[Meralgia paraesthetica - Pain Management].

Abstract

Meralgia paraesthetica (MP) is a mononeuropathy of the lateral femoral cutaneous nerve (LFCN), typically caused by compression at the level of the inguinal ligament. The syndrome presents with burning pain, paraesthesia, and hypaesthesia in the anterolateral thigh, without motor deficits. The LFCN, derived from the L2-L3 spinal nerves, is vulnerable to compression or traction due to its anatomical course under the inguinal ligament. MP may result from both traumatic (e.g., surgery, injury) and non-traumatic causes (e.g., obesity, pregnancy, tight clothing). In some cases, the etiology remains unknown. Diagnosis is primarily clinical and based on patient history and physical examination. Imaging techniques and electroneurography can support diagnostic confirmation in unclear cases. If symptoms extend beyond the typical LFCN territory, are bilateral, or are accompanied by motor or reflex abnormalities, differential diagnoses - including radiculopathy, involvement of adjacent nerves, or anatomical variations of the LFCN - should be considered. Initial treatment is conservative and includes patient education, avoidance of precipitating factors, pharmacological pain management (NSAIDs, opioids, co-analgesics), and physiotherapy. Diagnostic and therapeutic nerve blocks using local anesthetics can provide symptom relief and aid diagnosis. Non-invasive adjunct therapies such as transcutaneous electrical nerve stimulation (TENS), Botulinum toxin A injections, acupuncture, and kinesio taping may offer additional pain relief in selected patients. In refractory cases, minimally invasive procedures including radiofrequency therapy or surgical decompression of the LFCN may be considered.