Table 1 Components of pain associated with pelvic mesh implants illustrated by examples from published qualitative research and reviews
Reference and study type (organised alphabetically by first-author surname) | Components of pain associated with pelvic mesh implants | |||||
|---|---|---|---|---|---|---|
Timing (Onset/duration/ Frequency) | Intensity | Location | Phenomenological qualities | Impact/interference | Patient expectations/beliefs | |
Brown [27]—Qualitative | “When I was discharged I was still in the same amount of pain” “…the acute and chronic pain and the disabilities that I now live with” | “I am not sure how much more my body and spirit can take” | “It felt like when I was walking it would feel like I had barbed wire in me rubbing…” | Emotional: “I am not suicidal as such—I just don’t have the courage to do that—but I would rather no longer be here.” “In my darkest times I have thought about ending my life” QOL: “All of the things I could do are off the table now” “I feel it is the grief of losing my ‘pre-mesh’ life that brings me down the most” Relationships: “The problems caused by mesh for me has almost felt like a life sentence of home detention, it has been so isolating.” | “I did not need all of that surgery, I did not, probably did not need the mesh put in, there was other alternatives that he [my surgeon] never even offered me.” “It is not the life I envisioned for myself before I had the surgery. When the mesh was removed I had hoped there would be a big improvement, that my life would change, but it didn’t happen.” | |
Cadish et al. [28]—mixed methods | Postoperative onset pain highly prevalent at 2 weeks but decreased dramatically at 6 weeks | Mostly patients with pain reported that it was mild in severity. A minority reported severe postoperative-onset pain | Hip, leg, groin, incision site. A large proportion reported pain at more than one site | |||
Dunn et al. [29]—Qualitative | "I hurt all the time, all day, every day. I have not woken up pain-free since the surgery.” | “Like being ripped apart from the inside” | Physical/QOL: "It has destroyed my life. I cannot drive, I cannot travel, I cannot watch movies, I cannot wear heels; I can't drive my car because it's painful. My life has totally changed." Emotional: "I hope the pain and ache goes away, but I'm told it will likely not, which is depressing but not surprising." Sexual/relationships: "It took a big toll on my marriage as we were unable to be intimate for a year and a half.” QOL: "I've used up all of my sick pay and much of vacation." | ‘‘He [the original surgeon] was irresponsible, he did not explain to me any consequences, he was dishonest, he said the surgery would be easy for me, I was so much worse.’’ ‘‘I wish I had never had it done. The doctor who placed it was supposed to be a good doctor, but it really messed things up and made my life miserable for a while.” ‘‘I was thinking she’d be able to take all the mesh out, but I wonder if the remaining piece is where the pain is. [I’m] still worried about remaining mesh.’’ “The mesh is balled up and I think it affects my bowel movements.” | ||
Izett-Kay et al. [30] —Qualitative | “I am in pain every day since the operation” “I experienced a great deal of pain immediately after my op and my recovery took much longer than suggested” | “Lower back pain and heaviness in the vaginal area” A variety of codes for anatomical locations | “Heaviness” | Physical: “I don’t undertake heavy lifting now” | “I feel that [my pain] is because of the mesh but visits to a doctor and consultant have not confirmed, but not diagnosed anything else.” “What research was carried out on this vaginal mesh?” “I experienced a great deal of pain immediately after my op and my recovery took much longer than suggested so I think expectations should be adjusted” | |
Lee et al. [22]—Theory/review | Assessment should include duration of pain | Assessment should include severity of pain “Oftentimes the patient’s pain may be so severe that a detailed pelvic examination is impossible.” | Assessment should include location of pain and site of radiation Typically located in pelvic region, vaginal, or buttocks | Assessment should include nature and quality of pain | Sex/relationship: Dyspareunia Physical/QOL: Assessment should include aggravating and relieving factors | |
Roos et al. [31]—Mixed methods | Vaginal | “[During sexual penetration] it seems that there is an ending, whereas before there didn't seem to be. You seem to hit something. (…) And the feeling that it was going to break, does that make sense? It feels as if it was, it was stretching.” | Sex/relationships: “Sometimes it makes you not want to do it. If you, if you can feel that it's prolapsed any way during the course of the day, and if I can feel that it's hanging right down, yeah you do feel that you don't want to do it sometimes, you just can't be bothered, because you know that it's already uncomfortable, so all that's going do is make it worse.” | “Because, you know, I was told that it would be quite tight to start with. Why don't I feel that it is? (…) I suppose I was expecting things to be a bit tighter than they are.” | ||
Toozs-Hobson et al. [24]—Theory/review | Patterns of pain: Immediate onset Delayed Presentation (6 weeks to 3 months after surgery) Longer term delayed presentation (> 6 months after surgery) Late presentation (years after mesh insertion) | |||||
Uberoi et al. [32]—Qualitative | “Just unbelievable pain” | Pelvic | QOL: “It stops your life, you're in pain, you're stopped” Physical: “It hurts to sit here” | “Nothing was mentioned about being in pain” | ||