eMedicine Specialties > Physical Medicine and Rehabilitation > Lower Limb Musculoskeletal Conditions
Meralgia Paresthetica: Treatment & Medication
Updated: Mar 18, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
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Treatment
Rehabilitation Program
Physical Therapy
Meralgia paresthetica (MP) is treated with conservative therapy, such as physical therapy, weight reduction to reduce abdominal girth, heat application, and analgesics (see Medication). Patients should avoid wearing constrictive garments, belts, or braces that impart excessive focal pressure at the IL.5
Physical therapy may be recommended as an adjunct to analgesic medications for pain control in patients with MP. In addition to moist heat, other modalities that may be recommended by the physical therapist include transcutaneous electrical nerve stimulation, interferential current, or low-intensity phonophoresis. These modalities are used to help alleviate pain and enable the patient to perform gentle stretching exercises with greater ease. Soft-tissue techniques (eg, trigger point therapy) also may be beneficial for pain and tightness in the hip and thigh muscles. In addition, the physical therapist may instruct the patient in a general fitness program to assist with weight reduction, as well as proper biomechanics and postural reeducation.
Surgical Intervention
Patients failing conservative measures are referred to a surgeon for consideration of surgical decompression of the lateral femoral cutaneous nerve (LFCN).6,7 Successful predictors of excellent surgical results include positive Tinel sign, abnormal EMG, and immediate relief of symptoms following LFCN block. Although surgical transection of the LFCN has been performed for treatment, outcomes for this procedure have not been reported systematically, and some patients report worse dysesthesias.Other Treatment
Injection of lidocaine to block the lateral femoral cutaneous nerve (LFCN) at the IL results in only temporary relief of symptoms. This procedure is useful for exploring which patients may respond well to surgical manipulation of the LFCN, once conservative measures have been deemed inadequate and the patient complains of chronic discomfort.
- Improvement of symptoms also may occur with correction of leg length discrepancies. Use of shoe lifts or inserts may correct discrepancies sufficiently to minimize hip hyperextension on the affected side.
- Trigger point injections of the sartorius muscle may help to relieve symptoms.
- Steroid injections at the spinal or inguinal level may provide more chronic relief of symptoms.
Medication
Medications for treatment of meralgia paresthetica (MP) discomfort include nonsteroidal anti-inflammatory drugs (NSAIDs), narcotics, and other agents, such as amitriptyline, Neurontin, and Tegretol. In general, avoid prolonged use of NSAIDs and narcotics if possible.
A TCA or anticonvulsant is started at a low dosage and titrated upward until symptoms resolve or side effects dictate otherwise. These drugs are discontinued if there is no relief with maximal quantities. A common error is stopping the medication before serum levels reach therapeutic ranges.
Suggestions for initiating chemical treatment for MP follow. The treatment of neuropathic pain varies significantly among physicians. Consult the Physicians' Desk Reference (PDR) for more detailed drug information on the following agents.
Tricyclic antidepressants
Use for treatment of neuropathic symptoms; the exact mechanism is unknown.
Amitriptyline (Elavil)
Good medication for neuropathic pain, often discontinued because of somnolence and dry mouth.
Adult
10-25 mg PO qhs initially
Pediatric
Not established
Phenobarbital may decrease effects; coadministration with CYP2D6 enzyme system inhibitors (eg, cimetidine, quinidine) may increase levels; inhibits hypotensive effects of guanethidine; may interact with thyroid medications, alcohol, CNS depressants, barbiturates, and disulfiram
Documented hypersensitivity; patient has taken MAOIs in past 14 d; history of seizures, cardiac arrhythmias, glaucoma, and urinary retention
Pregnancy
C - Safety for use during pregnancy has not been established.
Precautions
Caution in cardiac conduction disturbances, history of hyperthyroidism, and renal or hepatic impairment; avoid using in elderly patients
Anticonvulsants
For treatment of neuropathic symptoms; the exact mechanism is unknown. These agents are used to manage severe muscle spasms and to provide sedation in neuralgia.
Carbamazepine (Tegretol)
Because of adverse side effects and risks associated with carbamazepine, this compound is initiated judiciously; prolonged use is monitored carefully.
Adult
100 mg PO bid initially
Pediatric
Not established
Serum levels may increase significantly within 30 days of danazol coadministration (avoid whenever possible); do not coadminister with MAOIs; cimetidine may increase toxicity especially if taken in first 4 wk of therapy; may decrease primidone and phenobarbital levels (their coadministration may increase carbamazepine levels)
Documented hypersensitivity; history of bone marrow depression; administration of MAOIs within last 14 d
Pregnancy
D - Unsafe in pregnancy
Precautions
Do not use to relieve minor aches or pains; caution with increased intraocular pressure; obtain CBC counts and serum-iron baseline prior to treatment, during first 2 months and yearly or every other year thereafter; can cause drowsiness, dizziness, and blurred vision; caution while driving or performing other tasks requiring alertness
Gabapentin (Neurontin)
Has anticonvulsant properties and antineuralgic effects; however, exact mechanism of action is unknown. Structurally related to GABA but does not interact with GABA receptors. Titration to effect can take place over several days (300 mg on day 1, 300 mg bid on day 2, and 300 mg tid on day 3). Well-tolerated and safe medication that essentially is excreted 100%.
Adult
300 mg PO qhs initially and increase to 300 mg tid over few d
Pediatric
Not established
Antacids may reduce bioavailability of gabapentin significantly (administer at least 2 h following antacids); may increase norethindrone levels significantly
Documented hypersensitivity
Pregnancy
C - Safety for use during pregnancy has not been established.
Precautions
Caution in severe renal disease
More on Meralgia Paresthetica |
| Overview: Meralgia Paresthetica |
| Differential Diagnoses & Workup: Meralgia Paresthetica |
 Treatment & Medication: Meralgia Paresthetica |
| Follow-up: Meralgia Paresthetica |
| Multimedia: Meralgia Paresthetica |
| References |
| Further Reading |
| « Previous Page | Next Page » |
References
Carai A, Fenu G, Sechi E, et al. Anatomical variability of the lateral femoral cutaneous nerve: findings from a surgical series. Clin Anat. Jan 27 2009;22(3):365-370. [Medline].
Otoshi K, Itoh Y, Tsujino A, et al. Case report: meralgia paresthetica in a baseball pitcher. Clin Orthop Relat Res. Sep 2008;466(9):2268-70. [Medline].
Schestatsky P, Llado-Carbo E, Casanova-Molla J, et al. Small fibre function in patients with meralgia paresthetica. Pain. Oct 15 2008;139(2):342-8. [Medline].
Knight RQ, Schwaegler P, Hanscom D, et al. Direct lateral lumbar interbody fusion for degenerative conditions: early complication profile. J Spinal Disord Tech. Feb 2009;22(1):34-7. [Medline].
Moucharafieh R, Wehbe J, Maalouf G. Meralgia paresthetica: a result of tight new trendy low cut trousers ('taille basse'). Int J Surg. Apr 2008;6(2):164-8. [Medline].
Alberti O, Wickboldt J, Becker R. Suprainguinal retroperitoneal approach for the successful surgical treatment of meralgia paresthetica. J Neurosurg. Oct 31 2008;[Medline].
van Eerten PV, Polder TW, Broere CA. Operative treatment of meralgia paresthetica: transection versus neurolysis. Neurosurgery. Jul 1995;37(1):63-5. [Medline].
Liveson JA, Ma DM. Lumbar plexus. In: Laboratory Reference for Clinical Neurophysiology. New York, NY: Oxford University Press; 1998:165-8.
Massey EW. Sensory mononeuropathies. Semin Neurol. 1998;18(2):177-83. [Medline].
Nahabedian MY, Dellon AL. Meralgia paresthetica: etiology, diagnosis, and outcome of surgical decompression. Ann Plast Surg. Dec 1995;35(6):590-4. [Medline].
Streiffer RH. Meralgia paresthetica. Am Fam Physician. Mar 1986;33(3):141-4. [Medline].
Travell JG, Simons DG. Tensor fasciae latae muscle and sartorius muscle. In: Myofascial Pain and Dysfunction: The Trigger Point Manual for the Lower Extremities. vol 2. Baltimore, Md: Williams & Wilkins; 1999:230-2.
Further Reading
Clinical guidelines:
EFNS guidelines on pharmacological treatment of neuropathic pain.
European Federation of Neurological Societies - Medical Specialty Society. 2006 Nov. 17 pages. NGC:005495
Clinical trials:
Effectiveness of Lumbar Facet Joint Nerve Blocks
Freedom Lumbar Disc in the Treatment of Lumbar Degenerative Disc Disease
Related eMedicine topics:
Meralgia Paresthetica [Neurology]
Meralgia Paresthetica [Orthopedic Surgery]
Nerve Entrapment Syndromes
Nerve Entrapment Syndromes of the Lower Extremity
Keywords
meralgia paresthetica, nerve entrapment, paresthesia, meralgia, dysesthesia, thigh pain, lateral femoral cutaneous nerve, Bernhardt-Roth syndrome, lateral femoral cutaneous neuropathy
