injury ultimately leading you to surgical intervention desired by the surgeon.
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Dr. Brown has written about how there is a certain level of knowledge and skill required to understand how to do diagnostic injections and how to interpret the results.
Related to my first post – if the surgeon is not inclined to remove the mesh if it is determined to be the problem then they will not have mesh removal in mind as an option. When Dr. Brown says “the mesh itself can be injected” he means to do that as a way to see if mesh removal will help. When you have mesh problems it’s almost a waste of time to talk to surgeons that do not accept mesh removal as a potential cure. The “vast majority” of surgeons that implant mesh do not want to be involved with mesh removal, at all. They will keep working on you but will avoid the most likely cure if it turns out to be mesh removal. They have been trained that mesh is never the source of the pain.
I hate to always be the negative commenter but it’s just the reality of today’s healthcare.
Here are some of Dr. Brown’s past posts about injections.
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I have had 2 cts scans of the abdomen and I am told there is nothing out of the ordinary with them . I had shots done that involved steroids and a numbing agent. The first was somewhat helpful for maybe a week or so. The second provided no relief. I also was on gabapentin twice a day and if anything it may have been worse while on that. I didn’t get any shots directly into the mesh as you suggested, I will talk to my surgeon about that.
Thank you all for your input
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Dear Timothy.
Your symptoms are more extensive than I would expect.
You should have imaging tests to evaluate for a recurrent hernia and scarring of the mesh.
Diagnostic injections can be very helpful.
for example, if you have an ilioinguinal and iliohypogastric nerve block in your symptoms improve that would be evidence that these nerves are a component of your trouble. In a similar manner, the mesh itself can be injected with the local anesthetic. If you improve that would be evidence that the mesh is a significant component of your trouble. The more information you can get prior to considering surgery.
Regards.
Bill Brown MD -
I have done physical therapy, meds and injections all to no real avail. The tramadol helps at times but I don’t really like using it. It throws me off for the rest of the day. Thanks for the link. I will go through them and see if I can’t find anything.
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Neurectomy is supposed to be a last resort. There is quite a bit on the site about the topic. I searched Google to find the herniatalk threads, link below. Going directly to triple neurectomy seems like malpractice but that’s how things are today. Your surgeon will say they tried and send you off to pain management with your new problems.
Avoid the run-of-the-mill mesh repair surgeons. They are all reading from the same playbook. Trying to make mesh work. It’s a high volume business so the low number of patients that actually report problems barely registers compared to the number of patients who never come back.
https://www.google.com/search?q=site%3Aherniatalk.com+neurectomy&rlz=1C1SQJL_enUS862US862&oq=site%3Aherniatalk.com+neurectomy&aqs=chrome..69i57j69i58.13630j0j8&sourceid=chrome&ie=UTF-8
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It was an open with mesh. Not sure of the mesh that was used :/ I was able to get a second opinion from another surgeon who does hernia surgery and he agreed with the first. Just exploring more options.
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Hi Timothy – sorry you are going thru this. What type of surgery did you have? Open or Laparoscopic? Do you know what the mesh was that was implanted? There are definitely others on this forum that probably have had similar experiences that can weigh in. There are also other doctors who deal with chronic pain that you can find here – I would recommend reaching out to several of them to get second and third opinions.
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