Pain – how a surgeon can misrepresent the data

Hernia Discussion Forums Hernia Discussion Pain – how a surgeon can misrepresent the data

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    • #26627
      Good intentions
      Participant

      Here is a recent paper about post-op pain where the writer clearly shows that pain is a significant problem, 24% apparently, but still states that it isn’t. It just makes no sense that a person would do this unless they just don’t understand numbers and words, or they have some other motive than healing patients. It’s incredible. Even worse, it appears to be just short-term data, immediately or very soon after surgery. They’re trying to support the use of mesh, showing that it doesn’t cause “chronic” pain by reporting post-op pain. I even got confused by the introduction, talking about mesh pain, assuming that they would be talking about long-term pain.

      These authors completely avoid the fact that 100% minus 76% = 24%. 24% of patients did not “describe no pain” post-operatively. That means it’s reasonable to assume (because they avoided the issue) that 24% of patients had pain post-operatively. 24% of 1171 patients.

      https://onlinelibrary.wiley.com/doi/full/10.1111/ans.15518

      ” Only 22% of patients described no pain pre‐operatively and this rose to 76% post‐operatively;”

      Their conclusion, inferred, is that 24% post-op pain is not “significant”. You can read this and just not even understand how they can say it.

      “Results
      A total of 1711 hernia in 1366 patients were repaired from 2002 to 2016. One thousand and forty‐seven repairs were laparoscopic total extraperitoneal (LTEP), 333 were open. Post‐operative pain scores were significantly lower than pre‐operative scores in inguinal hernia repair by any method. Only 22% of patients described no pain pre‐operatively and this rose to 76% post‐operatively; conversely 7.9% described severe pain pre‐operatively and this reduced to 1% post‐operatively. The recurrence rate for open inguinal hernia was zero and for LTEP repair was 0.81%.

      Conclusion
      Inguinal hernia repair using mesh does not appear to produce significant rates of chronic pain long term. Overall, the complications from open or LTEP inguinal hernia repair with mesh are low.

    • #26667
      mitchtom6
      Participant

      I often wonder how such simplistic conclusions can be made by medical studies, supposedly conducted by the best and brightest of the population. I do wonder if the conclusion is made first, and supportive evidence is sought retroactively. Perhaps that is cynical.

      One major flaw in most of these studies is their brevity. Days/weeks are not an appropriate timeline to make any serious determinations of anything medical. I’ve read in other studies that most recurrences/complications are immediate. Supposedly, the likelihood of complication decreases with each passing year. Of course, that may be a reflection of the study itself rather than the realities of the patients. If you conduct a 5 year study, of course most of the issues will be front-loaded. You will not see the down-the-road complications (such as myself) who had their mesh go wrong years later. This forum has revealed that this is a real issue and one the the med field isn’t well equipped to handle.

      Your only option, it seems, is to risk it all with a pseudo-experimental mesh explantation or hope it resolves with time/pain meds. My pain reduced from a 7/8 to a 3 over the course of a year and a half. It still flares up if I do certain activities. I thought for sure I had a recurrence, but 4 clinical exams, 1 CT scan, and 2 MRIs say nothing is amiss – all pointing to the dreaded mesh scenario.

      Sorry, I’ll end my rant now.

    • #26668
      Alephy
      Participant

      The misleading line is that they do not quantity pain ie somebody with some pain ending up with more pain after surgery is valued as neutral it seems…24% pain rate is very high!

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