Summary: The new approach to chronic groin pain after inguinal hernia surgery starts with a careful history to find the cause. That is because in many cases the pain comes from something else, like low back pain or an old injury. Only in a small number of cases is the surgery to blame. Experts also advise trying less common treatments for chronic pain, like psychedelic-assisted psychotherapy.
Chronic groin pain is a big problem for people who have had surgery for an inguinal hernia. This often leads patients to blame the mesh companies. The pain also causes long distress and trauma. Yet doctors often fail to treat it.
At the 2021 annual meeting of the American Hernia Society, Dr. Brian P. Jacob spoke on this pain. He stressed why it matters to understand chronic groin pain and solve it with new treatments.
Groin pain is a common complaint in people with an inguinal hernia. This hernia is often treated with mesh repair. It is a fairly simple operation that brings instant relief in 70% of cases. But experience shows that one-third of patients keep having pain. They often blame the mesh, and doctors fail to find the real cause.
Dr. Jacob has several tips for surgeons and pain clinics on handling this pain. He also stressed how much it matters to understand it. Pain that goes on after surgery causes real distress. It makes patients angry, and they keep blaming the mesh companies. Worse, untreated patients go through deep trauma that ends in PTSD.
What causes chronic groin pain after hernia surgery?
Dr. Jacob says this chronic pain after hernia surgery has two sources. The first, and often missed, is a problem the patient already had, like a back issue or an old injury. Doctors often fail to spot these causes. So the patient keeps tying the pain to the surgery.
The second source is the surgery itself, meaning an honest mistake. But surgeons are often slow to admit that the operation caused a problem. That denial only adds to the patient’s frustration.
Nothing frustrates a patient more than doctors who cannot name the cause of the pain. These patients live with constant pain. At the same time, they go through severe emotional trauma. Worst of all, most of them stay untreated.
So Dr. Jacob urges doctors to accept that the patient is in severe, chronic pain. Then they should focus on fixing it. Finding the cause of this pain is hard. Still, these patients need treatment. He stresses other kinds of therapy in particular.
How is chronic groin pain after hernia surgery treated?
Dr. Jacob pushes for trying other treatments for chronic pain. This does not just mean supplements. It also means trying less common approaches to pain management. The usual way of treating pain seems to hide where the pain comes from and give only short relief.
Instead of leaning on standard painkillers or opioids, doctors must try drug-free therapies. These include meditation, mindfulness, yoga, pilates, and even psychotherapy. Dr. Jacob also backs psychedelic-assisted psychotherapy.
Psychedelic-assisted psychotherapy mainly uses ketamine these days. Ketamine is proven to work, is safe, and is backed by many clinical studies. The results of ketamine-assisted psychotherapy are very promising.
Dr. Jacob also favors trying other kinds of psychedelic-assisted psychotherapy. Among the other drugs, psilocybin and MDMA show real promise. These drugs have excellent safety records, maybe even better than ketamine. And these therapies do more than treat pain. They also help overcome anxiety, depression, PTSD, and other severe mental health issues.
In short, Dr. Jacob strongly urges a thorough history for patients with groin pain. The doctor should not assume the pain comes only from an inguinal hernia. In many cases, other causes of groin pain go unfound. In some cases, the cause could be the surgery. In every case, doctors must understand the patient’s pain. They must focus on treating chronic pain with many methods.
Frequently asked questions
Is it normal to still have groin pain after hernia surgery?
It is common. Mesh repair of an inguinal hernia is a fairly simple operation. It brings instant relief in about 70% of cases. Experience shows that about one-third of patients keep having pain afterward. Common does not mean you should live with it. Lasting pain after surgery needs a real search for its cause, not a pat on the back.
Is the hernia mesh causing my groin pain?
Often it is not. Many patients blame the mesh. But Dr. Brian Jacob points out a source that is often missed: a problem the patient already had, such as a low back issue or an old injury. Only in a small share of cases is the pain caused by the surgery itself. A careful history is how the difference gets found.
Why does chronic groin pain after hernia repair so often go untreated?
Two reasons. Doctors often miss a cause the patient already had. So the patient keeps linking the pain to the operation. And surgeons are often slow to accept that the operation itself caused a problem. Either way, the patient is left with pain nobody owns. Many of these patients stay mostly untreated.
Can chronic groin pain affect your mental health?
Yes. Pain that goes on after surgery causes real distress. Patients whose pain is brushed off become angry and frustrated. Left untreated, some go through severe emotional trauma that ends in PTSD. That is why this approach pairs pain care with therapies such as psychotherapy. Those also help with anxiety, depression and PTSD.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
