New paper on chronic pain from mesh – Hernia, 2022
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.
“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 ”
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.”
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.”
Log in to reply.