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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B. Ramshaw
Table 45.2. Preoperative and postoperative factors that can contribute to the
development of chronic pain after hernia repair.
Preoperative factors
Pain greater than 1 month
Repeat surgery
Psychological vulnerability
Anxiety
Females
Younger age
Worker’s compensation
Inefficient diffuse noxious inhibitory control
Table 45.3. Factors that can contribute to
the development of chronic pain after hernia
repair and increase the vulnerability to pain.
Having English as a second language
Race and ethnicity
Income and education
Sex and gender
Age group
Geographic location
Military veteran status
Cognitive impairments
Surgical patient
Cancer patient
End of life
Postoperative factors
Pain
Post-op radiation
Neurotoxic chemotherapy
Depression
Psychological vulnerability
Anxiety
Neuroticism
patient-related factors that contribute to the development of chronic pain
after surgery. These factors are listed in Tables 45.2 and 45.3 [11 , 12 ].
Patients are offered a variety of choices for treatment (including nonoperative
management) of their chronic pain after hernia repair. Most
patients have already sought and received many nonsurgical treatments
prior to seeking a surgical option for their chronic pain. The surgical treatment
choices include a diagnostic laparoscopy with attention to the presence
of intra-abdominal adhesions, the presence of interstitial and hidden
hernias, and any foreign body such as mesh, tacks, sutures, etc. that may
be contributing to the entrapment or irritation of nerves and potentially
contributing to inflammation and chronic pain. A review of the current
evidence helped to establish the dynamic care processes. In all cases, the
patient and family are included in a shared decision process. Information
is provided by the hernia team, including the director of patient care management,
other patient care specialists, and a surgeon who is experienced