Our current understanding of the nature of chronic pain requires an understanding the phenomenon of Central Pain Sensitization. This is under acknowledged in the General medical community. New graduates of anesthesia are trained about this. Other specialists and doctors in practice more than 15 years don't deal with it unless they are self taught, Central Pain Sensitization explains why hernia mesh pain is so difficult to treat, why most treatments fail utterly and why some patients never get better. Central Pain Sensitization is a component of all chronic pain conditions such as osteoarthritis, chronic back pain and fibromyalgia.
Clinical components of Central Pain Sensitization are allodynia, hyperesthesia and widening of the pain field.
Widening of The Pain Field: Pain is perceived as coming from other areas of the body that are not receiving a pain stimulus. This happens because the pain pathways, that are normally anatomically oriented, cross link with different anatomical pain pathways.
Hyperesthesia: This is when a relatively minor pain stimuli causes extreme pain. Synapses in the pain pathways become enhanced amplifying the perception of pain.
Allodynia: Touch stimulus causes pain. This happens because central nervous system pain pathways and touch pathways become cross connected. So, a touch stimulus gets rerouted to the pain pathways.
Patients with hernia mesh pain also commonly have A.S.I.A. syndrome.
Painful stimulus over some period of time is a cause of Central Pain Sensitization. I do not have data on this but it is my suspicion that the longer the inciting painful stimulus lasts the harder it is to treat sensitization. This why I think it is a mistake to wait too long to remove hernia mesh causing chronic pain.
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