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Chronic pain rate
So what is the accepted chronic pain raze these days? Mesh and non mesh have similar numbers? Best mesh type for that? What was the ate back in the 80s? Anything one can do pre op to lower the risk and post op pain in general?
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10 Replies
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– to be fair to Dr Felix: he was assigned to debate one side of an issue.
– the AHSQC is the US database that is formed to do exactly as you suggest. We need more surgeons to participate (I do). We also need the patients to respond for their longterm outcomes. -
@good-intentions
Looking again at the first article you pointed to, I do not understand the statement: “The data about mesh is not so good, but we think it is safe”…..collect more data and come back, I would argue!
The thing that also bothers me is that we live longer and longer, so even in the elderly I question whether a mesh should be suggested….
Anyway I assume then that the complications/chronic pain rate at 5, 10, 15 and 20 years is and will probably remain unknown…
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I did a literature search through the Stanford Libary and I found two articles about the pain after hernia repair between 1980 and 1990.
I found 12 articles published about chronic pain after hernia repair for the year 2019 alone.
These numbers should give you the idea that chronic pain was not a problem prior to the introduction of mesh.
Regards.
Bill Brown MD -
I think medicine has been sidetracked by the machinery of it, and the patient is not the focus anymore….hopefully we will move from treatment stats in a population to personal medicine where the personal response matters and can be measured and determined..
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quote Alephy:I am just wondering, can one get chronic pain after years from an inguinal hernia repair without a mesh? I would assume that this can only happen with meshes…Of course..Dr Brown like to say that industry did not have even term chronic pain for hernia pain unless mesh was created ..You want meash go with drtowfigh
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Yes. If there is a hernia recurrence.
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I am just wondering, can one get chronic pain after years from an inguinal hernia repair without a mesh? I would assume that this can only happen with meshes…
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Here is Dr. Felix’s presentation.
https://www.sages.org/video/lets-be-honest-pain-after-inguinal-hernia-repair/
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Here is a recent and fairly comprehensions article about the situation, first article linked below, and a second one from not that long ago. The article answers one of your other questions also, about approving new products.
You”ll find that instead of stopping the actions that cause pain the new advice is to clearly explain to the patient that they might have pain. Basically shifting the responsibility for decision to the patient. Informed consent. The irony is that “they” can’t understand why people don’t want mesh after explaining that there is a significant chance of pain. They’re in a bind, if they explain about pain people walk away, if they want the business they have to stay quiet. There are even surgeons out there, like Dr. Felix, who suggest that patients just need to get tougher. Stop whining.
These two articles are fascinating also because you can see how at least one surgeon is working on both sides. He suggests creating a registry that identifies bad products, but recently recommends clearly explaining to the patient that they might have pain. His second speech seems much less focused than his first.
In sum, somehow, we are all stuck, for the most part, with mesh as the standard for hernia repair. Now, it’s time to weed out the bad products, that cause pain and complications, like the plugs. That’s what a registry could do. But nobody seems to want to step up and make that happen. They’re just living with the status quo, not offending any of the device makers or fellow surgeons. Lots of talk but no action.
Individual surgeons can survey their patients, and track and report the results from the mesh products that they use. They don’t have to wait for the crowd. But I imagine that anyone who does that will feel very exposed and alone.
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As somebody who has suffered through a great deal of pain after a mesh repair, I find that presentation by Dr Felix infuriating. He suggests around the 4:20 mark that it is ridiculous to suggest that mesh causes pain. Good lord! If I have chronic pain in parts of my body where the mesh is located, and had no pain in those areas prior to surgery, then what else, other than the mesh could possibly be causing pain?
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