Treatment for chronic post-herniorrhaphy groin pain
There are no specific guidelines on the treatment of CPGP. The providers at the Denver Spine and Pain Institute specialize in both conservative treatment and advanced procedural interventions to treat CPGP. In fact, Dr. Trainor has done extensive research on CPGP during his residency and fellowship at the Mayo Clinic.
The general treatment approach taken is to start conservatively and work to more aggressive interventions if indicated. This includes:
- Anticonvulsants – gabapentin or pregabalin
- Tricyclic antidepressants – amitriptyline, nortriptyline, etc.
- Serotonin and norepinephrine reuptake inhibitors – duloxetine etc.
- Non-steroidal anti-inflammatories – ibuprofen, diclofenac, etc.
- Opioid-based medications – when appropriate
- These can complement the effects of the neuropathic pain medication
- Behavioral health
- This is an important component of the multi-modal treatment plan in any chronic pain condition
- Ilioinguinal/iliohypogastric nerve block
- Genitofemoral nerve block
- Peripheral field blocks (blocking an entire area without specifying one nerve)
- Dorsal root ganglion (DRG) spinal cord stimulation
- Tiny electrical leads are placed at the appropriate site along the spinal cord
- Energy is delivered via these leads to the DRG
- Pain signal transmission is effectively blocked at the DRG, so your brain doesn’t interpret pain
- Research has shown this to be an extremely effective treatment in cases of refractory CPGP