The role of peripheral afferents in persistent inguinal postherniorrhaphy pain: a randomized, double-blind, placebo-controlled, crossover trial of ultrasound-guided tender point blockade

Wijayasinghe, Nelun; Ringsted, Thomas K.; Bischoff, Joakim M.; Kehlet, Henrik; Werner, Mads U.

doi:10.1093/bja/aew071

Cited by 15 publications

(34 citation statements)

References 26 publications

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“… 34 In a study, it was tested to use injections at tender points, meaning that the point of injection was tailored to each patient depending on where in the groin the pain was. 35 The study demonstrated some effect indicating that the peripheral nerves were involved in the chronic pain, but unfortunately, the effect did not last. 35 A recent study on injections with a mix of lidocaine, corticosteroids, and hyaluronic acid has investigated the use of up to three repeated injections over 6 weeks in order to treat chronic pain compared with surgical neurectomy.…”

Section: Injectionsmentioning

confidence: 92%

“… 35 The study demonstrated some effect indicating that the peripheral nerves were involved in the chronic pain, but unfortunately, the effect did not last. 35 A recent study on injections with a mix of lidocaine, corticosteroids, and hyaluronic acid has investigated the use of up to three repeated injections over 6 weeks in order to treat chronic pain compared with surgical neurectomy. The study demonstrated a 22% success rate, which was lower than the 71% success rate for the neurectomy group.…”

Section: Injectionsmentioning

confidence: 92%

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Management of chronic pain after hernia repair

Andresen¹,

Rosenberg²

2018

JPR

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Chronic pain following inguinal hernia repair is a common problem and feared complication. Up to 16% of people experience chronic pain following the repair of a groin hernia. The aim of this review was to provide an overview of treatment strategies for patients with chronic pain following inguinal hernia repair based on best practice guidelines and current clinical routines. The optimal management of chronic pain following inguinal hernia surgery should begin with a thorough clinical examination to rule out other causes of chronic pain and to rule out a recurrence. A scaled approach to treatment is recommended. Initially, watchful waiting can be tried if it can be tolerated by the patient and then systemic painkillers, escalating to blocks, and surgery as the final option. Surgery should include mesh removal and triple neurectomy following anterior approaches or mesh and tack removal following a posterior approach. The diagnosis and treatment strategies should be performed by or discussed with experts in the field.

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Section: Injectionsmentioning

confidence: 92%

Section: Injectionsmentioning

confidence: 92%

Management of chronic pain after hernia repair

Andresen¹,

Rosenberg²

2018

JPR

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“…First , confounding is likely, due to lack of blinding and randomization with regard to re-surgical or pharmacotherapy. As an example, baseline Q0 maximal pain intensity was significantly higher in the re-surgery group compared to the pharmacotherapy group.…”

Section: Discussionmentioning

confidence: 99%

A national center for persistent severe pain after groin hernia repair

et al. 2019

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“…For example, in 2016, it was found that patients who developed CPOP after breast cancer surgery were significantly more hyperalgesic to generalized pressure both 5 days after surgery and from 15 days to 12 months compared to patients who did not develop pain, suggesting that persistent central sensitization is an important process in CPOP development 46 . Also in 2016, a trial of 14 patients with CPOP, following inguinal hernia surgery, found that a tender point block with bupivacaine provided analgesia and reduced evoked pain responses, supporting the role of peripheral afferents in the maintenance of pain 47 . In addition to central sensitization from the surgical insult, which is maintained by peripheral input and peripheral sensitization of the primary nociceptors in the surgical field, other (non-mutually exclusive) potentially causal mechanisms for CPOP have been suggested 48 .…”

Section: Neural-based Mechanismsmentioning

confidence: 97%

Chronic postoperative pain: recent findings in understanding and management

Correll

2017

F1000Res

114

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Chronic postoperative pain is a poorly recognized potential outcome from surgery. It affects millions of patients every year, with pain lasting for months to years, resulting in patient suffering and ensuing economic consequences. The operations with the highest incidence of chronic postoperative pain are amputations, thoracotomies, cardiac surgery, and breast surgery. Other risk factors include preoperative pain, psychological factors, demographics, and the intensity of acute postoperative pain. Attempts to prevent chronic postoperative pain have often led to debatable results. This article presents data from recently published studies examining the incidence, risk factors, mechanisms, treatment options, and preventive strategies for chronic postoperative pain in adults. In summary, many of the previously identified risk factors for chronic postoperative pain have been confirmed and some novel ones discovered, such as the importance of the trajectory of acute pain and the fact that catastrophizing may not always be predictive. The incidence of chronic postoperative pain hasn’t changed over time, and there is limited new information regarding an effective preventive therapy. For example, pregabalin may actually cause more harm in certain surgeries. Further research is needed to demonstrate whether multimodal analgesic techniques have the best chance of significantly reducing the incidence of chronic postoperative pain and to determine which combination of agents is best for given surgical types and different patient populations.

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The role of peripheral afferents in persistent inguinal postherniorrhaphy pain: a randomized, double-blind, placebo-controlled, crossover trial of ultrasound-guided tender point blockade

Abstract: NCT02065219.

Cited by 15 publications

References 26 publications

Management of chronic pain after hernia repair

Management of chronic pain after hernia repair

A national center for persistent severe pain after groin hernia repair

Chronic postoperative pain: recent findings in understanding and management

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