From the Research
Meralgia paresthetica is a condition that should be initially managed with conservative measures, including weight loss, avoiding tight clothing, and using NSAIDs like ibuprofen for pain relief, with surgical decompression considered only in severe cases that don't respond to conservative treatment after 3-6 months. The condition is caused by compression of the lateral femoral cutaneous nerve, resulting in numbness, tingling, and burning pain in the outer thigh. According to the most recent study 1, the diagnosis is based on the patient's description of sensory disturbance, often painful, on the anterolateral aspect of the thigh, with normal strength and reflexes.
Initial Management
Initial treatment focuses on conservative measures, including:
- Weight loss if applicable
- Avoiding tight clothing or belts
- Using NSAIDs like ibuprofen (400-600mg three times daily) for pain relief
- Physical therapy exercises that stretch the hip and thigh muscles to help reduce pressure on the nerve For moderate symptoms, topical lidocaine patches or capsaicin cream may provide relief when applied to the affected area, as suggested by 2.
Further Treatment
If these approaches fail, a corticosteroid injection near the nerve (typically methylprednisolone 40mg with lidocaine) might be considered, as mentioned in 3. However, the incidence of complete pain relief appears to be the greatest among the 3 interventions after neurectomy, accompanied by the lowest incidence of revision procedures, according to 3.
Surgical Intervention
In severe cases that don't respond to conservative treatment after 3-6 months, surgical decompression of the nerve may be necessary, as stated in 1. The condition often results from mechanical factors like obesity, pregnancy, or tight clothing compressing the nerve as it passes through the inguinal ligament. Most patients improve with conservative management within several weeks to months, though symptoms may recur if the underlying cause isn't addressed, as noted in 4.
Key Considerations
- The strength of evidence for treatment choices in meralgia paresthetica is weak, with more extensive studies needed regarding the long-term benefit of peripheral and spinal cord stimulation therapy, as mentioned in 4.
- Emerging data regarding the benefit of interventional pain procedures, including steroid injection and radiofrequency ablation, and other interventions including spinal cord and peripheral nerve stimulation reserved for refractory cases, are discussed in 4.