title: Chronic pain after open inguinal hernia repair: a longitudinal self-assessment study.
abstract: BACKGROUND
  The aim of the present study was to assess the variation of self-reported pain over a period of 2 years in three groups of patients with no, moderate and severe pain at 3 months after primary open inguinal hernia repair.
  
  
  METHODS
  In two cohorts of patients from 2004 (n = 272) and 2005 (n = 292) who had given a self-report of postoperative pain at 3 months, 79 randomly selected patients without pain (box visual analogue scale [VAS] level 10) and all patients with moderate (Box VAS level 7-9) and severe pain (Box VAS level 1-6), 91 and 9, respectively, were included in the case series. The self-assessments were repeated for all patients 1-1.5 and 2-2.5 years after surgery (November 2006).
  
  
  RESULTS
  It was observed that moderate pain reappeared among the pain-free patients in 28 and 23% after 1-1.5 and 2-2.5 years, respectively. Of those patients with moderate pain at 3 months, 39 and 49% reported 'no pain' at 1-1.5 and 2-2.5 years, respectively, after surgery. A worsening from moderate pain to severe pain was reported by 22% of patients after 1-1.5 years and by 15% of patients after 2-2.5 years. Hernia recurrence (n = 3) was observed only in patients with increased pain. All nine patients with severe pain at 3 months reported less pain, but only one was pain-free at 2-2.5 years after surgery.
  
  
  CONCLUSIONS
  The study shows that a significant proportion of the patients developed pain later than 3 months after the operation. It further points to a difference in pain evolvement in patients with moderate pain and those with severe postoperative pain at 3 months. Pain can increase in intensity from moderate to severe, both with and without the presence of a clinical recurrence.
authors.affiliation: Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Medicinskt Centrum i Linköping, University Hospital, Linköping University, 581 85, Linköping, Sweden. staffan.smeds@medcentrum.se
authors.forename: S
authors.initials: S
authors.lastname: Smeds
authors.forename: A
authors.initials: A
authors.lastname: Kald
authors.forename: L
authors.initials: L
authors.lastname: Löfström
mesh_terms: D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis*; D012647:Self-Assessment