Chronic pain is one of the most significant long-term complications following inguinal hernia repair and has increasingly become a major outcome measure alongside recurrence rates. Chronic pain is generally defined as pain persisting for at least three months after surgery. It may range from mild discomfort to severe debilitating pain that adversely affects quality of life, daily activities, and employment. The etiology is multifactorial and includes neuropathic injury to the ilioinguinal, iliohypogastric, and genital branches of the genitofemoral nerves, mesh-related inflammation, fibrosis, mesh contraction, and periosteal injury. Risk factors include younger age, female sex, preoperative pain, severe early postoperative pain, recurrent hernia repair, and open mesh techniques. Diagnosis requires careful clinical assessment to identify neuropathic and non-neuropathic mechanisms. Management involves a stepwise approach ranging from pharmacological therapy and nerve blocks to neurectomy and mesh removal in selected cases. This review summarizes the incidence, risk factors, prevention, and treatment of Chronic pain following inguinal hernia repair in adults.