Phenotyping of isolated mesh associated pain secondary to continence mesh device insertion

Introduction Isolated Mesh associated Pain Syndrome (I-MAPS) is the most common complication of continence mesh devices. The pain mechanism involved remains unknown. The aim of this study is to characterise the phenotype of women with I-MAPS related to a single continence device and to determine the pain mechanisms involved. These findings are intended to support better understanding of the management of I-MAPS. Study design and methods A cross-sectional study set within a quaternary-level mesh complications service. All women with I-MAPS related to a single continence device were included. Pain phenotype was determined using pain body-mapping, the Pain DETECT questionnaire (PDQ), and the Electronic Patient Assessment Questionnaire (e PAQ) to measure vagina and bladder pain. Quality of Life (QOL) and mental wellbeing were ascertained using the EuroQol group-5 Dimension (EQ5D) and WHO-5 wellbeing index. Results Over 5-years, 280 women presented with I-MAPS. Subjects reported high levels of pre-existing pain-inducing conditions ( n = 146/280 52%). Body-mapping of pain identified localised pain suggestive of nociceptive pain and neuro-anatomically distributed pain consistent with neuropathic pain. Two percent ( n = 5/280) of patients reported distant pain suggestive of a nociplastic component. PDQ identified the largest patient group had neuropathic mediated pain ( n = 78/142 55%). Twenty-two percent ( n = 31/142) had nociceptive pain and the remaining 23% ( n = 33/142) exhibited pain of mixed origin. Trans-obturator (TOT) devices were associated with a significantly higher mean PDQ score of 20 compared to a mean of 17 in retropubic devices ( p = 0.04). There was a reported, “moderate” impact in ability to perform usual activities of daily living and “moderate” rates of anxiety and depression across the study group. Poor physical and mental well-being scores were reported in patients with I-MAPS of 53/100 and 28/100 respectively. Conclusion I-MAPS appears to be of neuropathic phenotype with evidence of mixed origin. Nociplastic features were identified including functional disability and reduced mood and QOL. These exemplify the multidimensional impact and burden of chronic pain.