Pain from primary inguinal hernia and the effect of repair on pain

Background: No previous study has attempted to quantify pain from a primary inguinal hernia. The aim of this study was to quantify patients' pain from inguinal hernia at rest and on moving, and to assess the effect of hernia repair on the pain. Methods: Linear analogue pain scores at rest and on moving were recorded before operation and at 1 year after surgery in a consecutive series of patients undergoing elective repair of a primary inguinal hernia. Results: During the study period 323 patients underwent inguinal hernia repair. Eighty-six patients (26.6 per cent) recorded no pain at rest from the hernia, and 174 (53.9 per cent) had mild pain only (score less than 10). On moving, 53 patients (16.4 per cent) had no pain and 137 (42.4 per cent) had mild pain on moving. Only 1.5 per cent experienced severe pain (score greater than 50) at rest, and 10.2 per cent had severe pain on moving. There was no association between pain and hernia type, direct or indirect, or patient occupation. One year after operation only 24.5 per cent of patients had no pain from the hernia repair site at rest, and 21.6 per cent had no pain from the site on moving. Overall there was a significant reduction in pain score at rest (mean(s.e.m.) decrease from baseline - 2.9(1.2), P = 0.019) and on moving (- 9.2(1.8), P = 0.001) compared with preoperative values, and this was due mainly to the large effect observed in patients with high preoperative values. Patients who had no pain at rest before operation had significant pain scores at rest at 1 year (P = 0.001). Conclusion: Clinical trials are required to evaluate hernia repair in patients with an asymptomatic inguinal hernia. Results from such trials should help to determine whether repair is the treatment of choice for these patients.