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

33. Foreign Body Reaction, Fibromyalgia…
433
In my experience, patients with a mesh foreign body reaction present
in very nonspecific constitutional manner; however, many share similar
complaints. These include pain in the general area of the mesh implantation,
bloating, edema, and feeling that their waist or pants size has
increased. It is not uncommon to have other gastrointestinal symptoms,
most commonly nausea and sometimes pain with defecation. Some have
intermittent diarrhea or constipation. Due to the predominance of the
bloating, many are diagnosed with irritable bowel syndrome (IBS) . Most
get minimal to no response to IBS medications or changes in diet (e.g.,
gluten-free). Some have urinary symptoms, especially pain with full
bladder and urinary frequency and urgency. Many are diagnosed with
interstitial cystitis (IC) as a result. The feeling of temperature changes,
especially feeling hot in the area, is also a common complaint. Body
temperature is rarely over 99° Fahrenheit. Also, numbness, tingling, and
swelling of the lower body, mons/base of the penis, and upper thigh are
commonly seen symptoms. These symptoms may be in a general pattern
of the ilioinguinal or genital nerves, thus leading some to provide nerve
blocks, sympathetic blocks, or even neurectomies. In most situations,
there is no true neuralgia. Also, most fail treatment with anti-inflammatories,
steroids, neurological modulating agents (e.g., gabapentin, pregabalin),
and antidepressants.
Most patients with mesh-related foreign body reactions are female.
They are also often young and have demonstrated sensitivities and intolerances
to a wide range of environmental allergens, medications, and
even tapes, the plastic of IV needles, and certain plastics and sutures.
Some patients are already diagnosed with fibromyalgia, which is
recognized as a diagnosable disorder by both the National Institutes of
Health and the American College of Rheumatology. Unfortunately, not
much is known about the cause of fibromyalgia, and there are likely
multiple subtypes that are yet to be determined. That said, patients with
fibromyalgia tend to be hypersensitized to pain and live in a heightened
inflammatory state. Thus, the use of inflammatory agents , such as synthetic
implants for hernia repair, can spiral the disease in these patients
out of control. Interestingly, as a manifestation of their disease, many of
these patients also have bowel and bladder derangements, thus the
prevalent diagnoses of IBD and IC among them. Endometriosis and
chronic pelvic pain are also notably higher in this patient population.
There also seems to be an overlap of this disease with autoimmune disorders
that affect inflammation at the tissue level, such as systemic lupus
erythematosus and rheumatoid arthritis [ 3 , 4 ].