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TECHNOLOGY, COMPUTING, AND SIMULATION

Pain and Sensory Dysfunction 6 to 12 Months After Inguinal Herniotomy

Trine Mikkelsen, MS^*, Mads U. Werner, MD PhD, Birgit Lassen, RNA, and Henrik Kehlet, MD PhD^*

*Department of Surgical Gastroenterology and Acute Pain Service, Department of Anesthesiology, Hvidovre University Hospital, Copenhagen, Denmark

Address correspondence to Mads U. Werner, MD, PhD, Department of Oncology, University Hospital, SE 221 85 Lund, Sweden. Address e-mail to madswerner{at}medscape.com Reprints will not be available from the authors.

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 herniorrhaphy. 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 herniotomy but has a low specificity for chronic postherniotomy pain. Factors other than nerve damage may be involved in the development of chronic postherniotomy pain.

IMPLICATIONS: Inguinal hernia repair is associated with a 5%–30% incidence of chronic pain. In this study, sensory testing of the surgical area did not show clinical significant differences between the pain and nonpain groups. These results suggest that factors other than cutaneous nerve damage are involved in the development of chronic pain after hernia repair.

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