Pain and sensory dysfunction 6 to 12 months after inguinal herniotomy.
Inguinal hernia repair is associated with a 5%-30% incidence of chronic pain, but the pathogenesis remains unknown. We therefore evaluated pain and sensory dysfunction by quantitative sensory testing 6-12 mo after open hemiorrhaphy. Before sensory testing, all patients (n = 72) completed a short-form McGill Pain Questionnaire and a functional impairment questionnaire. Sensory dysfunction in the incisional area was evaluated by quantification of thermal and mechanical thresholds, by mechanical pain responses (von Frey/pressure algometry), and by areas of pinprick hypoesthesia and tactile allodynia. The incidence of chronic pain was 28% (20 of 72). Quantitative sensory testing and pressure algometry did not demonstrate differences between the pain and nonpain groups, except for a small but significant increase in pain response to von Frey hair and brush stimulation in the pain group. Hypoesthesia, or tactile allodynia, in the incisional area was observed in 51% (37 of 72) of the patients, but the incidence did not differ significantly between the pain group and the nonpain group (14 of 20 versus 23 of 52; P > 0.3). We concluded that cutaneous hypoesthesia, or tactile allodynia, is common after inguinal hemiotomy but has a low specificity for chronic postherniotomy pain. Factors other than nerve damage may be involved in the development of chronic posthemiotomy pain.
*Department of Surgical Gastroenterology and †Acute Pain Service, Department of Anesthesiology, Hvidovre University Hospital, Copenhagen, Denmark.
Trine
T
Mikkelsen
Mads U
MU
Werner
Birgit
B
Lassen
Henrik
H
Kehlet
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D006987:Hypesthesia / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017288:Pain Threshold; D010149:Postoperative Pain / Q000453:epidemiology / Q000503:physiopathology*; D010812:Physical Stimulation; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D012018:Reflex / Q000502:physiology; D012678:Sensation Disorders / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D011795:Surveys and Questionnaires