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Long term pain drags you down mentally and physically. You find yourself thinking will I be in pain for the rest of my life? Will I never be better? Will I ever have sex again. The pain is very hard on personal relationships. I prefer to try to get treatment started early. There are thought to be three main causes of chronic pain after hernia repair. One is a recurrent hernia. This should be identifiable on physical examination or with ultrasound.
Next is the body’s reaction to the mesh itself. Mesh becomes scarred and shrinks and becomes stiff. This is usually a pain that feels deep. Often gets worse with aggressive activity. Often gets worse with long periods of sitting. The pain will get better with rest.
Next one of the nerves has been damaged. This will often be a shooting or an electric pain that is more superficial. The skin will often be sensitive to light touch.
If you think that the mesh is the source of pain, then the mesh can be injected with marcaine and steroids. This will often provide relief.
If the nerves are the source of the pain, then a nerve block with marcaine and steroids can be very beneficial.
Removal the mesh and neurectomy are the last resort. The operation can be very difficult and sometimes the patient does not get improvement.
A very difficult problem.
Regards.
Bill Brown MD