Geoff had seen the general surgeons and the urologists. When he was referred to The Manchester Pain Clinic, his scans and blood tests were reviewed. A diagnosis of chronic post-surgical pain was made. Pain after hernia surgery can affect between 15 and 40%.1
Geoff was assessed using a biopsychosocial framework. He had been tried on range of neuropathic or nerve type medication without benefit, making him feel unwell and confused. Therefore I tried jack on a newer novel neuropathic agent to try and minimise any interventions he might need. This medication relieved his pain significantly but led to nose bleeds, which is a rare side effect in combination with some of Geoff’s other medications. Through discussion with Jack and his GP we were able to rationalise his medication so that he was able to alter his dose of the nerve drug and other medications, so he continued to gain pain relief but his nose bleeds stopped.
Although Geoff’s pain had improved, he still wished for more pain relief. He has consented for pulsed radiofrequency for the illioinguinal and iliohypogastric nerves in the groin. This was performed with some local anaesthetic and as a day case procedure. Geoff was able to eat and drink as normal before and after the procedure.
Geoff’s pain resolved completely and several months after the procedure he continues to be pain free/ Geoff is able to sleep better and achieve the goals that he dreamed of, in terms of being able to play with his grandchildren without pain and enjoy his holidays. Geoff is aware that he might also benefit from some physiotherapy in future to help him maintain his strength and independence.
- Chronic Pain after Inguinal Hernia Repair Mallikarjuna Manangi, Santhosh Shivashankar, and Abhishek Vijayakumar*Int Sch Res Notices. 2014; 2014: 839681.
His medications were altered to ensure that he had pain relief going forward and a discussion about holistic methods of rehabilitation to help him with mood, sleep, mobility and function as well as the management of flare ups was discussed. A patient centred decision was made to access pain psychology and physio to help with the knock o consequences of his back pain. Mr G was also consented for an epidural to reduce the impact of his leg pain and facilitate his wider rehabilitation goals.
This was performed as a day case procedure with x ray guidance and local anaesthetic. Mr G was able to eat and drink as normal before and after the procedure. As a result of this his leg pain improved and then though his work with the medial physiotherapy and psychology teams, both his pain and function improved. He was able to walk further, manage flare ups more effectively and sleep better. He was then able to reduce some of his medication which improved his memory and enjoyment of life more generally.