Case Report: Postherniorrhaphy Pain from Muscle Calcification

Background: Inguinal hernia repair is a commonly performed surgical procedure. Surgical repair is a widely accepted treatment option as a corrective measure for inguinal hernias, but it is not without its potential for complications, including chronic postinguinal herniorrhaphy pain. Neuropathic pain, which is the result of nerve damage during inguinal herniorrhaphy, can be caused by compression, irritation, or entrapment by sutures, staples, mesh, tacks, or prosthetic material. It can also occur secondary to periosteal reactions or by actual nerve injuries, such as neurapraxia, axonotmesis, neurotmesis, or complete transection, which can cause end neuroma formation and pain. Nociceptive pain, however, can occur as a result of inflammatory changes at the surgical site leading to chronic pain. Foreign bodies, such as mesh, sutures, and staples, are all possible triggers for the inflammatory reaction. Case Report: Ultrasound (US) is a noninvasive and affordable diagnostic tool that showed benefit in identifying dystrophic calcification as a potential cause for postinguinal herniorrhaphy chronic pain. It is also used to successfully guide the administration of local pharmacologic agents to control this pain. Use of US in this case allowed us to detect the densely calcified part of the abdominal wall muscles as a hyperechoic area at the surgical bed. The ability of US to detect calcification is not limited to macroscopic calcification only. It was also found to be useful in early detection of microscopic calcification in certain musculoskeletal conditions. Conclusion: We suggest that US should be considered routinely in the evaluation of cases of postinguinal herniorrhaphy chronic pain. Key words: Postherniorrhaphy pain, neuropathic pain, muscle calcification, radiofrequency ablation, ultrasound

Management of Neuropathic Postoperative Pain

Pain following surgery is routine and unavoidable but expected to resolve with time. In some cases, postoperative pain persists as the result of a neuropathic process such as a neuroma or nerve entrapment. Postoperative neuropathic pain is physiologically distinct from acute pain, but the mechanisms by which pain is transduced, transmitted, decoded, and modulated are shared. Effective treatment regimens for postoperative neuropathic pain employ a deliberate strategy to disrupt the aberrant nociceptive signal. Some surgeries are high risk for chronic postoperative pain with postherniorrhaphy pain syndrome and persistent pain following breast cancer surgery existing as well described entities in the literature.