Ischemic Inflammatory Response Syndrome as an Alternative Explanation for Postherniorrhaphy Pain

In general, moderate to severe postherniorrhaphy pain occurs in 10% of patients. The incidence is higher after recurrent repair (22%) than after initial surgery (3%) [1]. Other factors increasing the risk of postherniorrhaphy pain are poor postoperative pain control, female gender, young age, and surgical nerve damage. Although abnormal inflammatory response is also proposed as a cause of chronic postherniorrhaphy pain, the specific signs and symptoms that would satisfy a diagnosis of complex regional pain syndrome (CRPS; also known as reflex sympathetic dystrophy or Sudeck’s atrophy) are lacking. In fact, a strong argument can be made that most postherniorrhaphy pain is neuropathic in nature and is a direct expression of neurogenic inflammation in the territory of an injured nerve or nerves.