Hope for relief months after surgery

[DrBrown]

Dear AJM.
Usually, pain related to hernia surgery will improve for upto a year. After a year there is usually very little improvement.
If you are having pain in the testicle, a spermatic cord block with local anesthetic and steroid will often be very beneficial.
If you are having pain from the mesh, the mesh can also be injected with the hope of getting some relief.
If you have nerve involvement, then there is usual a change in skin sensation and there is some pain 100% of the time.
A nerve block can be very helpful.
Mesh usually shrinks with time, which is probably the source of the tightness you feel.
Best wishes.
Bill Brown MD

[Arkj93]

Hi [USER=”2787″]BronxApple[/USER] ,

thank you for this post. I had laparoscopic mesh surgery 9 months ago and this post gave me hope that there will be improvement. Lately I am still dealing with some soreness in my testicle and hip area. My primary doctor thinks that the scar tissue around the mesh is causing the area to feel tighter than normal and it could take a while for that to go away. It has definitely been an up hill battle but I am glad that there is a light at the end for us. I really don’t want to have complications or have the mesh removed especially since it hasn’t even been a year yet.

Regards,
-AJ

[ajm222]

Thank you Dr. Brown. I believe I just found your website and was reading some of the information there. Sounds like you are pretty set against using mesh.

I had my laparoscopic surgery a year ago for an indirect hernia on my right side at the age of 41. I still have some soreness and tightness in the groin area occasionally and some general tightness and strange feelings overall on my right side all the way up to my chest. But very recently i haven’t been noticing it nearly as much. Most of the time I’m not in any pain. Doesn’t seem to be any better or worse with exercise. I also don’t appear to have a recurrence. So I have no idea what’s really going on but hoping it continues to fade. Some testicular discomfort as well but i also notice that sometimes on the opposite side where i didn’t get any mesh. And no pain or other issues with sex. I did have a vasectomy a couple years before the hernia repair.

Sounds like you’ve found that the pain will eventually go away in most patients, or at least lessen substantially, particularly if nerve blocks or other conservative treatments are used. Is that accurate? If so, does that suggest that it may just be a matter of settling those nerves down until the body has a chance to sort of come to terms with the presence of the mesh so to speak? Any theories on that? I guess it’s complicated.

I’ve also read other reports that suggest the incidence of chronic pain in pure tissue repairs in some studies isn’t that much less than with mesh, and I feel like some of the other surgeons here have suggested the same. But maybe I have that somewhat wrong. I guess it also depends on the technique, the skill of the surgeon, the type of mesh used and the patient themselves.

Thanks again for your reply.

[DrBrown]

Dear AJM.
I agree that the mind has to be considered in anyone that has chronic pain. Chronic pain may cause depression and financial problems. And the mind may make the pain worse.
It is important to try to determine the cause of the pain and try to get it under control.
Does the patient has a recurrent hernia? Is there a nerve involved? Has the mesh become stiff or adhered to something sensititve?
Regards.
Bill Brown MD

[ajm222]

I’ve certainly been struggling with this (mostly mild to moderate soreness and a variety of strange types of discomfort all over the groin area and abdomen), but I am a few days shy of one year out from surgery and have been feeling better lately. Just trying to ignore it actually has helped a fair amount. I really wonder how much of it is psychosomatic, at least in my case. I think anticipating problems after reading so much about mesh and chronic pain didn’t help. I’ve had numerous tests and exams in the last year and no one can find any issues with me despite all my complaints.

I saw one study that seemed to show that people dealing with chronic pain from hernia surgery tended to improve very slowly the more time passed – as much as 2 and even 3 years out the number continued to drop, down to almost nothing. So it wasn’t like those reporting chronic pain were just out of luck if they weren’t 100% 3 months after surgery, and had to spend the rest of their life dealing with the pain or have the mesh removed. It appeared that eventually most got better. It just took a really long time in some cases. Even some reporting very high levels of pain improved significantly or completely.

Obviously those in significant pain, especially very early on or immediately after surgery, might have something very specific that needs to be dealt with. And there are clearly those who have an adverse reaction to the mesh, or it gets infected, or there is a recurrence, etc etc. But I think some of us with less specific soreness and pain just need to let the body settle down and give the brain and body time to shut down those pain pathways that were built up during injury, surgery and recovery. Everyone is different in how they heal.

I know I have had injuries in the past that continued to nag me for years. But eventually they stopped bothering me. Some things even pop up now and again for brief periods years and years later, but then go away again eventually.

I think the study of pain is pretty fascinating (especially in a day and age where at least in the US we’re dealing with this major chronic pain and opioid crisis), and I think there’s a lot we don’t know about the very nature of pain and how the mind and body work together to create it. I’ve followed some people like Howard Schubiner (and other Mind Body Syndrome advocates) that believe that in many cases, chronic pain is not caused directly by actual injury or disease (though it often starts that way) but by our brain and body re-activating pain pathways that should have gone dormant. I think the theory is that we get hurt in some way or another and the body creates a nerve pathway to send those specific signals to the brain so that we perceive that pain and then can address the injury. Normally once we heal, the brain/body slowly turns off those pathways for good, but they’re often still there. In certain people (and it seems certain personality types are more prone to this), those connections don’t go dormant as they should, or they are re-activated at some point down the road (for example after a major life stress) and the signals start up again even though there is no actual tissue injury. Some think it serves a purpose – a distraction from psychological trauma. But others focus less on the Freudian aspects of the phenomena and are more interested in focusing on the neurochemistry involved.

Anyway, just another thing for people to consider if they still experience pain after surgery but medical professionals can’t seem to find a reason for it. Definitely don’t ignore it, especially if it’s a high level of pain or it seems to just be getting worse. But there’s a chance you may just be someone who needs a lot more time than the average person for the pain to subside. I know another individual here started feeling much better about a year after surgery. Glad to hear the OP is feeling better as well.

[DrBrown]

Chronic pain after hernia repair is an area that all surgeons are working on to improve.
If the pain is deep, then occasionally injecting the mesh with steroids will help.
If the pain is in the skin then a nerve block may help.
Try to be patient.
Regards.
Bill Brown MD

[drtowfigh]

Thank you!

Never give up!