A national center for persistent severe pain after groin hernia repair: Five-year prospective data
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A national center for persistent severe pain after groin hernia repair : Five-year prospective data. / Jensen, Elisabeth Kjær; Ringsted, Thomas K; Bischoff, Joakim M; Petersen, Morten A; Rosenberg, Jacob; Kehlet, Henrik; Werner, Mads U.
In: Medicine (Baltimore), Vol. 98, No. 33, 2019, p. e16600.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - A national center for persistent severe pain after groin hernia repair
T2 - Five-year prospective data
AU - Jensen, Elisabeth Kjær
AU - Ringsted, Thomas K
AU - Bischoff, Joakim M
AU - Petersen, Morten A
AU - Rosenberg, Jacob
AU - Kehlet, Henrik
AU - Werner, Mads U
PY - 2019
Y1 - 2019
N2 - Severe persistent pain after groin hernia repair impairs quality-of-life. Prospective, consecutive cohort study including patients with pain-related impairment of physical and social life. Relevant surgical records were obtained, and examinations were by standardized clinical and neurophysiological tests. Patients demonstrating pain sensitivity to pressure algometry in the operated groin underwent re-surgery, while patients with neuropathic pain received pharmacotherapy. Questionnaires at baseline (Q0) and at the 5-year time point (Q5Y) were used in outcome analyses of pain intensity (numeric rating scale [NRS] 0-10) and pain-related effect on the activity-of-daily-living (Activities Assessment Scale [AAS]). Data are mean (95% CI).Analyses were made in 172/204 (84%) eligible patients. In 54/172 (31%) patients re-surgery (meshectomy/selective neurectomy) was performed, while the remaining 118/172 (69%) patients received pharmacotherapy. In the re-surgery group, activity-related, and average NRS-scores at Q0 were 6.6 (5.6-7.9) and 5.9 (5.6-5.9), respectively. Correspondingly, NRS-scores at Q5Y was 4.1 (3.3-5.1) and 3.1 (2.3-4.0; Q0 vs. Q5Y: P < .0005), respectively. Although both groups experienced a significant improvement in AAS-scores comparing Q0 vs. Q5Y (re-surgery group: 28% (4-43%; P < .0001); pharmacotherapy group: 5% (0-11%; P = .005)) the improvement was significantly larger in the re-surgery group (P = .02).This 5-year cohort study in patients with severe persistent pain after groin hernia repair signals that selection to re-surgery or pharmacotherapy, based on examination of pain sensitivity, is associated with significant improvement in outcome. Analyzing composite endpoints, combining pain and physical function, are novel in exploring interventional effects.ClinicalTrials.gov Identifier NCT03713047.
AB - Severe persistent pain after groin hernia repair impairs quality-of-life. Prospective, consecutive cohort study including patients with pain-related impairment of physical and social life. Relevant surgical records were obtained, and examinations were by standardized clinical and neurophysiological tests. Patients demonstrating pain sensitivity to pressure algometry in the operated groin underwent re-surgery, while patients with neuropathic pain received pharmacotherapy. Questionnaires at baseline (Q0) and at the 5-year time point (Q5Y) were used in outcome analyses of pain intensity (numeric rating scale [NRS] 0-10) and pain-related effect on the activity-of-daily-living (Activities Assessment Scale [AAS]). Data are mean (95% CI).Analyses were made in 172/204 (84%) eligible patients. In 54/172 (31%) patients re-surgery (meshectomy/selective neurectomy) was performed, while the remaining 118/172 (69%) patients received pharmacotherapy. In the re-surgery group, activity-related, and average NRS-scores at Q0 were 6.6 (5.6-7.9) and 5.9 (5.6-5.9), respectively. Correspondingly, NRS-scores at Q5Y was 4.1 (3.3-5.1) and 3.1 (2.3-4.0; Q0 vs. Q5Y: P < .0005), respectively. Although both groups experienced a significant improvement in AAS-scores comparing Q0 vs. Q5Y (re-surgery group: 28% (4-43%; P < .0001); pharmacotherapy group: 5% (0-11%; P = .005)) the improvement was significantly larger in the re-surgery group (P = .02).This 5-year cohort study in patients with severe persistent pain after groin hernia repair signals that selection to re-surgery or pharmacotherapy, based on examination of pain sensitivity, is associated with significant improvement in outcome. Analyzing composite endpoints, combining pain and physical function, are novel in exploring interventional effects.ClinicalTrials.gov Identifier NCT03713047.
KW - Analgesics/therapeutic use
KW - Female
KW - Groin/innervation
KW - Hernia, Inguinal/psychology
KW - Herniorrhaphy/adverse effects
KW - Humans
KW - Male
KW - Middle Aged
KW - Neuralgia/etiology
KW - Pain Management/methods
KW - Pain Measurement
KW - Pain, Postoperative/etiology
KW - Prospective Studies
KW - Quality of Life
KW - Reoperation/statistics & numerical data
KW - Treatment Outcome
U2 - 10.1097/MD.0000000000016600
DO - 10.1097/MD.0000000000016600
M3 - Journal article
C2 - 31415351
VL - 98
SP - e16600
JO - Medicine (Baltimore)
JF - Medicine (Baltimore)
SN - 0025-7974
IS - 33
ER -
ID: 237848938