What Defines ‘Chronic Pain’ After Hernia Surgery?

This question may seem like an easy one to answer, but developing a systematic scale and a formal survey to evaluate patients after any surgery can be difficult. For the sake of my hernia practice, I describe to patients chronic pain being pain that develops usually by 6 months, and which can last for years. Fortunately, this is a very, very rare occurrence!

Pain is not the only measure that we look at over the course of this time frame. Other important variables include:

• physical functioning
• role limitations due to physical health
• energy and fatigue
• emotional well being
• social functioning
• pain
• general health

What causes chronic pain?

Chronic pain is rarely caused by the hernia itself returning; instead, it is typically related to how the body interacts with the repair. The three primary causes are:

• Nerve Irritation or Entrapment: The groin is a “high-traffic” area for sensory nerves (the ilioinguinal, iliohypogastric, and genitofemoral nerves). If these nerves are handled roughly, entrapped by a suture, or irritated by the edge of a mesh, it can cause persistent neuralgia.
• The “Meshoma” Effect: In some cases, a mesh that is too heavy or improperly placed can wrinkle or ball up, creating a hard mass that tugs on surrounding tissue.
• Inflammatory Response: A patient’s unique biological response to prosthetic material or the surgical trauma itself can lead to localized inflammation.

What is the Chance This Will Happen to Me?

The “chance” of chronic pain is not a fixed number; it is highly dependent on the experience of the surgeon and the technique used. At our center, we mitigate your risk through three specific clinical pillars:

• Nerve-Sparing Technique: Dr. Todd Harris utilizes a meticulous “nerve-identifying” approach. By clearly visualizing and protecting the sensory nerves during every procedure, we significantly reduce the risk of accidental entrapment or injury.
• Specialized Material Selection: We use only lightweight, high-porosity “macroporous” mesh, which allows for better tissue integration and less “stiffness” than the heavy-weight meshes of the past. For qualified patients, we also offer the Shouldice (No-Mesh) repair, eliminating prosthetic materials entirely.
• Narcotic-Free Recovery (NCT05929937): Our research has shown that eliminating opioids and using Multimodal Analgesia reduces the “wind-up” of the nervous system. By controlling pain effectively in the first 72 hours without narcotics, we help prevent the brain from “mapping” a chronic pain response.

Timeline for Chronic Pain

• Surgery
• 3 weeks: most patients pain is 90-100% resolved
• 3 months: some patients have a delayed recovery with pain resolving at this point
• 6 months: definition for chronic pain

Our Clinical Approach to Minimizing Chronic Pain

While medical science acknowledges that no surgeon can guarantee a 100% pain-free outcome for every patient, we believe that chronic post-operative discomfort should never be treated as an “unavoidable” byproduct of surgery. At California Hernia Specialists, we utilize a proactive, data-driven framework to mitigate the risk of Chronic Post-Herniorrhaphy Pain (CPHP).

By combining high-volume surgical precision with the protocols developed in our NOPIOIDS Clinical Trial (NCT05929937), we focus on four primary pillars of prevention:

1. High-Volume Precision & Nerve Preservation

The groin is a complex anatomical space home to several sensory nerves, including the ilioinguinal, iliohypogastric, and genitofemoral nerves. In high-volume specialized care—where we perform 500–600 repairs annually—we develop a “surgical eye” for these structures.

• Meticulous Dissection: We prioritize the visualization and protection of these sensory nerves throughout the procedure.
• Disruption Minimization: By reducing the disruption of healthy surrounding tissues and avoiding unnecessary tension on the abdominal wall, we limit the biological triggers that can lead to long-term nerve irritation.


2. Advanced Biomaterials: The Shift to Lightweight Mesh

A significant factor in the development of chronic pain is the “foreign body response” or inflammation caused by the mesh.

• Reduced Density: Years ago, the standard was a thick, “heavyweight” mesh. We now utilize modern lightweight meshes that contain only about 1/3 of the material of older versions while maintaining equal strength.
• Inflammation Control: Thinner, more porous mesh results in significantly less scar tissue and inflammation. This reduces the risk of “meshoma” (mesh bundling) and the restrictive, tugging sensation that many patients associate with chronic discomfort.


3. Preventing “Nerve Wind-Up” through Multimodal Protocols

Clinical research, including our own NOPIOIDS trial, suggests that the intensity of pain in the first 48 hours can influence the development of chronic pain pathways—a process known as “central sensitization” or nerve wind-up.

• Multimodal Analgesia: By using a scheduled protocol of non-narcotic medications (Tylenol and Advil) combined with local anesthetics and aggressive icing, we keep the nervous system “quiet” during the acute healing phase.
• Narcotic Avoidance: Limiting opioid use not only prevents addiction but also avoids “opioid-induced hyperalgesia,” where the body becomes more sensitive to pain signals.


4. AHSQC Data Benchmarking & Continuous Improvement

Success in medicine requires transparency. As a participant in the America Hernia Society Quality Collaborative (AHSQC), we don’t just hope for good outcomes—we measure them.

• Long-Term Tracking: We track our patients for years following surgery to monitor for any late-onset discomfort.
• Peer Validation: By benchmarking our data against national averages, we ensure our techniques remain at the forefront of surgical excellence. Our commitment to these outcomes is why Dr. Harris was recognized as an OCMA Physician of Excellence for 2015–2026.

Incidence of Chronic Pain

Probably the most important part of this information is to discuss how often we see patients with chronic pain. I want to break up my answer into two different parts. First, I want to discuss the medically published statistics on chronic pain. This will give you a formal, unbiased vantage point into chronic post-operative hernia pain. Second, I will provide you with my personal experience in my practice. Keep in mind that there may be patients that have chronic pain after one of my surgeries who decide to see another surgeon, or a pain specialist without my knowledge. I would guess that if those patients are factored into my personal experience, the statistics are likely almost the same.

In my hernia practice, we perform roughly 500 hernia surgeries a year. At the end of every year I see about 3-5 patients back in my office after 3 months with pain that has not improved since surgery. Of these patients, about 3 of them see marked improvement by 6 months. Thus, we probably have about 0.5% of our patients each year who are experiencing severe or disabling pain 6 months or more after surgery.

For medically published data, there was a very good article which looked at chronic pain in July of 2016. The article appeared in the Journal of the American College of Surgeons and examined patients up to two years after hernia surgery. The surgery technique that the authors used is identical the technique that I perform in my practice today. In their research, the determined that about 1% of patients had moderate, severe or disabling pain at 1 year after surgery. 89% had no symptoms and 8% had mild and not bothersome symptoms. 2% had mild symptoms that were bothersome.

Use of Light and Mid-weight Hernia Mesh

Over the last couple of years, hernia surgeons who specialize in hernia repair have adopted the newest types of mesh. Although prior hernia mesh was heavy, thick plastic, today’s newest mesh is much more lightweight and macroporous. This means that it is soft, and flexible like the muscles themselves. It causes much less scar tissue within the body which decreases the chances of acute and chronic pain after hernia surgery. Over time, the mesh remains soft and flexible minimizing the chances of chronic pain to almost zero.

Research Data on Chronic Pain

The following table demonstrates the results from a large medical study on chronic pain after hernia surgery. It indicates the responses from patients about their pain at one year after surgery.

Patient Response	Percentage of Patients
No symptoms	89%
Mild and not bothersome	8%
Mild and bothersome	2%
Moderate or worse	1%

Dr. Harris can discuss these items during your consultation to decide which method is best for you. Although basic open surgical hernia repair is still an important option for some patients, every patient should consider being seen by a surgeon who can perform advanced laparoscopic hernia surgery and who uses the newest lightweight mesh. Only a small handful of the hundreds of general surgeons in Orange County, Los Angeles, Riverside and San Diego have the experience to perform hernia surgeries using laparoscopic techniques and use cutting edge lightweight mesh.

Choosing a Hernia Surgeon: Why Specialization, Volume, and Facilities Matter

Dr. Todd Harris explains the importance of choosing a high-volume hernia specialist and a dedicated surgery center for the best surgical results.

Patient Success: Narcotic-Free Healing

Verified patient describes the ease of recovery and rapid return to activity using multimodal analgesia protocols.