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

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S. Towfigh
Conclusion
We have yet to prove a direct cause and effect of synthetic mesh and
chronic debilitating pain. However, some of us—those with surgical
practices that treat high volumes of patients with chronic pain after mesh
implantation—have noticed a commonality in a subset of these patients.
The details of their clinical presentation are noted above. Patients with
such a clinical presentation should be evaluated for a possible adverse
mesh foreign body reaction, and mesh removal should be a consideration
in their treatment plan. Many of these patients are already diagnosed
with fibromyalgia or have an autoimmune disorder. Using the
same logic, I strongly recommend that patients who present with a
known diagnosis of fibromyalgia or autoimmune disorder should not
undergo implantation of any inflammatory agent, such as a synthetic
mesh, for their hernia repair. If a tissue repair cannot be performed, then
a biologic allograft may be considered. Perhaps in the future we will
have an understanding of the disease of fibromyalgia and a better understanding
of the body’s reaction to mesh. And perhaps we will have an
objective diagnostic test for either fibromyalgia or mesh reaction prior
to implantation of such a foreign body.
References
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2. Aide N, Deux J-F, Peretti I, Mabille L, Mandet J, Callard P, et al. Persistent
foreign body reaction around inguinal mesh prostheses: a potential pitfall of
FDG-PET. Am J Roentgenol. 2005;184(4):1172–7.
3. Hawkins RA. Fibromyalgia: a clinical update. J Am Osteopath Assoc.
2013;113(9):|680–9.
4. Yunus MB. Role of central sensitization in symptoms beyond muscle pain,
and the evaluation of a patient with widespread pain. Best Pract Res Clin
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