Doctors recommend a new approach to treat chronic groin pain

Chronic Pain

Summary: Chronic groin pain is a significant issue in those who have undergone surgery for an inguinal hernia. This often leads to patients blaming the mesh companies. It also causes prolonged distress and trauma to the patients. However, doctors often fail to treat such pains. Studies suggest that in many such instances, pain is due to some other underlying cause like low back pain or trauma, and only in small cases is it secondary to surgical intervention. Thus, doctors recommend careful history taking to identify the cause of this pain and suggest various treatments like Suboxone treatment. Additionally, experts also recommend exploring nontraditional treatments for chronic pain, like psychedelic-assisted psychotherapy.


In the annual meeting of the American Hernia Society, 2021, Doctor Brian P. Jacob discussed the significance of understanding chronic groin pain and finding its solution using innovative treatment methods.


Groin pain is a pretty common complaint among those living with inguinal hernia. Quite often, this hernia is treated using mesh repair. It is a relatively simple surgical procedure that provides instant relief in 70% of cases. However, experience shows that one-third of patients continue to experience pain. Quite often, they blame mesh for their continued pain, and doctors fail to understand the cause of such pain.


Dr. Jacob has multiple recommendations for surgeons and pain clinics for managing such pain. He also underlined the importance of understanding this pain. Since this continued pain after surgery is a source of significant distress. It makes patients quite angry, and they also go on blaming the mesh companies for their pain. Not only that, untreated patients undergo significant trauma, resulting in PTSD.


Surgeons must identify the cause of chronic pain

Dr. Jacob says that there are two sources of these chronic pain in those who had hernia surgery. The first and often overlooked cause of this chronic pain is some pre-existing condition in the patient, like a back issue or some other trauma. Unfortunately, doctors often fail to notice or identify these causes, and the patient continues to associate this pain with the surgery.


The second reason for such chronic pains is naturally the surgery itself, which means unintentional fault. Unfortunately, however, surgeons are often hesitant to accept that something has occurred due to the surgical procedure, and this negation only adds to the patient’s frustration.


There cannot be more frustrating for the patient than doctors failing to recognize the cause of pain. Thus, such patients have to tolerate this continuous chronic pain, and at the same time, they undergo severe emotional trauma. Worst in this situation is the fact that these patients largely remain untreated.


Thus, Dr. Jacob recommends that doctors accept that their patient is going through severe and chronic pain and focus on finding the solution. It is true that identifying the cause of such chronic pain is challenging. Nevertheless, they need to treat such patients. He particularly recommends focusing on alternative therapies

Alternative therapy for chronic groin pain

Dr. Jacob advocates exploring alternative treatments for chronic pain. This does not essentially mean supplements. It also means exploring uncommon approaches to pain management. The traditional way of pain management appears to mask the pain origins and provide temporary relief.


Unlike traditional painkillers or opioids, doctors must explore non-pharmacological therapies like meditation, mindfulness, yoga, pilates, and even psychotherapy. Dr. Jacob is also a proponent of psychedelic-assisted psychotherapy.


When it comes to psychedelic-assisted psychotherapy, this therapy mainly uses ketamine these days. Ketamine is proven to work, safe, and supported by many clinical studies. The results of ketamine-assisted psychotherapy are pretty promising.


However, Dr. Jacobs also favors exploring other ways of psychedelic-assisted psychotherapy. Among the other agents, psilocybin and MDMA are pretty promising. These medicines have excellent safety profiles and maybe even better than ketamine. Moreover, these therapies not only treat pain but also help overcome anxiety, depression, PTSD, and other severe mental health issues.


In short, Dr. Jacob strongly recommends taking a thorough history of patients with groin pains. The doctor should not assume that this pain is only due to an inguinal hernia. In many cases, other unidentified causes of groin pain remain undiagnosed. Additionally, in some cases, the cause of chronic pain could be a surgical procedure. In all these conditions, doctors must understand the patient’s pain and focus on treating chronic pain using various methods.

Gurpreet Singh Padda, MD, MBA, MHP

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