Meralgia Paresthetica Review: Update on Presentation, Pathophysiology, and Treatment

Purpose of Review
Meralgia paresthetica (MP) is a condition characterized by paresthesias, neuropathic pain, and alterations in sensorium of the anterolateral thigh secondary to impingement of the lateral femoral cutaneous nerve (LFCN). MP is generally diagnosed by clinical history and is often a diagnosis of exclusion. When diagnosis remains a challenge, diagnostic modalities such as ultrasound, MRI, electromyography, and nerve conduction studies have been utilized as an adjunct. This review summarizes the most recent medical literature regarding MP, its pathophysiology, presentation, and current treatment options.
Recent Findings
Treatment options for patients with MP range from lifestyle modifications and conservative management to surgical procedures. Initial management is often conservative with symptoms managed with medications. When conservative management fails, the next step is regional blocks followed by surgical management. The conflicting data for treatment options for MP highlight how the evidence available does not point to a single approach that’s universally effective for treating all patients with MP.
Summary
Despite the apparent success at treating MP with regional blocks and surgical interventions, much remains to be known about the dosing, frequency, and optimal interventions due to the inconclusive results of current studies. Further research including randomized controlled trials are needed to better understand the most optimal treatment options for MP including studies with a larger number of participants.
1. Ivins GK. Meralgia Paresthetica, The Elusive Diagnosis: Clinical Experience With 14 Adult Patients. Ann Surg. 2000;232(2):281-286. doi:10.1097/00000658-200008000-00019
2. Kitchen C, Simpson J. MERALGIA PARESTHETIGA A REVIEW OF 67 PATIENTS. Acta Neurol Scandinav. 1972;48(5):547-555. doi:10.1111/j.1600-0404.1972.tb07575.x
3. Choi MH, Park H, Eom YI, Joo IS. Clinical and Electrophysiological Characteristics of Meralgia Paresthetica. Korean Journal of Community Nutrition. 2013;15:48-52.
4. Cheatham SW, Kolber MJ, Salamh PA. MERALGIA PARESTHETICA: A REVIEW OF THE LITERATURE. Int J Sports Phys Ther. 2013;8:883.
5. Glasović DM, Šlaus N, Šitum M, Pećina M. Review Article RAD 547. Medical Sciences. 2021;547:54-55.
6. Khalil N, Nicotra A, Rakowicz W. Treatment for meralgia paraesthetica. Cochrane Database Syst Rev. 2012;2012.
7. Glasović DM, Šlaus N, Šitum M, Pećina M. Review Article RAD 547. Medical Sciences. 2021;547:54-55.
8. Yoshida S, Oya S, Matsui T. Risk factors of meralgia paresthetica after prone position surgery: Possible influence of operating position, laminectomy level, and preoperative thoracic kyphosis. Journal of Clinical Neuroscience. 2021;89:292-296. doi:10.1016/j.jocn.2021.05.022
9. Patijn J, Mekhail N, Hayek S, Lataster A, van Kleef M, Van Zundert J. Meralgia Paresthetica. Pain Pract. 2011;11(3):302-308. doi:10.1111/j.1533-2500.2011.00458.x
10. Harney D, Patijn J. Meralgia paresthetica: Diagnosis and management strategies. Pain Med. 2007;8(8):669-677. doi:10.1111/j.1526-4637.2006.00227.x
11. Cheatham SW, Kolber MJ, Salamh PA. MERALGIA PARESTHETICA: A REVIEW OF THE LITERATURE. Int J Sports Phys Ther. 2013;8:883.
12. Shi X, Liu F, Liu F, Chen Z, Zhu J. Sonographic features of the lateral femoral cutaneous nerve in meralgia paresthetica. Quant Imaging Med Surg. 2021;11(10):4269-4274. doi:10.21037/qims-21-209
13. Powell GM, Baffour FI, Erie AJ, Puffer RC, Spinner RJ, Glazebrook KN. Sonographic evaluation of the lateral femoral cutaneous nerve in meralgia paresthetica. Skeletal Radiol. 2020;49(7):1135-1140. doi:10.1007/s00256-020-03399-8
14. Ally RM, Velleman MD, Suleman FE. Meralgia paresthetica: Now showing on 3T magnetic resonance neurography. SA J Radiol. 2019;23(1). doi:10.4102/sajr.v23i1.1745
15. Gupta A, Muzumdar D, Ramani PS. Meralgia paraesthetica following lumbar spine surgery: A study in 110 consecutive surgically treated cases. Neurol India. 2004;52:66.
16. Massey EW, Pellock JM. Meralgia paraesthetica in a child. J Pediatr. 1978;93(2):325-326. doi:10.1016/s0022-3476(78)80566-6
17. Weng WC, Wei YC, Huang WY, Chien YY, Peng TI, Wu CL. Risk factor analysis for meralgia paresthetica: A hospital-based study in Taiwan. J Clin Neurosci. 2017;43:192-195. doi:10.1016/j.jocn.2017.04.024
18. Parisi TJ, Mandrekar J, Dyck PJB, Klein CJ. Meralgia paresthetica. Neurology. 2011;77(16):1538-1542. doi:10.1212/wnl.0b013e318233b356
19. Yang SH, Wu CC, Chen PQ. Postoperative Meralgia Paresthetica After Posterior Spine Surgery: Incidence, Risk Factors, and Clinical Outcomes. Spine (Phila Pa 1976). 2005;30.
20. van Slobbe AM, Bernsen RMD, Bohnen AM, Bierma-Zeinstra SMA, Koes BW. Incidence rates and determinants in meralgia paresthetica in general practice. J Neurol. 2004;251(3):294-297. doi:10.1007/s00415-004-0310-x
21. Parisi TJ, Mandrekar J, Dyck PJB, Klein CJ. Meralgia paresthetica: relation to obesity, advanced age, and diabetes mellitus. Neurology. 2011;77(16):1538-1542. doi:10.1212/wnl.0b013e318233b356
22. van Slobbe AM, Bernsen RMD, Bohnen AM, Bierma-Zeinstra SMA, Koes BW. Incidence rates and determinants in meralgia paresthetica in general practice. J Neurol. 2004;251(3):294-297. doi:10.1007/s00415-004-0310-x
23. Knapik JJ, Reynolds KL, Orr R, Pope R. Load Carriage-Related Paresthesias (Part 2): Meralgia Paresthetica. J Spec Oper Med. 2017;17(1):94. doi:10.55460/6krp-71df
24. Mondelli M, Rossi S, Romano C. Body mass index in meralgia paresthetica: a case?control study. Acta Neurol Scand. 2007;116(2):118-123. doi:10.1111/j.1600-0404.2007.00814.x
25. Calabrò RS, Casella C, Manuli A, Militi D, Gervasi G. Meralgia Paresthetica Successfully Treated with Palmithoylethanolamide. Innov Clin Neurosci. 2020;17:10.
26. Payne RA, Harbaugh K, Specht CS, Rizk E. Correlation of Histopathology and Clinical Symptoms in Meralgia Paresthetica. Cureus. 2017;9. doi:10.7759/cureus.1789
27. Dureja GP, Gulaya V, Jayalakshmi TS, Mandal P. Management of Meralgia Paresthetica: A Multimodality Regimen. Anesth Analg. 1995;80(5):1060-1061. doi:10.1213/00000539-199505000-00043
28. Ercan S, Ataizi ZS, Ertilav K. The Correlation of Meralgia Paresthetica and Spinal Surgery in Prone Position. Turk Neurosurg. 2020;30:89-93.
29. Mirovsky Y, Neuwirth M. Injuries to the lateral femoral cutaneous nerve during spine surgery. Spine (Phila Pa 1976). 2000;25(10):1266-1269. doi:10.1097/00007632-200005150-00011
30. Richer LP, Shevell MI, Stewart J, Poulin C. Pediatric meralgia paresthetica. Pediatr Neurol. 2002;26(4):321-323. doi:10.1016/s0887-8994(01)00397-6
31. Goldberg VM, Jacobs B. Osteoid osteoma of the hip in children. Clin Orthop Relat Res. 1975;(106):41-47.
32. Yoshida S, Oya S, Matsui T. Risk factors of meralgia paresthetica after prone position surgery: Possible influence of operating position, laminectomy level, and preoperative thoracic kyphosis. J Clin Neurosci. 2021;89:292-296. doi:10.1016/j.jocn.2021.05.022
33. Zhou L, Siao P. Lateral femoral cutaneous neuropathy caused by prone positioning to treat COVID-19-associated acute respiratory distress syndrome. Muscle Nerve. 2021;63(6):E50-E52. doi:10.1002/mus.27202
34. Bellinghausen AL, LaBuzetta JN, Chu F, Novelli F, Rodelo AR, Owens RL. Lessons from an ICU recovery clinic: two cases of meralgia paresthetica after prone positioning to treat COVID-19-associated ARDS and modification of unit practices. Crit Care. 2020;24(1). doi:10.1186/s13054-020-03289-4
35. Juhl CS, Ballegaard M, Bestle MH, Tfelt-Hansen P. Meralgia Paresthetica after Prone Positioning Ventilation in the Intensive Care Unit. Case Rep Crit Care. 2016;2016:1-3. doi:10.1155/2016/7263201
36. Ellis J, Schneider JR, Cloney M, Winfree CJ. Lateral Femoral Cutaneous Nerve Decompression Guided by Preoperative Ultrasound Mapping. Cureus. 2018;10. doi:10.7759/cureus.3652
37. Ng E, Ekladious A, Gahlot P. Horses or zebras: a delayed diagnosis of meralgia paraesthetica. BMJ Case Rep. 2018;2018:bcr-2018-226905. doi:10.1136/bcr-2018-226905
38. Pereira MC, Carvalho JL. Ultrasound-Guided Pulsed Radiofrequency Treatment for Meralgia Paresthetica. Cureus. 2022;14.
39. Cho KT, Lee HJ. Prone Position-Related Meralgia Paresthetica after Lumbar Spinal Surgery: A Case Report and Review of the Literature. J Korean Neurosurg Soc. 2008;44(6):392. doi:10.3340/jkns.2008.44.6.392
40. Ivins GK. Meralgia paresthetica, the elusive diagnosis: clinical experience with 14 adult patients. Ann Surg. 2000;232(2):281-286. doi:10.1097/00000658-200008000-00019
41. Kesserwani H. Meralgia Paresthetica: A Case Report With an Update on Anatomy, Pathology, and Therapy. Cureus. 2021;13.
42. Seror P, Seror R. Meralgia paresthetica: clinical and electrophysiological diagnosis in 120 cases. Muscle Nerve. 2006;33(5):650-654. doi:10.1002/mus.20507
43. Ecker AD. Diagnosis of Meralgia Paresthetica. JAMA. 1985;253(7):976. doi:10.1001/jama.1985.03350310058008
44. Madiraca Glasović D, Šlaus N, Šitum M, Pećina M. Meralgia Paresthetica – Lateral Femoral Cutaneous Nerve Entrapment. Rad Hrvatske akademije znanosti i umjetnosti Medicinske znanosti. 2021;54-55:56-63. doi:10.21857/mzvkptq6v9
45. Craig A. Entrapment Neuropathies of the Lower Extremity. PM&R. 2013;5:S31-S40. doi:10.1016/j.pmrj.2013.03.029
46. Kaiser R. Meralgia paresthetica. Rozhl Chir. 97:286-290.
47. Gurbuz H, Gultekin A. Medical and surgical treatment of meralgia paresthetica. Pain Manag. 2021;11(4):389-393. doi:10.2217/pmt-2020-0085
48. Kothadia JP, Katz S, Ginzburg L. Chronic appendicitis: uncommon cause of chronic abdominal pain. Therap Adv Gastroenterol. 2015;8(3):160-162. doi:10.1177/1756283x15576438
49. Parisi TJ, Mandrekar J, Dyck PJB, Klein CJ. Meralgia paresthetica: Relation to obesity, advanced age, and diabetes mellitus. Neurology. 2011;77(16):1538-1542. doi:10.1212/wnl.0b013e318233b356
50. Ecker AD, Woltman HW. MERALGIA PARAESTHETICA. J Am Med Assoc. 1938;110(20):1650. doi:10.1001/jama.1938.02790200018006
51. KITCHEN C, SIMPSON J. MERALGIA PARESTHETIGA A REVIEW OF 67 PATIENTS. Acta Neurol Scand. 1972;48(5):547-555. doi:10.1111/j.1600-0404.1972.tb07575.x
52. Williams PH, Trzil KP. Management of meralgia paresthetica. J Neurosurg. 1991;74(1):76-80. doi:10.3171/jns.1991.74.1.0076
53. Massey E. Sensory Mononeuropathies. Semin Neurol. 1998;18(02):177-183. doi:10.1055/s-2008-1040871
54. Puig L, Alegre M, de Moragas JM. Treatment of Meralgia paraesthetica with Topical Capsaicin. Dermatology. 1995;191(1):73-74. doi:10.1159/000246496
55. Fisher AP, Hanna M. Transcutaneous electrical nerve stimulation in meralgia paraesthetica of pregnancy. BJOG. 1987;94(6):603-605. doi:10.1111/j.1471-0528.1987.tb03161.x
56. Dureja GP, Gulaya V, Jayalakshmi TS, Mandal P. Management of Meralgia Paresthetica. Anesth Analg. 1995;80:1060-1061.
57. Klauser AS, Abd Ellah MMH, Halpern EJ, et al. Meralgia paraesthetica: Ultrasound-guided injection at multiple levels with 12-month follow-up. Eur Radiol. 2016;26(3):764-770. doi:10.1007/s00330-015-3874-1
58. Shannon J, Lang SA, Yip RW, Gerard M. Lateral femoral cutaneous nerve block revisited. A nerve stimulator technique. Reg Anesth. 1995;20:100-104.
59. Kiliç S, et al. Conservative Treatment Versus Ultrasound-Guided Injection in the Management of Meralgia Paresthetica: A Randomized Controlled Trial. Pain Physician. 2020;23:253-262.
60. Tagliafico A, Serafini G, Lacelli F, Perrone N, Valsania V, Martinoli C. Ultrasound-guided treatment of meralgia paresthetica (lateral femoral cutaneous neuropathy): Technical description and results of treatment in 20 consecutive patients. Journal of Ultrasound in Medicine. 2011;30(10):1341-1346. doi:10.7863/jum.2011.30.10.1341
61. Haim A, Pritsch T, Ben-Galim P, Dekel S. Meralgia paresthetica: A retrospective analysis of 79 patients evaluated and treated according to a standard algorithm. Acta Orthop. 2006;77(3):482-486. doi:10.1080/17453670610046433
62. Philip CN, Candido KD, Joseph NJ, Crystal GJ. Successful treatment of meralgia paresthetica with pulsed radiofrequency of the lateral femoral cutaneous nerve. Pain Physician. 2009;12:881-885.
63. Dalmau-Carolà JM. Treatment of meralgia paresthetica with pulsed radiofrequency of the lateral femoral cutaneous nerve. Pain Phys. 2009;6;12(6;12):1025-1027. doi:10.36076/ppj.2009/12/1025
64. Lee JJ et al. Clinical Efficacy of Pulsed Radiofrequency Neuromodulation for Intractable Meralgia Paresthetica. Pain Physician. 2016;19:173-179.
65. Chmiela MA, Hendrickson M, Hale J, et al. Direct Peripheral Nerve Stimulation for the Treatment of Complex Regional Pain Syndrome: A 30-Year Review. Neuromodulation. 2021;24(6):971-982. doi:10.1111/ner.13295
66. Perryman LT, Kubias J, Stockli S, Herschkowitz D. Wireless Peripheral Nerve Stimulation in the Management of Debilitating Extremity Pain from Meralgia Paresthetica and Complex Regional Pain Syndrome: Report of Two Case Illustrations. Biomed J Sci Tech Res. 2018;9(3). doi:10.26717/bjstr.2018.09.001806
67. Barna SA, Hu MM, Buxo C, Trella J, Cosgrove GR. Spinal cord stimulation for treatment of meralgia paresthetica. Pain Phys. 2005;3;8(7;3):315-318. doi:10.36076/ppj.2005/8/315
68. Solomons JNT, Sagir A, Yazdi C. Meralgia Paresthetica. Curr Pain Headache Rep. 2022;26(7):525-531. doi:10.1007/s11916-022-01053-7
69. de Ruiter GCW, Wurzer JAL, Kloet A. Decision making in the surgical treatment of meralgia paresthetica: Neurolysis versus neurectomy. Acta Neurochir (Wien). 2012;154(10):1765-1772. doi:10.1007/s00701-012-1431-0
70. de Ruiter GCW, Kloet A. Comparison of effectiveness of different surgical treatments for meralgia paresthetica: Results of a prospective observational study and protocol for a randomized controlled trial. Clin Neurol Neurosurg. 2015;134:7-11. doi:10.1016/j.clineuro.2015.04.007
71. Emamhadi M. Surgery for Meralgia Paresthetica: neurolysis versus nerve resection. Turk Neurosurg. 2012;22:758-762.
72. Morimoto D, Kim K, Kokubo R, et al. Deep Decompression of the Lateral Femoral Cutaneous Nerve Under Local Anesthesia. World Neurosurg. 2018;118:e659-e665. doi:10.1016/j.wneu.2018.06.252
73. Benezis I, Boutaud B, Leclerc J, Fabre T, Durandeau A. Lateral femoral cutaneous neuropathy and its surgical treatment: A report of 167 cases. Muscle Nerve. 2007;36(5):659-663. doi:10.1002/mus.20868
74. Payne R, Seaman S, Sieg E, Langan S, Harbaugh K, Rizk E. Evaluating the evidence: is neurolysis or neurectomy a better treatment for meralgia paresthetica? Acta Neurochir. 2017;159(5):931-936. doi:10.1007/s00701-017-3136-x
75. Lu VM, Burks SS, Heath RN, Wolde T, Spinner RJ, Levi AD. Meralgia paresthetica treated by injection, decompression, and neurectomy: A systematic review and meta-analysis of pain and operative outcomes. Journal of Neurosurgery. 2021;135(3):912-922. doi:10.3171/2020.7.jns202191
76. Tagliafico AS, Torri L, Signori A. Treatment of meralgia paresthetica (Lateral Femoral Cutaneous Neuropathy): A meta-analysis of ultrasound-guided injection versus surgery. Eur J Radiol. 2021;139:109736. doi:10.1016/j.ejrad.2021.109736