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Acknowledgement that chronic pain is real by the Editor-in-Chief of Hernia
G. Campanelli, Editor-in-Chief of Hernia published a letter in the Editor’s corner of Hernia, titled:
“Chronic pain after inguinal hernia repair is a real risk and a major issue”
The topic of “chronic postoperative pain ” will be “broached” by Hernia in 2022. Kind of an odd thing to say, “broach” implying that the topic is new to the field, but, maybe he is recognizing that it has been ignored or discounted and they have decided to stop ignoring it. Time will tell if any good comes of the effort. He describes it as much more complex than the facts seem to show. At least the subject will get some more light.
It will be interesting to see who steps up and how much influence the mesh producers will have. What if the evidence definitively shows that mesh is worse than pure tissue for the majority of simple hernias? What then?
https://link.springer.com/article/10.1007/s10029-022-02576-z
Excerpt –
“For all these reasons, several essential points need to be defined as we seek to broach the topic of chronic postoperative pain. What is needed, once again, is a precise definition of the condition, an exhaustive diagnostic process that aims at excluding the presence of other comorbidities, clarification on the choice of possible non-surgical therapies and their correct timing (start and end), as well as eventual surgical interventions, choice and timing.
In the course of 2022, we are planning to organize a Forum and subsequent Special Issue and Topical Collection devoted to this hot topic, and will be inviting internationally renowned experts to contribute.”
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18 Replies
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I created a new Topic about the Special Issue itself. As new papers become available I will post the links there. I included a link back to this Topic to keep the chain of information intact.
https://herniatalk.com/forums/topic/hernia-journal-special-issue-on-chronic-pain/#post-33726
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That’s my view Watchful and one the last consultant put in his report, that at this time risks with surgery outweigh the need for it.
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If post-surgery issues such as some level of chronic pain are that common, there should at least be better disclosure to the patient before surgery. Some boilerplate language buried in doctor’s notes or consent forms isn’t enough because no one reads them, and they don’t mention the incidence, so patients can’t tell if these complications are extremely rare, or common-enough to be of concern.
Also, if these complications are that common, both the patient and the surgeon need to think very carefully before deciding to operate. Most inguinal hernias are minimally symptomatic, and it’s horrible to convert by surgery a minor problem to a worse problem. Fixing the hernia while ending up in worse shape overall isn’t smart.
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It’s also debatable if people were tougher as there is evidence of all sorts of medical interventions to alleviate or try to alleviate pain.
Sorry to labour this point but surgeons used to amputate without anaesthetic and tar for cauterisation. Why change?
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What happened to “Quality of life is the most important outcome measure of hernia repair” ?
Years ago people put up with unsafe working conditions, wife beating, etc etc. It doesn’t mean it’s wrong not to now.
I don’t understand why it makes any difference if people were tougher less complaining then. It’s just an excuse and side steppimg the issue.
(Incidentally, I heard the British army during WW2, routinely removed all soldiers teeth, if they went into jungle/tropics where military dentists were, the troops went along with it uncomplaining I can’t see that being put up with that now).
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It looks like the issue of Hernia dedicated to chronic pain is about to be released or has been already. Dr. Campanelli has written an introductory Editorial. It kind of fits with the times, he comes very close to using the popular word “woke”. He implies that the chronic pain problem is amplified by patients being too aware and too demanding. He even uses the word “completely” as if 20 years ago is an incomprehensible amount of time. People were “different” back then. Tougher or more ignorant maybe. A little bit disappointing in that it is a form of giving up.
So, just like many of today’s huge issues this one will continue as part of the fabric of today’s modern society.
https://link.springer.com/article/10.1007/s10029-023-02750-x
“EDITOR’S CORNER
Published: 02 February 2023
Primary inguinal hernia, postoperative chronic pain and quality of life
G. Campanelli
Hernia (2023)”“It is also true that the perception of postoperative symptoms has changed completely compared with the past: today’s “self-awareness”, prioritisation of quality of life, and “demand” for perfect results have led to a situation in which postoperative symptoms tend to be overestimated compared with before.
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Nevertheless, the possibility of postoperative pain should not be underestimated, and we should indeed strive to generate more correct data, both on surgical indications and “surgical” prevention of this pain, and on the adoption of an integrated approach to these situations.”
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I really do wish that I could post some news of progress. I just can’t find any. Professional researchers keep confirming that mesh repair causes chronic pain at rates in the teens. But it seems to be accepted as normal now.
This seems to be the “Collection” that Dr. Campanelli refers to. There’s not really much there.
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My recent Topic about Dr. Felix, and Dr. Towfigh’s reply, reminded me that the Editor of Hernia, Dr. Campanelli, had talked about a special Forum and a publication about chronic pain from inguinal hernia repair. Has anybody seen anything? Things seem exactly the same.
https://link.springer.com/article/10.1007/s10029-022-02576-z
“In the course of 2022, we are planning to organize a Forum and subsequent Special Issue and Topical Collection devoted to this hot topic, and will be inviting internationally renowned experts to contribute.”
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Dr. Campanelli seems to be thinking deeply about what it means to be a physician in today’s world and expressing his thoughts in Editorials. It will be interesting to see what the corporations think of the issues he is raising.
Here is a search page and a couple of his most recent articles.
https://link.springer.com/search?dc.creator=G.%20Campanelli
“Quality of life is the most important outcome measure of hernia repair”
https://link.springer.com/article/10.1007/s10029-022-02634-6
“Super-technology, quality of life and ethics in surgery”
https://link.springer.com/article/10.1007/s10029-022-02655-1
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It’s good that there’s finally more focus on the issue of chronic pain resulting from hernia surgery.
I’m really skeptical of studies of hernia surgery outcomes, though. They’re all over the place. Pick a conclusion you want to draw, and you’ll find studies to substantiate that.
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Here is an example of where business factors could drive change in the mesh-based hernia repair industry. “workdays missed”. Once a dollar figure gets put on the problem, people with power start to think differently.
The study is broad-based, including all types of chronic pain. But the concerns are the same.
Excerpt –
” Respondents with chronic pain reported significantly more workdays missed compared with those without chronic pain (10.3 vs 2.8, P < 0.001). Overall, these findings indicate that more than 1 in 5 adults in America experiences chronic pain; additional attention to managing the burden of this disease is warranted.”
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Dr. Campanelli has been studying chronic pain from hernia repair for quite a while. Here’s a paper from 2011.
Interesting that the problem was serious enough in 2007 that a group of nine experts was assembled in 2007, eventually resulting in this work. But, somehow, the problem persists.
The same general strategy was used to produce the “Guidelines” for hernia repair.
https://link.springer.com/article/10.1007/s10029-011-0798-9
“Purpose
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.Methods
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.” -
Here is a recent paper citing Dr. Campanelli’s Editorial. There’s only one shown. 890 “accesses”.
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A recent paper with Dr. Campanelli as a co-author. Might be related to why he wrote the letter. Who knows. He started out as an author of the original mesh Guidelines and now is moving back to Shouldice as a possible choice, before mesh in certain situations. At least, a surgeon should know both, and choose appropriately. That seems like progress to me.
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Here is something to think about. Dr. Campanelli was one of the original authors of the “Guidelines”. The original was published in 2009, almost thirteen years ago.
https://link.springer.com/article/10.1007/s10029-009-0529-7
I am not sure that they have kept up with their stated goals though.
” In between revisions, it is the intention of the Working Group to provide every year, during the EHS annual congress, a short update of new high-level evidence (randomised controlled trials [RCTs] and meta-analyses). Developing guidelines leads to questions that remain to be answered by specific research.”
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Hopefully this will filter through to consultants who should inform their patients it’s a real risk and major issue
Some at present say it’s a (very) small percentage, even that it’s “imagined” and all in the head.
Once again Good Intentions, thanks for the analysis, good find, informative.
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My first post seems cynical and skeptical about the stated effort to discuss chronic pain from hernia repair but here is why. Two of the various hernia societies associated with Hernia use the “Guidelines” as their guide to hernia repair surgeons. The Guidelines were created by the Herniasurge group through an effort funded by Ethicon and Bard (before Bard was purchased by BD). The Guidelines state clearly at the beginning of the document that they are meant as guidelines for the use of mesh in hernia repair. They assert that mesh is the preferred method for hernia repair, but do not provide reasons why. The “Guidelines” are not hernia repair guidelines they are mesh usage for hernia repair guidelines. So, there is an inherent conflict of interest at the very foundation of Hernia. It’s just the way things are.
It might be that Hernia is somehow independent of these large organization but it seems unlikely. The details of the “affiliations” are not clear. I hope that the editors and staff at Hernia can find the will to push past this inherent conflict. There is a lot invested in the promotion of mesh for hernia repair and it is stated clearly in his letter that chronic pain is a new problem that parallels the use of mesh prosthetics.
https://www.springer.com/journal/10029/aims-and-scope
“Hernia is a rigorously peer reviewed journal that regularly publishes specific topical issues and collections in addition to original articles, and is affiliated with the European Hernia Society (EHS), the Americas Hernia Society (AHS), the Canadian Hernia Society, and the Asia Pacific Hernia Society (APHS).”
https://www.europeanherniasociety.eu/science
https://americanherniasociety.org/surgeon-resources/guidelines
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Here are some links describing Hernia.
https://www.springer.com/journal/10029
https://www.springer.com/journal/10029/ethics-and-disclosures
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