Persistent Groin Pain After Hernia Surgery

Understanding Nerve Injury, Mesh Problems and Modern Treatment Options

Inguinal hernia surgery is one of the most commonly performed operations. Most patients recover well, but a significant minority develop persistent pain in the groin after surgery, even when the repair has been technically successful and scans do not show an obvious problem.

Introduction

What is post-inguinal hernia surgery pain?

Post-inguinal hernia surgery pain refers to pain that persists after repair of an inguinal hernia. Some discomfort in the first few days and weeks after surgery is expected. However, when significant pain continues beyond the normal healing period, particularly beyond three months, it is recognised as chronic postoperative inguinal pain, often abbreviated to CPIP.

This pain may affect the groin, lower abdomen, pubic region, inner thigh, scrotum or labia. It may feel burning, shooting, stabbing, aching, pulling or pressure-like. Some patients also experience numbness, tingling or hypersensitivity, where even light touch from clothing can feel painful.

Why patients are often told everything looks normal

Many patients with persistent pain after hernia surgery are told that the operation went well, the hernia has not returned and the scan looks normal. This can be very frustrating, because the pain may still be severe and disabling.

The reason is that many important causes of post-hernia surgery pain do not show clearly on routine scans. Nerve irritation, nerve entrapment, painful scar tissue, neuroma formation and abnormal sensitivity of the nervous system may all cause significant pain even when the mesh appears well positioned and there is no recurrent hernia.

A recognised and treatable condition

Persistent pain after inguinal hernia repair is not imaginary and it is not simply something patients have to tolerate. It is a recognised medical condition with several well-described causes, including nerve injury, mesh-related irritation, scar tissue, testicular pain syndromes, abdominal wall pain and hernia recurrence.

The key to successful treatment is identifying the main pain generator. Some patients need treatment directed at the ilioinguinal, iliohypogastric or genitofemoral nerves. Others may need assessment for mesh-related pain, myofascial pain, recurrence or central sensitisation.

At Pain Spa, patients with persistent groin pain after hernia surgery are assessed carefully to understand the likely mechanism of pain and to guide targeted treatment options, including rehabilitation, medication optimisation, ultrasound-guided diagnostic nerve blocks, pulsed radiofrequency treatment, dorsal root ganglion interventions and referral for surgical opinion where appropriate.

Main Causes of Persistent Pain After Hernia Repair

Comparing the Three Nerves

Why Different Operations Affect Different Nerves

Key Clinical Message

A useful rule of thumb is that persistent pain following an open hernia repair is more likely to involve the ilioinguinal nerve, whereas persistent pain following a laparoscopic repair is more likely to involve the genitofemoral nerve. Although there is overlap and other nerves may be involved, this anatomical principle often provides an important clue during assessment.

Why Is Mesh Used?

The purpose of mesh is to reinforce the weakened area of the abdominal wall where the hernia has developed. By providing additional support to the repair, mesh has significantly reduced hernia recurrence rates and has become the standard approach for most inguinal hernia repairs worldwide.

For the overwhelming majority of patients, the mesh remains stable and functions exactly as intended, providing long-term reinforcement without causing symptoms.

What Happens After Mesh Is Implanted?

After implantation, the body naturally responds to the mesh by forming scar tissue around it. This is a normal part of the healing process and helps anchor the mesh firmly within the tissues.

Your source article highlights that mesh also triggers a persistent foreign-body reaction involving inflammatory cells and fibrosis. In most patients this causes no symptoms. In a small minority, however, the healing response may become excessive and contribute to pain.

Why Do Some Patients Develop Problems?

Over time, all synthetic meshes undergo some degree of contraction. In some patients, this process can become more pronounced, leading to shrinkage, folding or wrinkling of the mesh. When the mesh contracts into a firm folded mass surrounded by scar tissue, it may form what is known as a meshoma.

Mesh contraction and fibrosis may also distort local tissues and, in some cases, contribute to irritation or entrapment of nearby nerves. These mechanisms are thought to play an important role in some patients with chronic post-hernia surgery pain.

Fortunately, significant mesh-related complications remain uncommon when compared with the large number of successful hernia repairs performed worldwide.

An Important Clinical Point

One of the most important messages from the medical literature is that the presence of mesh does not automatically mean that the mesh is causing the pain. Many patients with persistent groin pain actually have neuropathic pain arising from irritation or injury of the ilioinguinal, iliohypogastric or genitofemoral nerves.

For this reason, careful assessment is essential. The challenge is not simply determining whether mesh is present, but identifying whether the patient’s symptoms are predominantly nerve-related, mesh-related, or due to another cause entirely.

Meshoma

A meshoma develops when the mesh contracts, folds or wrinkles into a dense mass surrounded by scar tissue. Patients often describe a persistent foreign-body sensation, a feeling of tightness in the groin, or discomfort that is aggravated by movement. In some cases, the meshoma may also irritate nearby nerves and contribute to mixed neuropathic and nociceptive pain.

Mesh Contraction and Shrinkage

All implanted mesh undergoes some degree of contraction as part of the normal healing response. In a small number of patients this process becomes excessive, resulting in significant shrinkage and fibrosis. This may place tension on surrounding tissues, distort local anatomy and contribute to chronic groin discomfort.

Mesh Infection

Mesh infection is uncommon but remains an important complication to recognise. Patients may develop persistent pain, swelling, redness, discharge or systemic symptoms. Although infections often occur in the early post-operative period, delayed presentations can occasionally occur months or years after surgery.

Mesh Migration

Rarely, mesh may move from its original position. Migration can lead to chronic pain, recurrent symptoms or irritation of adjacent structures. The presentation varies depending on the direction and extent of migration.

Mesh Erosion

In very rare cases, mesh may erode into surrounding tissues or organs. The symptoms depend on the structure involved and may include chronic pain, infection, inflammation or dysfunction of adjacent organs.

Fluid Collections (Seroma and Haematoma)

Fluid collections can develop following hernia surgery. Most resolve spontaneously, but persistent seromas or organised haematomas may occasionally contribute to ongoing discomfort, pressure symptoms or inflammation around the repair site.

Neuropathic Pain vs Mesh-Related Pain

Common Symptoms Reported by Patients

Why Symptoms Matter

The pattern of symptoms often provides important clues about the underlying pain mechanism. Burning pain, tingling, numbness and electric shock sensations tend to suggest neuropathic pain arising from one of the groin nerves. In contrast, a feeling of tightness, pulling or a foreign body sensation may suggest fibrosis, mesh contraction or mesh-related pathology.

Although symptom patterns are helpful, there is often overlap between different causes of pain. This is why a careful history, examination and, in some cases, diagnostic nerve blocks are often required to establish the dominant pain generator.

Factors Associated with Persistent Post-Hernia Surgery Pain

The Important Message

The presence of one or more risk factors does not mean that chronic pain is inevitable. Many patients with recognised risk factors recover completely, while others develop persistent pain despite having no obvious warning signs. Understanding these factors simply helps clinicians identify patients who may benefit from closer assessment and earlier intervention.

Diagnostic Pathway

History

The history often provides the most important diagnostic clues. Patients are asked about the location of pain, the quality of symptoms, the timing of onset after surgery and the activities that aggravate or relieve symptoms.

Burning pain, electric shock sensations, tingling and hypersensitivity tend to suggest neuropathic pain. In contrast, a sensation of tightness, pulling, pressure or a foreign body within the groin may suggest mesh-related pathology. Testicular pain may indicate orchialgia, whilst the return of a groin bulge raises concern about recurrence.

Physical Examination

Examination focuses on identifying sensory abnormalities, areas of tenderness, recurrent hernia, trigger points and signs of mesh-related complications. Particular attention is paid to areas of altered sensation, allodynia and hyperalgesia which may indicate nerve involvement.

Dermatomal Mapping

Careful sensory examination can help identify which nerve may be involved. Mapping areas of numbness, tingling, hypersensitivity or pain may provide clues to involvement of the ilioinguinal, iliohypogastric or genitofemoral nerves.

Tinel’s Sign

Gentle tapping over an irritated nerve may reproduce tingling, shooting pain or paraesthesia within the distribution of that nerve. A positive Tinel’s sign can support the diagnosis of neuropathic pain arising from nerve irritation or entrapment.

Cremasteric Reflex

Assessment of the cremasteric reflex may provide additional information regarding the integrity of the ilioinguinal and genitofemoral nerves. Although not diagnostic on its own, it may contribute to the overall clinical assessment.

Imaging Studies

Diagnostic Nerve Blocks

Diagnostic nerve blocks play an important role when neuropathic pain is suspected. Ultrasound-guided blocks of the ilioinguinal, iliohypogastric or genitofemoral nerves may help determine whether a particular nerve is contributing to symptoms.

Temporary pain relief following a diagnostic block can provide valuable information and may help guide subsequent treatment decisions, including targeted nerve procedures.

A Sensitised Nervous System

In the early stages after surgery, pain serves a useful purpose by warning the body that healing is taking place. However, if pain signals continue for months, the nervous system can become sensitised. The spinal cord and brain begin to process normal sensory information differently, causing pain to persist even when tissue healing is largely complete.

Allodynia

Allodynia occurs when normally non-painful stimuli become painful. Patients may find that clothing rubbing against the groin, light touch, gentle pressure or everyday movement triggers disproportionate discomfort. This is a hallmark feature of a sensitised nervous system.

Hyperalgesia

Hyperalgesia refers to an exaggerated response to a painful stimulus. Something that would normally cause mild discomfort may produce much more severe pain than expected. Patients often describe feeling that their nervous system has become overly reactive or permanently “switched on.”

Overlap with Other Chronic Post-Surgical Pain Syndromes

Central sensitisation is not unique to hernia surgery. Similar mechanisms are recognised in many chronic post-surgical pain conditions, including persistent pain after breast surgery, thoracic surgery, joint replacement surgery and other procedures involving nerve injury.

This helps explain why two patients with apparently similar surgical outcomes can have very different experiences. One patient may recover completely, whilst another develops a nervous system that remains highly sensitive long after the original injury has healed.

Why This Matters

Recognising central sensitisation is important because it changes the treatment approach. Simply looking for more surgery or additional structural problems may not address the underlying issue. Instead, treatment often focuses on calming the nervous system through education, rehabilitation, medication optimisation and carefully targeted pain interventions where appropriate.

Importantly, central sensitisation does not mean the pain is psychological or imaginary. The pain is very real, but the nervous system has become overly sensitive and continues to generate pain out of proportion to any ongoing tissue injury.

An Important Point

Conservative treatment does not mean that the pain is being dismissed or that symptoms are not genuine. These approaches form an important part of modern pain management and are often used alongside diagnostic nerve blocks, pulsed radiofrequency treatment and other targeted interventions when appropriate.

Commonly Used Medications

A Practical Point

Medication is often most effective when used as part of a broader treatment strategy rather than in isolation. For many patients, the best outcomes are achieved when medication optimisation is combined with rehabilitation, desensitisation strategies and targeted interventional treatments where appropriate.

It is also important to recognise that medications rarely eliminate pain completely. The goal is usually to reduce pain intensity, improve function and allow patients to participate more effectively in rehabilitation and everyday activities.

How Nerve Blocks Help Clinically

Ilioinguinal Nerve Block

The ilioinguinal nerve is particularly relevant after open inguinal hernia repair. It may be involved when pain is felt in the groin crease, pubic region, scrotum or labia, and upper inner thigh.

Symptoms suggesting ilioinguinal nerve involvement include burning pain, shooting pain, tingling, numbness or hypersensitivity in this distribution. The pain may be aggravated by walking, standing, hip extension or pressure around the inguinal canal.

A diagnostic block can help confirm whether this nerve is contributing to symptoms. If the response is clear but temporary, longer-lasting options such as pulsed radiofrequency may be considered.

Iliohypogastric Nerve Block

The iliohypogastric nerve is usually considered when pain is higher than the groin crease, particularly in the suprapubic region or lower abdominal wall.

Patients may describe aching, burning, numbness or altered sensation above the inguinal ligament rather than pain centred mainly in the scrotum, labia or upper thigh.

Because the ilioinguinal and iliohypogastric nerves overlap anatomically, they may sometimes need to be assessed together. A clear response can help guide treatment planning and reduce diagnostic uncertainty.

Genitofemoral Nerve Block

The genitofemoral nerve is especially important after laparoscopic hernia repair because it runs in the deeper preperitoneal plane used during TEP and TAPP procedures.

Genitofemoral nerve pain may involve the pubic region, upper inner thigh, scrotum or labia. Some patients describe deep aching genital pain, burning pain into the upper thigh, or symptoms that worsen with walking, standing or inguinal pressure.

Because this nerve has a deeper course than the ilioinguinal and iliohypogastric nerves, reliable assessment may require targeting the nerve closer to its spinal origin rather than simply injecting in the groin. This distinction is clinically important when pain persists after laparoscopic repair.

Trigger Point Injections

Not all post-hernia pain is purely nerve-related. Some patients develop localised tender points, abdominal wall guarding, scar sensitivity or myofascial pain around the groin and lower abdominal wall.

Trigger point injections may be considered when there are focal areas of tenderness that reproduce the patient’s familiar pain. These injections are aimed at the myofascial or local tender-point component rather than at a specific named nerve.

This can be particularly helpful when the pain pattern is mixed, with both neuropathic symptoms and local muscle or scar-related tenderness.

Interpreting the Response

The response to a block should be assessed carefully. A meaningful reduction in pain after a targeted block supports the diagnosis and helps guide the next stage of treatment.

PRF Can Be Targeted at Different Levels

In chronic post-hernia surgery pain, PRF can be directed either at the peripheral nerves in the groin and lower abdominal wall, or more proximally at the dorsal root ganglion where sensory pain signals enter the spinal nervous system.

Peripheral Nerve PRF Targets

Peripheral nerve PRF is directed at the named sensory nerves that are commonly affected after inguinal hernia surgery. The choice of target depends on the patient’s symptoms, examination findings, surgical history and response to diagnostic blocks.

Dorsal Root Ganglion PRF Targets

The dorsal root ganglion, or DRG, is a collection of sensory nerve cells close to the spine. It acts as an important relay station for pain signals travelling from the groin, lower abdominal wall, upper thigh and genital region.

In post-hernia surgery pain, DRG PRF may be considered when pain is not confined to one peripheral nerve, when several nerve territories overlap, or when peripheral nerve blocks have not provided sufficient or lasting relief.

Why DRG PRF May Be Useful

Peripheral nerve pain after hernia surgery can be difficult to localise because the sensory territories of the ilioinguinal, iliohypogastric and genitofemoral nerves overlap. A patient may also have pain that has become more widespread or sensitised over time.

Targeting the DRG allows treatment closer to the origin of the sensory pathway, before pain signals enter the spinal cord. This may be particularly useful when symptoms are complex, when more than one nerve appears to be involved, or when previous peripheral treatments have only partially helped.

Advantages of PRF in Post-Hernia Surgery Pain

Who May Benefit?

PRF is most suitable for patients whose symptoms suggest neuropathic post-hernia surgery pain rather than purely mesh-related pain or recurrence. Typical features include burning pain, shooting pain, electric shock sensations, tingling, numbness, hypersensitivity and pain following a recognisable nerve distribution.

Patients who obtain significant temporary relief from a diagnostic nerve block are often the strongest candidates for peripheral nerve PRF. Patients with overlapping pain territories, incomplete response to peripheral blocks or more proximal symptoms may be considered for DRG-level PRF.

PRF is not suitable for every patient, and careful assessment is essential. If symptoms suggest meshoma, recurrent hernia, infection or another structural problem, those issues need to be investigated and managed appropriately.

The Key DRG Targets in Post-Hernia Surgery Pain

The most important DRG targets are usually L1 and L2, with T12 occasionally being relevant depending on the distribution of symptoms.

Why Peripheral Treatments Do Not Always Work

One of the challenges in post-hernia surgery pain is that the ilioinguinal, iliohypogastric and genitofemoral nerves have overlapping sensory territories. Patients often struggle to identify a single pain distribution, and examination findings may not clearly implicate one nerve alone.

In addition, long-standing pain may gradually become more widespread, making it increasingly difficult to isolate a single peripheral pain generator. A patient may obtain only partial relief from an ilioinguinal block, for example, because pain signals are also travelling through adjacent pathways.

This helps explain why some patients experience only limited or short-lived benefit from peripheral nerve treatments despite apparently appropriate nerve targeting.

Why DRG Treatment May Help

The DRG acts as a relay station where sensory information from multiple peripheral nerves converges before entering the spinal cord. By targeting the DRG, treatment can influence pain transmission at a higher level within the sensory pathway.

This may be particularly useful when:

• Pain involves more than one nerve territory.
• Symptoms extend beyond a single anatomical distribution.
• Peripheral nerve blocks have provided only partial relief.
• Pain has become longstanding and more complex.
• Previous peripheral treatments have failed to provide durable benefit.

Because the DRG sits closer to the origin of the pain pathway, treatment at this level may provide broader coverage than targeting an individual peripheral nerve alone.

DRG Blocks and DRG PRF

The DRG can be approached diagnostically or therapeutically. Diagnostic DRG blocks may help determine whether pain is being transmitted through a particular spinal segment, whilst pulsed radiofrequency can be used to modulate pain signalling at the DRG itself.

As with peripheral PRF, the goal is not to destroy the nerve but to reduce abnormal pain transmission whilst preserving normal neurological function.

For carefully selected patients with persistent neuropathic post-hernia surgery pain, DRG treatment has become an increasingly important part of the non-surgical treatment pathway and may help avoid more invasive procedures.

Botox and Neuropathic Pain

In neuropathic pain, injured or irritated nerves can become overactive and continue to send abnormal pain signals. Botox may help reduce this abnormal pain signalling by acting on sensitised nerve endings and reducing the release of pain-related chemical mediators.

This means Botox may be considered in selected patients with burning pain, shooting pain, hypersensitivity, scar sensitivity or localised neuropathic pain after hernia surgery.

Peripheral Sensitisation

After surgery, some tissues and nerve endings around the scar and abdominal wall can remain abnormally sensitive. This is called peripheral sensitisation. Patients may experience pain from light touch, pressure, clothing contact or gentle movement.

By reducing excessive local pain signalling, Botox may help calm this sensitised peripheral pain state in selected patients.

Abdominal Wall Muscle Spasm and Guarding

Pain often causes the abdominal wall muscles to tighten as a protective response. Over time, this guarding can become persistent and may itself contribute to pain, stiffness, pulling sensations and restricted movement.

Botox may help when excessive abdominal wall muscle activity, spasm or guarding is a significant contributor to the pain pattern.

Myofascial Pain and Trigger Points

Some patients develop myofascial pain around the lower abdominal wall, groin or scar region. This may present as tender trigger points, painful bands of muscle, localised tenderness or pain reproduced by pressing specific areas.

In this situation, Botox may be considered as part of a broader strategy to reduce muscle overactivity and local pain amplification.

Scar-Related Guarding and Local Pain

Surgical scars can sometimes remain painful, tethered or hypersensitive. This may lead to protective guarding of the abdominal wall and altered movement patterns.

When scar-related pain is associated with local muscle tightness, trigger points or neuropathic hypersensitivity, Botox may have a useful role in carefully selected cases.

Which Patients May Benefit?

A Selected Treatment, Not a Routine Treatment for Everyone

Botox is not a first-line treatment for every patient with chronic post-hernia surgery pain. It is best considered when the clinical picture suggests localised neuropathic pain, peripheral sensitisation, scar-related guarding, abdominal wall spasm or a significant myofascial component.

Patients with clear meshoma, recurrent hernia, infection or major structural pathology require assessment and treatment directed at those specific problems. In the right patient, however, Botox may provide a useful additional treatment option alongside nerve blocks, pulsed radiofrequency, medication optimisation and rehabilitation.

Before Considering Surgery

A thorough assessment is essential before proceeding with any surgical intervention. This typically includes a detailed history, examination, appropriate imaging and, where relevant, diagnostic nerve blocks.

The aim is to determine whether the pain is primarily neuropathic, mesh-related, due to recurrence, or driven by another mechanism. Without a clear diagnosis, surgery may fail to improve symptoms and, in some cases, may make them worse.

Mesh Removal

Mesh removal may be considered when there is convincing evidence that the mesh itself is contributing to symptoms. Examples include meshoma formation, significant mesh contraction, chronic infection, migration or erosion into surrounding structures.

Mesh removal is technically challenging surgery and carries its own risks. Importantly, removal of mesh does not guarantee complete pain relief, particularly if long-standing neuropathic changes have already developed.

For this reason, careful patient selection is critical.

Selective Neurectomy

Selective neurectomy involves surgical division or excision of a specific nerve that has been identified as the dominant pain generator. This approach is generally considered when symptoms, examination findings and diagnostic nerve blocks consistently point towards involvement of a particular nerve.

The goal is to interrupt the transmission of pain signals arising from that nerve whilst avoiding unnecessary treatment of unaffected structures.

Triple Neurectomy

Some patients have symptoms involving multiple overlapping nerve territories, making it difficult to identify a single responsible nerve. In these situations, surgeons may consider triple neurectomy, which involves treatment of the ilioinguinal, iliohypogastric and genitofemoral nerves.

The rationale is based on the considerable anatomical overlap between these nerves and the difficulty of reliably isolating a single pain source in some patients.

Whilst this approach can be effective in selected cases, it is a major intervention and requires careful counselling regarding potential sensory changes and expected outcomes.

Repair of Recurrent Hernia

When investigations demonstrate recurrent herniation, surgical repair may be appropriate. In this situation, the goal is to address the underlying structural problem rather than simply treating pain symptoms.

A recurrent hernia should be considered separately from neuropathic and mesh-related pain syndromes because the treatment pathway is fundamentally different.

A Balanced Perspective

The Key Message

Surgery should generally be reserved for carefully selected patients in whom a clear pain generator has been identified. For many individuals, non-surgical treatments such as nerve blocks, pulsed radiofrequency and DRG-based interventions may provide meaningful improvement without the risks associated with further surgery. The most important factor is not whether surgery is performed, but whether the correct diagnosis has been established before treatment decisions are made.

Post-Hernia Surgery Pain: Practical Treatment Pathway

Key Principle

The pathway should be guided by diagnosis rather than by escalation alone. Neuropathic pain, mesh-related pain, recurrence, orchialgia, myofascial pain and central sensitisation each require different treatment strategies. The best outcomes are usually achieved when treatment is targeted to the dominant pain mechanism.

Dr Krishna’s Expert Perspective

Dr Murli Krishna is a Consultant in Pain Medicine with extensive experience in the assessment and treatment of chronic post-surgical pain syndromes. A significant proportion of his practice involves the management of complex neuropathic pain conditions where symptoms persist despite apparently successful surgery.

One of the most important aspects of managing post-hernia surgery pain is identifying the dominant pain generator. Not all pain after hernia surgery is caused by the mesh, and not all groin pain is neuropathic. Careful assessment is required to distinguish between nerve-related pain, mesh-related pain, recurrent hernia, orchialgia, abdominal wall pain and central sensitisation.

A particular area of expertise is the diagnosis and treatment of ilioinguinal, iliohypogastric and genitofemoral neuralgia. Using advanced ultrasound-guided techniques, it is often possible to identify the structures most likely to be contributing to symptoms and develop a targeted treatment plan.

The aim is always to achieve the greatest possible improvement using the least invasive treatment necessary. For many patients, careful diagnosis and precision-targeted interventions may provide significant relief without the need for further surgery.

Treatments Available at PainSpa

Is the pain real if my scans are normal?

Yes. Neuropathic pain, nerve entrapment and central sensitisation often cannot be seen on routine scans. Normal imaging does not mean the pain is imaginary or that there is no physical explanation for the symptoms.

Is the mesh causing my pain?

Not necessarily. Whilst mesh-related complications can occur, many patients with persistent pain actually have neuropathic pain involving the ilioinguinal, iliohypogastric or genitofemoral nerves. Careful assessment is required to determine the most likely cause.

Will I need surgery?

Most patients do not require further surgery. Many improve with a combination of medication, rehabilitation, nerve blocks, pulsed radiofrequency treatment and other targeted interventions. Surgery is usually reserved for carefully selected cases.

Can nerve blocks cure the pain?

Sometimes nerve blocks provide prolonged relief, but their most important role is often diagnostic. They help identify the nerve responsible for symptoms and can guide further treatment such as pulsed radiofrequency or DRG-based interventions.

Can pain start years after hernia surgery?

Yes. Whilst many patients develop symptoms soon after surgery, pain can occasionally emerge months or even years later due to nerve irritation, mesh contraction, scar-related changes or other delayed complications.

Can mesh be removed?

Yes, but only in selected circumstances. Mesh removal is usually considered when there is convincing evidence that the mesh is contributing to symptoms, such as meshoma formation, significant contraction, infection, migration or erosion.

What happens if injections do not work?

A poor response to injections can provide useful diagnostic information. It may suggest that the pain is not arising from the targeted nerve, that multiple pain mechanisms are present, or that further investigation is required. Alternative treatments may include different nerve targets, DRG interventions, medication optimisation, Botox for selected cases or surgical review where appropriate.

Can chronic post-hernia surgery pain improve even after several years?

Yes. Although longstanding pain can be more challenging to treat, meaningful improvement is often possible once the dominant pain mechanism has been identified and an appropriate treatment plan is implemented.

Does persistent pain mean the hernia has come back?

No. Recurrence is only one possible cause of pain after hernia surgery. Neuropathic pain, mesh-related problems, orchialgia, abdominal wall dysfunction and central sensitisation can all cause symptoms even when the hernia repair remains intact.

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