New paper on chronic pain from mesh – Hernia, 2022

Hernia Discussion Forums Hernia Discussion New paper on chronic pain from mesh – Hernia, 2022

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    • #32900
      Good intentions
      Participant

      Here is a recent paper offering a look at how chronic postoperative inguinal pain (CPIP) is being addressed by the surgeons who were involved in creating the “International Guidelines”. It’s fascinating how they clearly show that the problem is tied to the use of mesh for hernia repair, but still refuse to even consider avoiding mesh as a preventive measure. The focus of the paper is on treating the problem that they have created. It’s like they are tied to this enormous weight and have no way to get free.

      Dr. Pawlak is a co-author. The primary author, N. van Veenendaal, was involved in the creation of the Guidelines and even participated in writing a summary after the full document was published. They disclosed their conflicts in that summary.

      Worth a look for those still wondering about mesh. They lay out the facts but refuse to acknowledge what they are showing. No mention of reducing the overall pain burden on society by using less mesh. They don’t have to give it up. Just use less.

      You can see some defending of the Guidelines and some “patient-blaming” in the Introduction.

      https://link.springer.com/article/10.1007/s10029-022-02693-9

      “A narrative review on the non-surgical treatment of chronic postoperative inguinal pain: a challenge for both surgeon and anaesthesiologist
      N. van Veenendaal, N. B. Foss, M. Miserez, M. Pawlak, W. A. R. Zwaans & E. K. Aasvang ”

      “Introduction
      Chronic pain is one of the most frequent clinical problems after inguinal hernia surgery. Despite more than two decades of research and numerous publications, no evidence exists to allow for chronic postoperative inguinal pain (CPIP) specific treatment algorithms.”

      “The optimal solution for CPIP would be prevention. However, despite several intra-operative strategies (e.g. laparoscopic technique, careful tissue handling, mesh selection, anaesthesiological and analgesic techniques, etc.), it is still impossible to avoid CPIP from occurring in specific patients. This is partially due to inpatient factors, such as patient’s genetics and nociceptive systems, making them susceptible to chronic pain. Thus, we as clinicians are left with the task of managing CPIP, which is difficult due to its complexity and heterogeneity, and the lack of clear evidence based guidelines.”

      “Conclusion
      CPIP is one of the most frequent clinical problems after inguinal hernia surgery and despite more than two decades of research and numerous publications, no evidence exists to allow for CPIP specific treatment algorithms. We suggest that non-surgical treatment is introduced in the management of all CPIP patients. The overall approach to interventions should be pragmatic, tiered and multi-interventional, starting with least invasive and only moving to more invasive upon lack of effect. Evaluation should be multidisciplinary and should take place in specialized centres. We strongly suggest to follow general guidelines for treatment of persistent pain and to build a database allowing for establishing CPIP specific evidence for optimal analgesic treatments.”

    • #32901
      Good intentions
      Participant

      Here is some of Dr. van Veenendaal’s previous work. He did not report a conflict in the latest paper above, even though he is still referring to and supporting the Guidelines that he reported a conflict for below. Ethically, they still seem very well tied together.

      https://link.springer.com/article/10.1007/s10029-018-1729-9

      “Summary for patients: International guidelines for groin hernia management
      N. van Veenendaal, M. P. Simons & H. J. Bonjer
      Hernia volume 22, pages167–168 (2018)”

      “Ethics declarations
      Conflict of interest
      N van Veenendaal and M.P. Simons report grants for meeting expenses related to the submitted work from Johnson & Johnson and Bard, during the conduct of the study. H.J. Bonjer declares conflict of interest not directly related to the submitted work by receiving grants from Johnson & Johnson, Medtronic, Olympus, Applied Medical and Stryker; and by receiving personal fees from Medtronic, Olympus and Cook and reports grants for meeting expenses related to the submitted work from Johnson & Johnson and Bard, during the conduct of the study.”

    • #32902
      ajm222
      Participant

      “Evaluation should be multidisciplinary and should take place in specialized centres.”

      I’m sure this’ll be easy for the estimated 80k people across the country potentially experiencing this issue (sarcasm)

    • #32903
      Good intentions
      Participant

      Dr. van Veenendaal presented at the EHS Manchester meeting on “Recommendations of hernia surge update on CPIP”. The publication in Hernia looks like the official document. “Herniasurge” seems to be some sort of phantom organization now. Professionals are referring to “Herniasurge” but there is no way to find out who or what, exactly, the thing is today. It seems to exist only as a memory of the group that created the “Guidelines”.

      The only mention of “Herniasurge” in the paper referred to in the first post is a single reference back to the 2018 Guidelines publication. Edit – actually I see that Dr. Veenendaal split the word in to two in the paper. Even the author does not know what it is.

      European Hernia Society Manchester 2022

      Even the use of “hernia surge” as two separate words is odd. Where is it? What is it? How does a person contact them? Who is leading them?

      “CHRONIC PAIN IN INGUINAL HERNIA SURGERY: MDT Main Auditorium
      Moderator: Maciej Pawlak, UK, Diego Cuccurollo, Italy
      MDT approach to diagnosing and treatment CPIP
      Maciej Pawlak, UK
      MDT treatment of CPIP in the US
      David Chen, USA
      Persistent Pain cycle; why we need to focus on patient’s ideas and concerns
      Matthew Lund, UK
      Non-surgical treatment of CPIP
      Eske Kvanner Aasvang, Denmark
      Recommendations of hernia surge update on CPIP
      Nadine Van Veenendaal, Netherlands
      When all else fails is it ACNES?
      Rudi Roumen, Netherlands”

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