A new study has found evidence that mesh-related injury may trigger central sensitisation, a biological process linked to widespread, persistent pain.

Researchers studying 280 women with isolated mesh-associated pain found that more than half (52%) had co-existing conditions including fibromyalgia, chronic back pain and irritable bowel syndrome.

The study was conducted by the Manchester Mesh Complications Specialist Service.

The authors suggest that, in some women, nerve injury caused by mesh may contribute to central sensitisation, a process already associated with conditions such as fibromyalgia, endometriosis and interstitial cystitis.

As patient advocates, who have spent more than a decade listening to mesh-injured women, one message stands out from this study – fibromyalgia is a big part of the mesh story.

For years, women reporting both mesh complications and fibromyalgia have been told that the two conditions are unrelated. However, this study tells a more complex story. While the authors stop short of claiming causation, their findings suggest the potential link can no longer be ignored and call for further research and scientific attention.

Fibromyalgia is frequently discussed within our Sling The Mesh community. In our most recent survey 39% of respondents reported having a fibromyalgia diagnosis. We believe the true figure may be much higher. Many women describe widespread pain consistent with fibromyalgia, but have never received a formal diagnosis and therefore do not appear in these statistics.

The Study: Women Treated at Manchester Mesh Complications Specialist Service

The study included all women with Isolated Mesh Associated Pain Syndrome (I-MAPS) related to a TVT or TVTO mesh sling who presented to the Manchester Mesh Complications Service between January 2018 and April 2024. Women with prolapse mesh, multiple mesh implants, or other mesh complications were excluded.

The research reported three different types of pain from pelvic mesh related jury: 

• Pain from tissue damage
• Pain from nerve injury
• Widespread systemic pain. Over half of women (52%) reported conditions such as fibromyalgia, chronic back pain and Irritable Bowel Syndrome (IBS).

The study found that patients with I-MAPs may have pre-existing Chronic Overlapping Pain Conditions (COPC) and therefore experience widespread painful and multi-symptom disorders. These individual conditions may have been diagnosed in isolation without consideration for their systemic and interrelated nature. Another possibility is that chronic pain secondary to peripheral nerve injury by mesh implantation may have provoked a central pain syndrome through hyperexcitablility of the central nervous system resulting in Central Sensitization

The strength of the study includes the large study size of 280 patients. This is likely to be one of the largest single centre groups of of women with I-MAPS. This means findings are more likely to be representative of this patient group. Other strengths include the use of validated questionnaires to assess pain and non-pain symptoms. It is the first published study to explore pain mechanisms involved in I-MAPS.