The new approach to chronic groin pain after inguinal hernia repair starts with a full history, because the pain often comes from an older cause, such as a back problem or past trauma, not the mesh. Treatment then moves past opioids to mindfulness, yoga, talk therapy and ketamine-assisted psychotherapy.
Summary: Chronic groin pain is a big problem for people who had surgery for an inguinal hernia. Many patients blame the mesh companies. The pain also causes long distress and trauma. Yet doctors often fail to treat it. Studies suggest that in many cases the pain comes from some other cause, like low back pain or trauma. Only in a few cases does it come from the surgery. So doctors recommend a careful history to find the cause. They suggest treatments like Suboxone treatment. Experts also recommend trying nontraditional treatments for chronic pain, like psychedelic-assisted psychotherapy.
At the annual meeting of the American Hernia Society, 2021, Doctor Brian P. Jacob spoke about chronic groin pain. He explained why it matters and how new treatments can solve it.
Groin pain is a common complaint for people with an inguinal hernia. Doctors often fix this hernia with mesh. It is a fairly simple surgery that gives instant relief in 70% of cases. But one-third of patients still have pain. Many blame the mesh, and doctors fail to find the real cause.
Dr. Jacob has several tips for surgeons and pain clinics on how to manage this pain. He stressed that doctors must understand it, because pain that lasts after surgery causes real distress. It makes patients angry, and they blame the mesh companies. Worse, patients who go untreated suffer deep trauma, which leads to PTSD.
Surgeons must identify the cause of chronic pain
Dr. Jacob says this chronic pain after hernia surgery has two sources. The first is often missed: a condition the patient had before, like a back problem or an old trauma. Doctors often fail to spot it. So the patient keeps linking the pain to the surgery.
The second cause is the surgery itself, through an honest mistake. But surgeons often do not want to admit that the surgery caused a problem. This denial only adds to the patient’s anger.
Nothing frustrates a patient more than doctors who cannot find the cause of the pain. These patients live with constant pain. At the same time, they suffer deep emotional trauma. Worst of all, most of them get no treatment.
So Dr. Jacob tells doctors to accept that the patient is in real, chronic pain and to focus on a fix. Finding the cause is hard. Still, these patients need treatment. He stresses other kinds of therapy.
Alternative therapy for chronic groin pain
Dr. Jacob pushes doctors to try other treatments for chronic pain. This does not just mean supplements. It means trying less common ways to manage pain. Standard pain care seems to hide where the pain comes from and gives only short relief.
Instead of standard painkillers or opioids, doctors must try therapies without drugs. These include meditation, mindfulness, yoga, pilates, and talk therapy. Dr. Jacob also backs psychedelic-assisted psychotherapy.
Today, psychedelic-assisted psychotherapy mostly uses ketamine. Ketamine is proven to work and is safe. Many clinical studies support it. The results of ketamine-assisted psychotherapy look very good.
Dr. Jacob also wants doctors to try other kinds of psychedelic-assisted psychotherapy. Psilocybin and MDMA look very promising. These drugs have strong safety records and may work even better than ketamine. These therapies do more than treat pain. They also help people beat anxiety, depression, PTSD, and other serious mental health problems.
In short, Dr. Jacob urges doctors to take a full history of patients with groin pain. Doctors 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 surgery itself could cause the chronic pain. In every case, doctors must understand the patient’s pain. They must treat the chronic pain with many methods.
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