[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.

[ajm222]

Very sorry to hear that. Hopefully you can get some good answers soon.

I’m having some issues of my own about 11 months out. Still have the same mild to moderate soreness I’ve had since early on. And the right side of my body is a bit tight and feels different than the left. Hard to describe, but sitting for long periods of time is getting a bit uncomfortable and I feel sort of a fullness and spots of cramping everywhere on my right from below my ribs down to my groin. Had several physical exams, blood tests and even a CT Scan. nothing showing up. relieved it isn’t something serious like pancreatic, liver or kidney disease/cancer, but worried it’s related to the mesh and the surgery (some sort of inflammation, adhesions, etc). hoping that time will improve things instead of them getting worse. I’ve also had some IBS-like symptoms here and there as well, but I had that issue before the surgery, too.

[ajm222]

You seem very certain the issues are directly related to the mesh. Out of curiosity, have you considered other possibilities? Have you had any blood tests or imaging or consultations with any specialists about your symptoms? Just wondering if they could be caused by anything else.

Also following this thread because it’s a good question.

[ajm222]

thanks! i worry i will be sick from the IV contrast material. but i guess i won’t know until later. i too had an MRI but don’t remember getting ill. i assume i must have had contrast. i have anxiety issues but amazingly i managed to get through the MRI ok. i think i was only up to my chest as they were only looking at my head.

did some research online and it seems a double scan these days is rarely seen as necessary anymore. double the cost and double the dose of radiation, with little diagnostic value except in rare cases.

seems there is also conflicting opinions about the true dangers of these doses of radiation. much higher than x-ray (one abdominal ct scan equals about 500 or more chest x-rays – very scary) but still considered ‘low’. i think all the cancer expectations are based on a lot of statistical data that is made by extrapolation and not actual cancer cases and deaths. i guess it’s just a risk vs. benefit analysis that may be impossible to truly assess given that there is a 1 in 4 chance of getting cancer in life while i think they estimate that a ct scan theoretically results in an increased chance of getting cancer by 1 in 2,000 or 4,000. But given how common cancer is, it’s impossible to say if there’s truly any actual risk at all. the risk is based on the LNT model (linear no threshold) that says no amount of radiation is safe. but some doubt if that’s actually the case given that we are all exposed to very low doses from the environment all our lives and have evolved immune system mechanisms to handle certain amounts.

i’ve got a call to my doctor about the need for a double scan. and to ask if it matters if i take oral or IV contrast. i think they are the same.

[ajm222]

The area I’m having an issue with now actually isn’t the area where the mesh is. It’s more the right side of my mid-torso. Kind of right around the area the instruments were inserted. Though I do still have some soreness around the hernia area. My latest thought was adhesions or something.

[ajm222]

Indirect. IBS symptoms before surgery but honestly don’t know if the bulge was there. The tightness and pressure I mention wasn’t.

[ajm222]

thanks! all great ideas. i’ll see if my PCP wants to do any additional testing to rule anything else out. i think if he feels like it’s unnecessary then I should probably explore the options you mentioned full steam. i would think that swelling, bloating etc. caused by any auto-immune-related issues having to do with the mesh would likely cause quite a bit of discomfort. and i’m just not really experiencing any of that. nor any pain. i do still have some very mild soreness or tenderness occasionally around the area of the hernia repair but nothing i would exactly describe as sharply painful or especially distracting. just some tightness and a feeling that things are kind of cramped and full on that side, but not in the typical kind of way that’s usually associated with nausea, bloating etc.

a couple of times in the past when i was told nothing was wrong, i felt better and was able to kind of forget about it. then i tend to start worrying about it again eventually, and the more i worry the more tight/full the area feels. the mind can play some crazy tricks and perhaps that’s all it is. but the other thing is that i have reached my out-of-pocket max on my healthcare for the year so i’m also thinking now is the time to do any additional testing if need be.

[ajm222]

So I think the surgeon is Dr. James Goodyear with the North Penn Hernia Institute in Lansdale, PA, north of Philadelphia.

[ajm222]

I think your instincts are spot-on. You shouldn’t be feeling like this at all. Most are a little sore and have to take it slow for a while, but the pain is generally pretty minimal, and should get better slowly over time. I also think your instincts about your surgeon are totally correct. Sounds like you desperately need to find someone else. I don’t have much else to add in terms of help, but I do know there is a surgeon that many on this forum recommend who is based in PA. Unfortunately I just can’t remember his name or precisely where he is located. I will do a search and try and find it. I’d call their office and see if you can get an appt asap. Could be a number of things. Maybe the mesh is coming into contact with a number of the many important nerves in the area perhaps. Or the mesh has folded or migrated. [USER=”935″]drtowfigh[/USER] or another surgeon here would be the best to respond. There also seem to be a few very good surgeons in the mid-atlantic and northeast who could help. Hopefully someone else can chime in.

[ajm222]

Forgot to mention my grandfather had an inguinal hernia repaired with mesh in the 70’s. He died around 2007. Never remember him mentioning any issues with the repair. I never asked so I don’t know any of the details and no one else still alive does either, but it seems it worked OK for him for all those years. I never heard him complain about it or heard anyone discuss it.

I also have a friend who had a repair done in high school. He’s now 39 and no issues at all. My neighbor across the street has had 3 (!!!) inguinal hernia repairs over the last decade or so (both open and lap) and currently has no issues. He’s a hard core runner, too. Last surgery was at least 5 or 7 years ago. And a friend from college I consulted had two repairs maybe 7 or 8 years ago and he said he’s been perfectly fine ever since. Lastly, another good friend I spoke with (all of these people I discovered had repairs done after posting something on Facebook before my surgery) had two separate surgeries and while he had some big complications after the second surgery (housebound for a month and issues walking because of numbness in the legs), he says he has no remaining issues currently and all is well. His first one was done about 5 years ago (open) and the second was done early last year or the year before (lap). Interestingly they were both on the same side but he didn’t seem to think it was a recurrence.

I couldn’t get further details from any of these guys because none had any idea exactly what type of mesh was used and barely remembered the method used for the repair in many cases. I think most people in my experience just don’t bother asking a lot of questions and simply take the doctor’s advice and go in and get surgery and recover and kind of forget about it unless there are major issues.

[ajm222]

Dr. Levi Procter who is one of the surgeons associated with this site, could be a good option. He’s here in Richmond. I didn’t use him myself but have emailed him several times and he’s always very promptly responded. There is also another surgeon that works with him who can apparently do non-mesh repairs. I actually consulted the latter surgeon but ended up using someone else. I went with Dr. Richard Pettit, also here in Richmond/Henrico. He’s a specialist. I’m 7 months out from a laparoscopic repair and still having some pain, though. Haven’t fully figured out the reasons yet. But I don’t have anything but good things to say about him at this point.

Not sure if there is anyone closer, but there is a website you can use that will find local surgeons for specific specialty areas that will also tell you how they compare to other area surgeons and surgeons nationally in terms of how many of those types of surgeries they perform. I wish I could remember the name. Among other things, it’s probably good to try and find someone who is in the top 5% or so in terms of the number of hernia repairs they perform and who are also listed at this site: https://americanherniasociety.org/find-a-surgeon/

[ajm222]

Dr. Towfigh actually just posted on Twitter three days ago that ‘a high riding or undescended testicle is almost always associated with an inguinal hernia’. So I would say yes.

For me, I actually have this occasionally in certain positions under certain circumstances, but I believe it only started after vasectomy. [USER=”935″]drtowfigh[/USER]

[ajm222]

quote Chaunce1234:

I don’t think you are rambling at all, this is an important topic.

Pain is so incredibly complex, chronic pain perhaps even more so, and there is obvious need for extensive research to manage and treat it effectively.

You are right though, and what you describe is one of several theories about chronic pain. That is, that chronic pain may be more of a secondary mechanism or interpretation by the nervous system rather than from a new or ongoing tissue injury, whether due to the original injury or due to repeat pain signals being sent to/from the brain which eventually overly excites that particular neural pathway. Two quite different but similar mechanisms occur with eating extremely spicy food which often sensitizes to temperature and other spices, and sexual arousal which sensitizes to stimulation but in a pleasurable manner. The difference in those situations however is eventually the stimulation ends, and so does that sensitivity. With chronic pain, that stimulation and sensitivity continues, for an uncertain reason. The pain is still very real, but perhaps it is a different mechanism of pain compared to the typical “injury = pain” route.

​​​And as you allude to, that also may be why sometimes pain diminishes over time, or can be diminished over time with things like nerve blocks, medications, various brain training, and it may even be the functional mechanism for why certain other treatments can be helpful to some people. There is also a variety of working theories that medical marijuana may be effective for chronic pain for a similar reason, whether by distraction or by offerring indirect changes to brain signaling and pain interpretation. You will also find that many experienced pain management doctors will push their patients to engage in mentally challenging and mentally consuming tasks too, since the brain is clearly a major component in the pain experience, and participating in mentally difficult tasks causes changes to the brain itself, that’s essentially what learning is.

Here’s a recent interesting article on brain plasticity, and while it’s not on the direct topic of pain, you can imagine why it’s relevant:

http://news.mit.edu/2018/mit-scientists-discover-fundamental-rule-of-brain-plasticity-0622

Fascinating article, thank you!

[ajm222]

Interesting, thanks.

It reminds me that I was looking at the Wikipedia page for “Post herniorraphy pain syndrome” the other day, and I found the following to be very interesting:

“A followup of a randomized study of 750 laparoscopic vs. open hernia repair followed patients’ pain scores at 2 and 5 years post hernia repair via questionnaire. At 2 years, the chronic pain rate was 24.3% (lap) vs. 29.4% (open), and at 5 year follow up it was 18.1% (lap) vs. 20.1% (open). At 5 years, 4.3% in lap group and 3.7% in open group had attended a pain clinic.^[5]“

It’s almost as if for some patients the pain reduction and healing happens over much longer time scales. If true, while unfortunate that it can take so long (and clearly the pain doesn’t completely go away in all patients), the encouraging thing would be that over time things can still steadily improve even several years down the line.

I can’t read the full article so I can’t be sure those conclusions are entirely accurate. And obviously the little section posted above raises a number of questions. But I’d like to think that in some cases where the pain is not steadily increasing and not very severe initially, people can still have hope that even if they’re in pain at 6 months or 2 years, they may still experience improvement without having to consider removal.

Prior to this article I had been thinking that any consistent pain after only 3 months was a really bad sign, as many studies consider hernia pain to be chronic if not completely resolved after that amount of time.

Pain in general is just such an interesting topic. It seems that in some cases it’s not even that damage is occurring to cause pain but instead some sort of sensitization process begins where the nerves are simply over excited after surgery and never quite settle down. I wonder if this is how injections and conservative pain management most often leads to resolution – almost like training the brain to ignore the area and any false signaling and to relax, which eventually leads to improvement.

Anyway, I’m just rambling at this point.

[ajm222]

quote Feuermann:

I agree with Momof4. I am a year out from open inguinal hernia surgery with mesh and the long-term recovery has been a “2 steps forward, one step back” kind of experience. I have felt burning, tingling, aches, heaviness, hypersensitive skin, itching, leg and back pain and discomfort. Since the initial post-operative pain went away, I have had some or all of these symptoms daily. Some days have been better than others and the issues have improved over time, but very slowly.

I don’t want to give the wrong impression – I have been able to live my life. I have just been surprised at how long these sensations have persisted.

That all being said, I am in much less regular pain and discomfort than I was even a couple of months ago. I hope this provides you with some comfort. For some of us, recovery from this surgery may be a longer long road.

I have also found that there is a psychological element to all of this. I don’t know if it is perception or if it is real, but I feel these sensations less when I am involved in something immersive like playing an instrument, reading or writing.

I was happy to read all of this as I am approaching 3 months since my laparoscopic indirect inguinal hernia surgery. I still have some discomfort in the form of very mild and regular soreness in the inguinal area (more if I am more active) and sometimes testicles, and occasional sharper, acute pains here and there in that same area along with mild pains in other parts of my side, hip and abdomen. I was hoping by 3 months out I would be totally fine as that’s sort of the marker for the official “chronic pain” definition, thought I think the understanding is also that “chronic pain” is defined as pain that is more intense than what I notice most days. But I also know that everyone has said all along that one should expect to feel a variety of different things for up to a year (and in some cases longer).

I also like what you said about the psychological element. As someone who is very OCD, has a lot of anxiety and is also a hypochondriac, I am personally extremely sensitive to even the slightest physical discomfort. I have also noticed that I can perceive pain just about anywhere in my body if I focus on it. I’ve been studying TMS theory a lot as a result and basically think there is a very close mind-body connection that makes some people more susceptible to regular pains and discomforts that often have no real physical cause. Long-story short, any type of surgery can do a number on someone like that for a long period of time. But I also think literally anyone is capable of suffering in the same kind of way under the right circumstances. I would add that I am not at all dismissing the very real pain caused by hernia surgery complications, which I don’t doubt for a minute. I think that type of pain usually starts very soon after surgery and never really abates but only worsens, and has very real physical causes that have been discussed at length on this site. I just know that personally I wake up every day wondering about my surgery and how I am progressing, and I feel that I am probably creating a mountain out of a molehill in the process. Like you, I tend to not notice as much or any discomfort if I am distracted. Hoping that as time goes by I will slowly but surely get better and better.

To the OP, I think that increasing pain is something to definitely keep an eye on as overall the pain should be going in the opposite direction. But it’s still so early that a day or two can make all the difference. How are you feeling now? Any concerns should immediately be brought to the attention of your surgeon. They should be more than happy to talk with you or see you in person if you are worried (though I think we all know that in reality that often isn’t the case).

[ajm222]

quote clive63:

Thanks, GoodIntentions. Are you suggesting there are some advantages to open surgery over keyhole/mesh? I think mine is what you call direct: i.e. it shows as a visible bulge in the groin area. I do need a rapid convalescence, as I’m the only driver in the house and my child is still in school. But I don’t want to sacrifice long-term efficacy for short-term gain. I have not found anyone yet who has said the belt/truss relieves the pain, although I was hoping it might allow me to walk further without discomfort. (I enjoy long country walks ordinarily.) Thanks again!

Both direct and indirect types will cause the bulge.

[ajm222]

It’s my understanding that swelling and inflammation in the area, particularly after an open repair, is quite common and can even take weeks or in some cases months to fully subside. So I don’t think that in an of itself is evidence the hernia wasn’t adequately repaired. It’s probably technically possible to tear the repair with coughs and sneezes, especially if the repair was done via open method vs. laparoscopic. But probably quite unlikely. Just try and keep it to a minimum and follow doctor’s orders. If you just had this done Monday, I wouldn’t jump to any conclusions too quickly. Surgery is hard on the body and recovery takes time. You are definitely going to hurt and be sore for a while, in a number of different and unexpected ways. But only your surgeon will know for sure if everything is going as it should. I would see what they say when you go in. Or if you are really concerned I wouldn’t hesitate to call and speak with them or go in for an earlier follow-up to put your mind at ease.

[ajm222]

Thanks. I guess it’s a good excuse/motivation to stay on the thinner side. Just surprised I hadn’t read more about this.

[ajm222]

Thanks, guys.

I had a right side indirect hernia repaired with 10cm x 15cm Parietex ProGrip mesh (placed at least 4cm proximal to the base of the hernia defect), done laparoscopically using a robotic system. Don’t know for sure which technique was used but I had two incisions (one on each side of the abdomen) along with one slightly above the navel. They gave me a very detailed write-up (all the notes from the surgeon made during the procedure). The direct spaces on either side apparently looked fine, and no indirect hernia was observed on the left side (despite the fact that another surgeon I consulted felt strongly that I had bilateral hernias). They also found a fatty lipomatous cord lipoma on the right at the same time. They dealt with that as well.

Regarding the “8x more strong” comment, it was always my understanding that a hernia repaired with mesh will never be quite as strong as the original anatomy (pre-hernia). But maybe I misunderstood.

[ajm222]

quote drtowfigh:

Pain after hernia surgery is often inflammatory. Anti-inflammatories work best: i.e., ice and either naproxen/ibuprofen.

The chest pain after laparoscopy is from the CO2 gas. It goes away after a day or so. Most pain from laparoscopy is related to where there is a cut (e.g., the belly button) and where there was a lot of dissection, e.g., groin if the hernia was large. Lastly, testicular pain can occur. It is related to dissection of the hernia off the spermatic cord and placing an inflammatory mesh over the spermatic cord. Once the inflammation reduces, the pain should resolve.

Thanks! I’m on day 9 I think and the pain and discomfort is minimal if not absent. Just some soreness in the inguinal area and around my hip. It actually seems like there’s still a fair amount of abdominal swelling, and tightness particularly on the side that was repaired. My assumption is that it’s fluid that will take some weeks to be reabsorbed, and the localized inflammation. At least that’s what I hope.