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Psychological disorders in patients with chronic postoperative inguinal pain

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Abstract

Purpose

Chronic postoperative inguinal pain (CPIP), a complication of inguinal hernia repair, may negatively affect mental health. The rates of psychological disorders in patients with CPIP are unknown. We aimed to describe the prevalence of psychological disorders coinciding with CPIP.

Methods

A retrospective chart review was performed of all patients seen at the Cleveland Clinic Center for Abdominal Core Health’s inter-disciplinary Chronic Groin Pain Clinic. This clinic is unique in that all patients are evaluated by a surgeon, a sonographer and radiologist, and a behavioral medicine psychologist. Patient psychological history and treatment, Depression Anxiety and Stress Scale (DASS) scores, pain catastrophizing, and trauma or abuse history were captured.

Results

From January 2018 to January 2022, 61 patients were evaluated and included in the study. Psychological treatment had been provided to 37 (61%) patients (present: 16 (27%), past: 21 (35%)). The most common psychological disorders represented were depression (N = 13, 22%), anxiety (N = 10, 17%), and post-traumatic stress disorder (N = 5, 8%). DASS scores indicated that 20 (33%) patients were reporting symptoms of depression and 16 (27%) patients were reporting symptoms of anxiety. Of the 40 patients assessed for pain catastrophizing, 28 (70%) reported rumination, 9 (23%) reported magnification, and 23 (58%) reported feelings of helplessness. A childhood history of emotional or physical abuse was reported by 11 (18%) patients.

Conclusion

An inter-disciplinary groin pain clinic has revealed that patients with CPIP frequently have pre-existing complex psychosocial issues. A multi-specialty approach to CPIP may improve preoperative assessments and identify patients who may benefit from further psychological evaluation and treatment.

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References

  1. Nguyen DK, Amid PK, Chen DC (2016) Groin pain after inguinal hernia repair. Adv Surg 50(1):203–220. https://doi.org/10.1016/j.yasu.2016.04.003

    Article  PubMed  Google Scholar 

  2. Kehlet H, Jensen TS, Woolf CJ (2006) Persistent postsurgical pain: risk factors and prevention. Lancet 367(9522):1618–1625. https://doi.org/10.1016/S0140-6736(06)68700-X

    Article  PubMed  Google Scholar 

  3. Fafaj A, Tastaldi L, Alkhatib H, Zolin S, Alaedeen D, Petro C, Prabhu AS, Rosenblatt S, Rosen MJ, Krpata DM (2020) Surgical treatment for chronic postoperative inguinal pain—short term outcomes of a specialized center. Am J Surg 219(3):425–428. https://doi.org/10.1016/j.amjsurg.2019.10.020

    Article  PubMed  Google Scholar 

  4. Kalliomaki ML, Sandblom G, Gunnarsson U, Gordh T (2009) Persistent pain after groin hernia surgery: a qualitative analysis of pain and its consequences for quality of life. Acta Anaesthesiol Scand 53(2):236–246. https://doi.org/10.1111/j.1399-6576.2008.01840.x

    Article  PubMed  Google Scholar 

  5. Fine PG (2011) Long-term consequences of chronic pain: mounting evidence for pain as a neurological disease and parallels with other chronic disease states. Pain Med 12(7):996–1004. https://doi.org/10.1111/j.1526-4637.2011.01187.x

    Article  PubMed  Google Scholar 

  6. Dobscha SK, Corson K, Perrin NA, Hanson GC, Leibowitz RQ, Doak MN, Dickinson KC, Sullivan MD, Gerrity MS (2009) Collaborative care for chronic pain in primary care: a cluster randomized trial. JAMA 301(12):1242–1252. https://doi.org/10.1001/jama.2009.377

    Article  CAS  PubMed  Google Scholar 

  7. Courtney CA, Duffy K, Serpell MG, O’Dwyer PJ (2002) Outcome of patients with severe chronic pain following repair of groin hernia. Br J Surg 89(10):1310–1314. https://doi.org/10.1046/j.1365-2168.2002.02206.x

    Article  CAS  PubMed  Google Scholar 

  8. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association, Washington

    Book  Google Scholar 

  9. Henry JD, Crawford JR (2005) The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol 44(2):227–239. https://doi.org/10.1348/014466505X29657

    Article  PubMed  Google Scholar 

  10. Pollard CA (1984) Preliminary validity study of the pain disability index. Percept Mot Skills 59(3):974. https://doi.org/10.2466/pms.1984.59.3.974

    Article  CAS  PubMed  Google Scholar 

  11. Pain disability index. https://www.med.umich.edu/1info/FHP/practiceguides/pain/detpdi.pdf Accessed 15 April 2022

  12. Sullivan MJL (1995) The pain catastrophizing scale: user manual. https://aspecthealth.ca/wp-content/uploads/2017/03/PCSManual_English1.pdf Accessed 15 April 2022

  13. Darnall BD, Sturgeon JA, Cook KF, Taub CJ, Roy A, Burns JW, Sullivan M, Mackey SC (2017) Development and validation of a daily pain catastrophizing scale. J Pain 18(9):1139–1149. https://doi.org/10.1016/j.jpain.2017.05.003

    Article  PubMed  PubMed Central  Google Scholar 

  14. Terlizzi EP, Zablotsky B (2019) Mental health treatment among adults: United States, 2019. NCHC Brief no. 380, September 2020. https://www.cdc.gov/nchs/products/databriefs/db380.htm#:~:text=Interview%20Survey%2C%202019.-,Summary,from%20a%20mental%20health%20professional Accessed 30 Mar 2022

  15. Major depression. National institute of mental health. https://www.nimh.nih.gov/health/statistics/major-depression Accessed 30 Mar 2022

  16. Any anxiety disorder. National institute of mental health. https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder#part_2579 Accessed 30 Mar 2022

  17. Villarroel MA, Terlizzi EP (2019) Symptoms of depression among adults: United States, 2019. Centers for disease control and prevention. https://www.cdc.gov/nchs/products/databriefs/db379.htm Accessed 30 Mar 2022

  18. Terlizzi EP, Villarroel MA (2019) Symptoms of generalized anxiety disorder among adults: United States, 2019. Centers for disease control and prevention. https://www.cdc.gov/nchs/products/databriefs/db378.htm Accessed 30 Mar 2022

  19. Kind S, Otis JD (2019) The interaction between chronic pain and PTSD. Curr Pain Headache Rep 28(23):91. https://doi.org/10.1007/s11916-019-0828-3

    Article  Google Scholar 

  20. Post-traumatic stress disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/post-traumatic-stress-disorder-ptsd Accessed 30 Mar 2022

  21. Siqveland J, Hussain A, Lindstrøm JC, Ruud T, Hauff E (2017) Prevalence of posttraumatic stress disorder in persons with chronic pain: a meta-analysis. Front Psychiatry 8:1–8. https://doi.org/10.3389/fpsyt.2017.00164

    Article  Google Scholar 

  22. Lampe A, Doering S, Rumpold G, Solder E, Krismer M, Kantner-Rumplmair W, Schubert C, Sollner W (2003) Chronic pain syndromes and their relation to childhood abuse and stressful life events. J Psychosom Res 54(4):361–367. https://doi.org/10.1016/S0022-3999(02)00399-9

    Article  PubMed  Google Scholar 

  23. Wildeman C, Emanuel N, Leventhal JM, Putnam-Hornstein E, Waldfogel J, Lee H (2014) The prevalence of confirmed maltreatment among US children, 2004 to 2011. JAMA Pediatr 168(8):706–713. https://doi.org/10.1001/jamapediatrics.2014.410

    Article  PubMed  PubMed Central  Google Scholar 

  24. Leung L (2012) Pain catastrophizing: an updated review. Indian J Psychol Med 34(3):204–217. https://doi.org/10.4103/0253-7176.106012

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kneeland ET, Griffin ML, Taghian N, Weiss RD, McHugh RK (2019) Associations between pain catastrophizing and clinical characteristics in adults with substance use disorders and co-occurring chronic pain. Am J Drug Alcohol Abuse 45(5):488–494. https://doi.org/10.1080/00952990.2019.1581793

    Article  PubMed  Google Scholar 

  26. Sansone RA, Sansone LA (2012) Rumination. Innov Clin Neurosci 9(2):29–34

    PubMed  PubMed Central  Google Scholar 

  27. Staal E, Nienhuijs SW, Keemers-Gels ME, Rosman C, Strobbe LJA (2008) The impact of pain on daily activities following open mesh inguinal hernia repair. Hernia 12:153–157. https://doi.org/10.1007/s10029-007-0297-1

    Article  CAS  PubMed  Google Scholar 

  28. Rusu AC, Santos R, Pincus T (2016) Pain-related distress and clinical depression in chronic pain: a comparison between two measures. Scand J Pain 12:62–67. https://doi.org/10.1016/j.sjpain.2016.04.001

    Article  PubMed  Google Scholar 

  29. Arnow BA, Blasey CM, Constantino MJ, Robinson R, Hunkeler E, Lee J, Fireman B, Khaylis A, Feiner L, Hayward C (2011) Catastrophizing, depression, and pain-related disability. Gen Hosp Psychiatry 33(2):150–156. https://doi.org/10.1016/j.genhosppsych.2010.12.008

    Article  PubMed  Google Scholar 

  30. Kaye AD, Kandregula S, Kosty J, Sin A, Guthikonda B, Ghali GE, Craig MK, Pham AD, Reed DS, Gennuso SA, Reynolds RM, Ehrhardt KP, Cornett EM, Urman RD (2020) Chronic pain and substance use disorders: preoperative assessment and strategies. Best Pract Res Anaesthesiol 34(2):255–267. https://doi.org/10.1016/j.bpa.2020.04.014

    Article  Google Scholar 

  31. Key substance use and mental health indicators in the United States: results from the 2019 National survey on drug use and health. https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR090120.htm Accessed 1 April 2022

  32. Grant BF, Saha TD, Ruan WJ, Goldstein RB, Chaou SP, Jung J, Zhang H, Smith SM, Pickering RP, Huang B, Hasin DS (2016) Epidemiology of DSM-5 drug use disorder: results from the national epidemiological survey on alcohol and related conditions-III. JAMA Psychiat 73(1):39–47. https://doi.org/10.1001/jamapsychiatry.2015.2132

    Article  Google Scholar 

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Authors and Affiliations

  1. Cleveland Clinic Center for Abdominal Core Health, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA

    B. T. Miller, C. C. Petro, L. R. A. Beffa, A. S. Prabhu, M. J. Rosen & D. M. Krpata

  2. Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    J. Scheman

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  3. C. C. Petro
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  4. L. R. A. Beffa
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  5. A. S. Prabhu
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  7. D. M. Krpata
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Contributions

BTM contributed to study design, data acquisition and interpretation, manuscript writing, and final approval. JS, CCP, LRAB, ASP, MJR, and DMK contributed to study design, data interpretation, manuscript revision, and final approval.

Corresponding author

Correspondence to B. T. Miller.

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Conflict of interest

Dr. Ajita S. Prabhu is a consultant for Verb Surgical and CMR Surgical. She has also been a speaker for and has received grant support from Intuitive Surgical. Dr. Michael J. Rosen receives salary support as medical director of the Abdominal Core Health Quality Collaborative and is a board member of Ariste Medical with stock options. Drs. Benjamin T. Miller, Judith Scheman, Clayton C. Petro, Lucas R. A. Beffa, and David M. Krpata have no conflicts of interest or financial ties to disclose.

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The Cleveland Clinic Foundation Institutional Review Board reviewed and approved this study.

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Miller, B.T., Scheman, J., Petro, C.C. et al. Psychological disorders in patients with chronic postoperative inguinal pain. Hernia 27, 35–40 (2023). https://doi.org/10.1007/s10029-022-02662-2

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  • DOI: https://doi.org/10.1007/s10029-022-02662-2

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