Inguinodynia: Nonoperative Management

Chronic postherniorrhaphy pain is a significant burden on society, and prevention by meticulous hernia repair is essential to reduce this burden. Preoperative identification of patients who are likely to suffer from chronic pain is possible by identifying risk factors. A detailed history and targeted physical examination is required to identify the cause of pain, and diagnostic tests like CT scan or MRI can help rule out treatable causes of pain. Once the diagnosis of chronic postherniorrhaphy pain has been made, a multimodal, multidisciplinary approach to treatment is necessary. Referral to a dedicated pain management facility may be warranted. Identification and treatment of comorbidities is important in the management of all types of chronic pain. Patients should be pharmacologically optimized with antidepressants, antiepileptics, NSAIDs, and topical medications. Patients who have pain in classical nerve distributions should undergo diagnostic and potentially therapeutic nerve blocks. Neuroablation and neuromodulation are promising techniques that may help avoid repeat surgery.