NIS

Onset of Hernia Mesh Pain

The popular use of mesh to repair hernias started in 1992 which was 24 years ago. The oldest mesh that I have removed is 24 years old. Since I started keeping track of these statistics 7 years ago I have seen 6 patients with mesh placed in 1992.

There are two patterns of mesh pain onset, immediate and delayed. Half of my patients experienced immediate onset of pain starting the day of their hernia surgery and never getting better or going away until they get their mesh explanted. These patients can make the distinction between normal post op pain and their abnormal mesh pain. They say that they experienced excruciating pain right from the start and that they were told by their surgeon that their pain was normal and that it would go away in time. I am inclined to believe that excruciating pain is not normal immediately after surgery and that these patients are high risk for developing chronic pain and for this reason I am willing to explant mesh in these patients without making them wait 3 months. I know other mesh explant surgeons who advise patients to wait one year and I am certain this is wrong. Inordinate delay leads to semi-permanent changes in the central nervous system called central sensitization which is the reason why some mesh pain patients do not get better after explant and why some patients take years to get better after explant. This would be a great study if someone would ever do it but it will never be done.

The other 50% of my mesh explant patients experience delayed onset of their hernia mesh pain. A very common story that I hear from my mesh explant patients is that they can remember the exact day that their pain started because it was triggered by some kind of traumatic event. But other than the pain there is no physical evidence of trauma. Nothing has broke or tore and the hernia has not reoccurred. Findings at explant surgery do not indicate that there was trauma, And the pain persists for years and decades after it starts never getting better until the mesh is removed. It is like the trauma was a light switch that turned on the pain. My theory is that central sensitization is mounting while the patient is not conscious of the pain then the trauma causes the central nervous system's inhibitory mechanisms decompensate. This has been shown to be a real phenomenon experimentally in animal models. Pain perception in mammals is modulated by apposing mechanisms of central sensitization and desensitization.

28% of patients have pain onset after 3 months and 5% of patients have pain onset after 10 years. I have seen patients pain free for 20 years then develop mesh pain. This is of particular concern because it means that we may be seriously underestimating the incidence of hernia mesh pain. I have seen mesh put in patients as young as 15. We have no idea what happens to mesh after 50 or 60 years. I strongly advise young patients not to have mesh hernia surgery.

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