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Pre‐operative pain and sensory function in groin hernia
Author(s) -
Aasvang Eske K.,
Hansen Jeanette B.,
Kehlet Henrik
Publication year - 2009
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1016/j.ejpain.2008.11.015
Subject(s) - groin , medicine , anesthesia , threshold of pain , referred pain , hyperalgesia , hernia , sensory threshold , sensory system , nociception , hernia repair , chronic pain , surgery , physical therapy , psychology , receptor , cognitive psychology , cognitive science
Background: Although persistent postherniotomy occurs in 5–10% of patients, pathogenic mechanisms remain debatable. Since pre‐operative pain has been demonstrated to be a risk factor for persistent postherniotomy pain, pre‐operative alterations in nociceptive function may be a potential pathogenic mechanism. Aims: To investigate the correlation between pre‐operative pain intensity and sensory functions in the groin hernia area. Methods: Patients with unilateral groin hernia were examined preoperatively by quantitative sensory testing (thermal, mechanical, and pressure [detection and pain thresholds]) and assessments were correlated to patients’ reports of intensity and frequency of spontaneous pain in the groin area. Results: Forty‐two patients were examined, whereof one was excluded since no hernia was found intraoperatively. Mechanical pain threshold was inversely correlated with spontaneous pain intensity (rho = −0.413, p = 0.049), indicating a paradoxical association between level of mechanical pain threshold and magnitude of spontaneous pain. No other sensory modality was significantly correlated to pain intensity. New/increased pain during repetitive pinprick stimulation (wind‐up) was seen in 3 patients (7%), all whom experienced no pain or pain less than weekly. Only cool detection thresholds were significantly lower between the hernia vs. contralateral side ( p < 0.04), but with numerically very small differences (Δ = 0.4 °C, range 0.1–0.7 °C). Conclusion: Pre‐operative groin hernia pain is not related to findings of hyperalgesia or other changes in sensory function that may support pain‐induced pre‐operative neuroplasticity as a pathogenic mechanism for the development of persistent postherniotomy pain.