Treatment algorithm for inguinal pain following herniorrhaphy or pfannenstiel incision, Integrative Pain Centers of Arizona

              Initial Evaluate and treat:

              General surgery:

·       Evaluate for recurrent hernia, ultrasound, CT scan, MRI as needed.

·       Evaluate for entrapment of the nerve within mesh screw, repair as needed

              Rule out urological problems, neurology consult as needed.

              Probable inguinal neuralgia, if the above are negative

              Trial of peripheral nerve blocks, this is sometimes curative.

              Include medications, especially at night if pain is preventing the patient

              from sleeping.

·       Antineuralgic medications such as gabapentin TCA

·       Opioid medication as needed

              If no better, evaluate for nerve resection and proximal embedment.

              If no better, trial of peripheral nerve stimulation.

              Long-term potent opioid as last resort.