Chronic postoperative pain and inguinal herniorrhaphy
Editor—Avasvang and Kehlet1 highlight the complex nature of perioperative pain management. It serves to add to the growing body of evidence that alteration in the central and peripheral nervous system can lead to both acute and chronic pain outcomes following surgery. This alteration, which can be excitatory or inhibitory, is termed neuroplasticity. Their paper identifies a lack of preoperative pain assessment data available in the literature they reviewed. However, data do exist which suggest that preoperative pain is a significant predictive value of developing chronic pain following inguinal herniorrhaphy.2 Indeed, the presence of chronic pain before surgery has been suggested to increase patient vulnerability to chronic pain complications after surgical nociception.3 This raises the possibility that neuroplasticity may contribute to the increased incidence of chronic postoperative pain in patients undergoing inguinal herniorrhaphy. Perhaps quantitative sensory testing, which is an accepted non-invasive tool to assess neuroplasticity in the perioperative clinical context,4 could be considered to give insight into the nociceptive neuroplasticity in these patients. This would offer the potential to develop evidence based perioperative pain management in the future. This combined with a comprehensive pain history may prove useful in the perioperative management of these patients.
Cork, Ireland
E-mail: dominichegarty{at}hotmail.com
References
1 Avasvang E and Kehlet H. Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 2005; 95:69–76
2 Poobalan AS, Bruce J, King PM, et al. Chronic pain, quality of life following open inguinal hernia repair. Br J Surg 2001; 88:1122–6[CrossRef][Web of Science][Medline]
3 Bach S, Noreng MF, Tejellden TN, et al. Phantom limb pain in amputees during the first 12 months following limb amputation after preoperative lumbar epidural blockade. Pain 1988; 33:297–301[CrossRef][Web of Science][Medline]
4 Wilder-Smith OH, Tassonyi E, Senly C, et al. Surgical pain is followed not only by spinal sensitisation but also by supraspinal antinociception. Br J Anaesth 1996; 76:816–21
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