From the Guidelines
Meralgia paresthetica is primarily treated with conservative measures, including eliminating pressure on the lateral femoral cutaneous nerve and using over-the-counter pain relievers, with gabapentin being a potential prescription option for more severe symptoms. When considering treatment options, it's essential to prioritize approaches that minimize morbidity, mortality, and improve quality of life. Although the provided evidence [ 1 ] focuses on erythromelalgia, we can infer some relevant treatment strategies for meralgia paresthetica, given the overlap in symptom management for neuropathic conditions. Key considerations for managing meralgia paresthetica include:
- Eliminating pressure on the lateral femoral cutaneous nerve by avoiding tight clothing, losing weight if needed, and modifying activities that compress the nerve.
- Using over-the-counter pain relievers like ibuprofen or acetaminophen to manage discomfort.
- For more severe symptoms, prescription medications such as gabapentin, starting at a low dose (e.g., 300mg daily) and gradually increasing as needed and tolerated, can be beneficial [ 1 ].
- Physical therapy focusing on gentle stretching and strengthening exercises can also be beneficial.
- If conservative treatments fail, other options like corticosteroid injections or, in rare cases, surgical interventions may be considered, prioritizing the least invasive approaches first to minimize risk and maximize quality of life.
From the Research
Treatment Options for Meralgia Paresthetica
- Conservative measures such as weight loss and eliminating tight-fitted clothing are considered first-line treatment for meralgia paresthetica 2
- Neuropathic pain medications and corticosteroid injections are also treatment options for some patients with significant pain complaints 2, 3
- Surgical intervention, including neurolysis (decompression and transposition) and neurectomy procedures, can be considered in more refractory cases 4, 3
- Peripheral nerve stimulation has been shown to be a helpful treatment modality for patients with refractory meralgia paresthetica 2, 5
- Spinal cord stimulation therapy is also being considered as a treatment option for refractory cases 5
Efficacy of Treatment Options
- High quality observational studies report comparable high improvement rates for meralgia paresthetica following local injection of corticosteroid and surgical interventions (either nerve decompression or neurectomy) 6
- A single natural history study reported spontaneous improvement of meralgia paresthetica in 69% of cases 6
- Nonoperative management usually results in satisfactory results, but efforts should be made to avoid injury at the time of surgery 3
Emerging Trends in Treatment
- Emerging data regarding the benefit of interventional pain procedures, including steroid injection and radiofrequency ablation, are being reported 5
- Peripheral and spinal cord stimulation therapy are being considered as treatment options for refractory cases, but more extensive studies are needed to determine their long-term benefit 5