What is the treatment for meralgia paresthetica?

Treatment of Meralgia Paresthetica

The treatment of meralgia paresthetica should follow a stepwise approach, beginning with conservative management and progressing to interventional treatments only when conservative measures fail. 1

Conservative Management (First-Line)

• Weight loss and avoidance of tight clothing should be recommended for all patients to reduce compression on the lateral femoral cutaneous nerve (LFCN) 1, 2
• Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective first-line pharmacologic treatment to reduce inflammation around the nerve 3, 2
• Local analgesics can provide temporary relief of symptoms 3
• Activity modification including avoiding positions that exacerbate symptoms and reducing activities that compress the nerve 2
• Conservative measures should be tried for at least 4-6 weeks before considering more invasive options 3

Interventional Management (Second-Line)

• Local corticosteroid injections around the LFCN at the anterior superior iliac spine can provide significant symptom relief when conservative measures fail 3, 2
• Diagnostic nerve blocks with local anesthetic can both confirm the diagnosis and provide temporary relief 2
• Pulsed radiofrequency neuromodulation of the LFCN may be considered for patients who have failed conservative management but are not candidates for surgery 4

Surgical Management (Third-Line)

Surgical intervention should be considered only when conservative and interventional treatments have failed after an adequate trial period (typically 3-6 months) 5, 3

Two main surgical approaches are available:

• Decompression/neurolysis - This approach preserves the nerve and is considered the primary surgical procedure of choice 5

  • Advantages: Preserves sensation in the distribution of the LFCN
  • Results in significant pain reduction (average 6.6 points on numeric rating scale) 5
  • High patient satisfaction rates (86% reporting complete satisfaction) 5

• Neurectomy/avulsion - Complete transection of the nerve 3

  • Advantages: May provide more definitive relief for intractable cases
  • Disadvantages: Results in permanent numbness in the distribution of the nerve 2

Treatment Algorithm

1. Initial conservative management (4-6 weeks):

   • Weight loss if applicable
   • Avoidance of tight clothing
   • NSAIDs
   • Activity modification 3, 2

2. If symptoms persist:

   • Local corticosteroid injection at the LFCN 2
   • Consider repeat injection if partial relief is achieved 3

3. For refractory cases:

   • Consider pulsed radiofrequency neuromodulation 4
   • If symptoms remain intractable, consider surgical consultation 5

4. Surgical options:

   • Decompression/neurolysis as the preferred first surgical approach 5
   • Consider neurectomy only if neurolysis fails or is contraindicated 3

Special Considerations

• Iatrogenic meralgia paresthetica (resulting from surgical procedures like anterior iliac-crest bone-graft harvesting) may respond differently to treatment and should be evaluated carefully 2
• Morbidly obese patients may have lower success rates with conservative management and might require more aggressive intervention 4
• Patients with previous spine surgeries should be carefully evaluated to rule out other causes of anterolateral thigh pain 4