Chronic groin pain in hernia practice: diagnosis, mechanisms, and management.

backgroundChronic groin pain is an increasingly recognised and complex problem in contemporary hernia practice, presenting both as a primary clinical complaint and as a complication following inguinal hernia repair. Despite advances in operative techniques and mesh technology, chronic pain remains a leading cause of long-term patient dissatisfaction and reduced quality of life.Aim:To examine the evolving understanding of chronic groin pain, with particular emphasis on chronic postoperative inguinal pain (CPIP), and to explore its implications for hernia surgeons in terms of diagnosis and management.

methodsA narrative review of the current literature was undertaken, focusing on the pathophysiology, diagnostic challenges, and management strategies associated with chronic groin pain and CPIP.

resultsContemporary evidence indicates that chronic groin pain is multifactorial, arising from a complex interaction of musculoskeletal dysfunction, neuropathic injury, surgical factors, and central sensitisation. CPIP is increasingly recognised as a distinct pain syndrome rather than a simple consequence of technical failure. Diagnostic uncertainty, inconsistent terminology, and overreliance on imaging have contributed to variable outcomes and, in some cases, unnecessary surgical intervention. Conservative management, including structured physiotherapy, mechanism-specific pharmacotherapy, and targeted image-guided injections, forms the cornerstone of treatment. Early multidisciplinary involvement, particularly with pain specialists, enhances diagnostic precision and supports tailored management strategies.

conclusionChronic groin pain, particularly CPIP, requires a paradigm shift in management away from a purely surgical approach towards a comprehensive, multidisciplinary model. Surgical intervention should be reserved for carefully selected patients with well-defined inguinal-related pain and performed in specialist centres, with the primary goal of pain reduction rather than complete resolution. Future advances will depend on improved diagnostic stratification, validated pain phenotyping, and the development of integrated multidisciplinary care pathways. Chronic groin pain is an increasingly recognised and challenging problem in hernia practice, arising both as a primary presentation and as a complication following inguinal hernia repair. Despite advances in surgical technique and mesh technology, chronic pain remains a major determinant of long-term patient dissatisfaction and impaired quality of life. Contemporary evidence demonstrates that chronic groin pain is rarely attributable to a single anatomical abnormality and instead reflects a complex interplay of musculoskeletal dysfunction, neuropathic injury, surgical factors, and central pain sensitisation. This narrative review examines the implications of this evolving understanding for hernia surgeons, with particular emphasis on chronic postoperative inguinal pain (CPIP). Diagnostic uncertainty, inconsistent terminology, and overreliance on imaging have contributed to unnecessary surgical intervention and variable outcomes. CPIP is now recognised as a distinct pain syndrome rather than a technical failure, requiring a fundamentally different management paradigm. Conservative treatment, including structured physiotherapy, mechanism-specific pharmacotherapy, and targeted image-guided injections, remains the cornerstone of management and should be pursued comprehensively before surgery is considered. Early multidisciplinary involvement, particularly with pain specialists, is essential to improve diagnostic accuracy and guide treatment. Surgical intervention should be reserved for carefully selected patients with clearly defined inguinal-related pain and undertaken only in specialist centres, with the primary aim of pain reduction rather than guaranteed resolution. Future progress will depend less on further technical refinement and more on improved diagnostic stratification, validated pain phenotyping, and integrated multidisciplinary care pathways.