Does Re-surgery Improve Somatosensory Outcomes in Persistent Pain After Groin Hernia Repair

NCT ID: NCT05238571

Last Updated: 2022-11-28

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

60 participants

Study Classification

OBSERVATIONAL

Study Start Date

2009-04-24

Study Completion Date

2015-03-19

Brief Summary

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Groin hernia repair is accompanied by persistent severe pain in 2-4% of the patients significantly restraining psychophysical functions. Re-surgery with meshectomy and selective neurectomy may improve the pain condition, compared to non-surgical alternatives. In the current study, the primary objective was to examine and describe the underlying pathophysiological perturbations by quantitative somatosensory testing before and after re-surgery.

Detailed Description

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Persistent severe pain occurring in the aftermath of a surgical procedure is frequently associated with significant impairment of physical and psycho-social functions. After groin hernia repair (GHR), 2-4% of patients develop persistent severe pain. The GHR procedure, previously considered belonging to "minor" surgeries, qualifies as a rather complex procedure performed in a territory with a high density of nerve fibers, accommodating essential functions for locomotion and reproduction. More than 20 million repairs are performed annually worldwide, and consequently, it is estimated that 400.000-800.000 patients each year will develop persistent severe pain after the groin hernia repair (PSPG). Management of PSPG is medically challenging and may require re-surgery with mesh removal and selective neurectomy. After re-surgery for pain after open primary GHR, a potential pain-relieving effect, as well as an improvement of the deteriorated physical functions, has been demonstrated.

Quantitative somatosensory testing (QST) is an investigational psychophysiological tool with the potential to uncover the putative pathophysiological substrate in PSPG, i.e., neuropathic and inflammatory constituents. The method may also be used to quantitate changes induced by the re-surgery. Since re-surgery is a neuroablative procedure, essentially performed in previously damaged tissue, it is of interest to examine the extent of neurological perturbations, i.e., 'loss' and 'gain' of sensory functions and the relation to clinical outcome measures.

The authors are only aware of one previous PSPG-study (n = 21) finding that re-surgery, including meshectomy and selective neurectomy, was associated with increased pain pressure thresholds, decreased pain ratings and improved pain-related functional measures. The objectives of the current study, comparing pre with post-re-surgery data, were first to perform a more detailed analysis of the quantitative somatosensory data regarding 'loss' and 'gain' of sensory functions and their relation to clinical outcome measures. Second, to corroborate the clinical outcome findings of the previous study using a threefold larger cohort.

Conditions

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Patients With Persistent Severe Pain After Groin Hernia Repair

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Interventions

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Re-surgery

Re-surgery with meshectomy and selective neurectomy

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Patients with persistent severe pain (activity-related or maximal pain intensity \> 7 NRS-scores \[numeric pain rating scale 0-10\]) following unilateral, uncomplicated, open groin hernia repair.

Exclusion Criteria

* All that contradicts the above.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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mads u werner

OTHER

Sponsor Role lead

Responsible Party

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mads u werner

Principal Investigator, MD, DMSci

Responsibility Role SPONSOR_INVESTIGATOR

Locations

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Multidisciplinary Pain Center, Neuroscience Center, Copenhagen University Hospital, DENMARK

Copenhagen, , Denmark

Site Status

Countries

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Denmark

References

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Bande D, Molto L, Pereira JA, Montes A. Chronic pain after groin hernia repair: pain characteristics and impact on quality of life. BMC Surg. 2020 Jul 6;20(1):147. doi: 10.1186/s12893-020-00805-9.

Reference Type BACKGROUND
PMID: 32631293 (View on PubMed)

Chapman CR, Vierck CJ. The Transition of Acute Postoperative Pain to Chronic Pain: An Integrative Overview of Research on Mechanisms. J Pain. 2017 Apr;18(4):359.e1-359.e38. doi: 10.1016/j.jpain.2016.11.004. Epub 2016 Nov 28.

Reference Type BACKGROUND
PMID: 27908839 (View on PubMed)

Campanelli G, Bruni PG, Morlacchi A, Cavalli M. Chronic Pain after Inguinal Hernia Repair. In: Campanelli G, editor. Inguinal Hernia Surgery. Milano: Springer Milan; 2017. p. 157-68.

Reference Type BACKGROUND

Nikkolo C, Kirsimagi U, Vaasna T, Murruste M, Suumann J, Seepter H, Lepner U. Prospective study evaluating the impact of severity of chronic pain on quality of life after inguinal hernioplasty. Hernia. 2017 Apr;21(2):199-205. doi: 10.1007/s10029-016-1569-4. Epub 2016 Dec 26.

Reference Type BACKGROUND
PMID: 28025741 (View on PubMed)

HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018 Feb;22(1):1-165. doi: 10.1007/s10029-017-1668-x. Epub 2018 Jan 12.

Reference Type BACKGROUND
PMID: 29330835 (View on PubMed)

Jorgensen SG, Oberg S, Rosenberg J. Treatment of longstanding groin pain: a systematic review. Hernia. 2019 Dec;23(6):1035-1044. doi: 10.1007/s10029-019-01919-7. Epub 2019 Feb 28.

Reference Type BACKGROUND
PMID: 30820781 (View on PubMed)

Andresen K, Rosenberg J. Management of chronic pain after hernia repair. J Pain Res. 2018 Apr 5;11:675-681. doi: 10.2147/JPR.S127820. eCollection 2018.

Reference Type BACKGROUND
PMID: 29670394 (View on PubMed)

Jensen EK, Ringsted TK, Bischoff JM, Petersen MA, Rosenberg J, Kehlet H, Werner MU. A national center for persistent severe pain after groin hernia repair: Five-year prospective data. Medicine (Baltimore). 2019 Aug;98(33):e16600. doi: 10.1097/MD.0000000000016600.

Reference Type BACKGROUND
PMID: 31415351 (View on PubMed)

Werner MU. Management of persistent postsurgical inguinal pain. Langenbecks Arch Surg. 2014 Jun;399(5):559-69. doi: 10.1007/s00423-014-1211-9. Epub 2014 May 23.

Reference Type BACKGROUND
PMID: 24849039 (View on PubMed)

Bischoff JM, Enghuus C, Werner MU, Kehlet H. Long-term follow-up after mesh removal and selective neurectomy for persistent inguinal postherniorrhaphy pain. Hernia. 2013 Jun;17(3):339-45. doi: 10.1007/s10029-013-1073-z. Epub 2013 Mar 15.

Reference Type BACKGROUND
PMID: 23494661 (View on PubMed)

Aasvang E, Kehlet H. Surgical management of chronic pain after inguinal hernia repair. Br J Surg. 2005 Jul;92(7):795-801. doi: 10.1002/bjs.5103.

Reference Type BACKGROUND
PMID: 15962258 (View on PubMed)

Aasvang EK, Kehlet H. The effect of mesh removal and selective neurectomy on persistent postherniotomy pain. Ann Surg. 2009 Feb;249(2):327-34. doi: 10.1097/SLA.0b013e31818eec49.

Reference Type BACKGROUND
PMID: 19212190 (View on PubMed)

Linderoth G, Kehlet H, Aasvang EK, Werner MU. Neurophysiological characterization of persistent pain after laparoscopic inguinal hernia repair. Hernia. 2011 Oct;15(5):521-9. doi: 10.1007/s10029-011-0815-z. Epub 2011 Apr 9.

Reference Type BACKGROUND
PMID: 21479588 (View on PubMed)

Other Identifiers

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H-2-2011-023-FE

Identifier Type: -

Identifier Source: org_study_id

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