Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

3. Complex Regional Pain
Syndrome Types I and II
Payam Vahedifar and Evish Kamrava
Introduction
Chronic pain is described by the International Association for the
Study of Pain as pain lasting greater than 3 months. Some etiologies of
chronic groin pain are radicular in nature, such as from lumbar impingement
of the L1–3 lumbar nerves, muscle strains and sports hernias, pain
from pubic structures and enthesopathy, osteoarthritis of the hip, and
labral tears of the hip. These pain problems are often treatable, and
despite their chronicity, follow an anatomical and pain pattern that is
consistent with the underlying injury.
Additionally, chronic groin pain has become a common problem
associated with hernia operations. Pain after inguinal hernia repair can
be classified as acute postoperative pain, hernia recurrence, nerve injury,
foreign body reaction, and injury due to surgical technique. In the past,
hernia repair had complication and recurrence rates of up to 67 %; however,
newer techniques using mesh reinforcement with lighter-weight
mesh have shown reduction in post-procedure chronic pain. Despite
technical improvements, chronic groin pain continues to be a frequent
complaint after hernia repair, with incidence of at least 10 %. In the
majority of patients, pain can be the result of localized disruptions that
are directly the consequence of the operation, such as from the sutures,
clips, or scar tissue. It can also be due to entrapped nerves. Pain can also
be due to recurrence of the hernia. Revisional procedures and appropriate
directed care can resolve the symptoms in a good proportion of
patients.
In some patients, however, pain continues or even intensifies
despite treatment and revision surgery and, in a subset of patients, may
have a faster course. These patients should be further evaluated for the
© Springer International Publishing Switzerland 2016
B.P. Jacob et al. (eds.), The SAGES Manual of Groin Pain,
DOI 10.1007/978-3-319-21587-7_3
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