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General Surgery
 General surgeons see several patients with chronic pain mimicking chronic diverticulitis, prostatitis, and epididymoorchitis. Patients may also present with post- inguinal herniorrhaphy pain or simply idiopathic pain.
Among females, upon detailed questioning, nearly 70% have dyspareunia, some have rectal pain, some have bladder symptoms, and some have gluteal and coccygeal pain. All of these symptoms suggest pelvic pathology. Another interesting subset that the general surgeon sees is patients with undiagnosed rectal pain, pain over ischial tuberosities (sitting bones), and coccygeal pain (coccydynia). Surgeons may also see patients with non-bacterial prostatitis and interstitial cystitis. Another commonly discussed topic among general surgeons is groin pain following repair of groin hernias. Typically, after the initial incisional pain subsides, usually within 2-3 weeks depending on the techniques used, there is a short pain-free interval of 1 to 4 weeks. The pain of POPSS syndrome starts 4-6 weeks postoperatively.
Rutkow noticed chronic groin pain in 102 patients out of 1,442 groin surgeries he performed over 3 years. More importantly he observed that 99 out of 102 patients had pain in the groin prior to herniorrhaphy. The majority of these patients continue to have persisting groin pain after the surgery. Our observations have been similar, and we feel that pain in the groin associated with clinically documented groin hernia is usually due to enthesopathy and, in fact, we give steroid injections during the repair and also administer one or 2 additional injections, 2 weeks apart, during the postoperative follow-up.
Rutkow discounts nerve entrapment theory on the grounds that 99 of 102 post hernia groin pain patients had preoperative pain in the groin. In our series, all patients with post-operative groin pain were treated as enthesopathy/periosteitis with steroid injections, and we had excellent to good results in 89% of the patients. (See Fitzgibbon article in “References” for details.)
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