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Scholz C, Hohenhaus M, Pedro MT, Uerschels AK, Dengler NF. Meralgia Paresthetica: Relevance, Diagnosis, and Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:655-661. [PMID: 37534445 PMCID: PMC10622057 DOI: 10.3238/arztebl.m2023.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/05/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Pain and sensory disturbance in the distribution of the lateral femoral cutaneous nerve in the ventrolateral portion of the thigh is called meralgia paresthetica (MP). The incidence of MP has risen along with the increasing prevalence of obesity and diabetes mellitus and was recently estimated at 32 new cases per 100 000 persons per year. In this review, we provide an overview of current standards and developments in the diagnosis and treatment of MP. METHODS This review is based on publications retrieved by a selective literature search, with special attention to meta-analyses, systematic reviews, randomized and controlled trials (RCTs), and prospective observational studies. RESULTS The diagnosis is mainly based on typical symptoms combined with a positive response to an infiltration procedure. In atypical cases, electrophysiological testing, neurosonography, and magnetic resonance imaging can be helpful in establishing the diagnosis. The literature search did not reveal any studies of high quality. Four prospective observational studies with small case numbers and partly inconsistent results are available. In a meta-analysis of 149 cases, pain relief was described after infiltration in 85% of cases and after surgery in 80%, with 1-38 months of follow-up. In another meta-analysis of 670 cases, there was pain relief after infiltration in 22% of cases, after surgical decompression in 63%, and after neurectomy in 85%. Hardly any data are available on more recent treatment options, such as radiofrequency therapy, spinal cord stimulation, or peripheral nerve stimulation. CONCLUSION The state of the evidence is limited in both quantity and quality, corresponding to evidence level 2a for surgical and non-surgical methods. Advances in imaging and neurophysiological testing have made the diagnosis easier to establish. When intervention is needed, good success rates have been achieved with surgery (decompression, neurectomy), and variable success rates with infiltration.
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Affiliation(s)
- Christoph Scholz
- Department of Neurosurgery, University Hospital Freiburg, Faculty of Medicine, University of Freiburg
| | - Marc Hohenhaus
- Department of Neurosurgery, University Hospital Freiburg, Faculty of Medicine, University of Freiburg
| | - Maria T. Pedro
- Department of Neurosurgery, Peripheral Nerves Section, University of Ulm at Günzburg District Hospital
| | | | - Nora F. Dengler
- Department of Neurosurgery, Charité–University Medical Center Berlin
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2
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Roecker CB, Hewawasam SR, Skalski MR. Chiropractic management of bilateral meralgia paresthetica: a case report. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2023; 67:175-185. [PMID: 37840579 PMCID: PMC10575328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Objective The purpose of this report is to describe the course of chiropractic care for an adult male experiencing persistent anterolateral thigh pain due to bilateral meralgia paresthetica. Clinical features A 40-year-old male U.S. Veteran was referred to chiropractic care for a two-year history of bilateral anterolateral thigh pain and paresthesia that worsened with inguinal pressure and hip extension activities. Intervention and outcomes A total of six chiropractic visits, including a combination of telehealth and in-person appointments, took place over a period of 10 weeks. Treatments included patient education, soft-tissue therapy, therapeutic exercise prescription, and spinal manipulation directed toward the lumbar spine. The patient's pain was reduced from a 6/10 rating to a 0/10, he was able to reengage in recreational activities without discomfort, and sustained improvement was reported. Summary In this case, a trial of chiropractic care was associated with a resolution of the patient's bilateral meralgia paresthetica symptoms.
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Schönberg B, Pigorsch M, Huscher D, Baruchi S, Reinsch J, Zdunczyk A, Scholz C, Uerschels AK, Dengler NF. Diagnosis and treatment of meralgia paresthetica between 2005 and 2018: a national cohort study. Neurosurg Rev 2023; 46:54. [PMID: 36781569 PMCID: PMC9925535 DOI: 10.1007/s10143-023-01962-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 01/22/2023] [Accepted: 02/01/2023] [Indexed: 02/15/2023]
Abstract
The prevalence of meralgia paresthetica (MP), which is caused by compression of the lateral femoral cutaneous nerve (LFCN), has been increasing over recent decades. Since guidelines and large-scale studies are lacking, there are substantial regional differences in diagnostics and management in MP care. Our study aims to report on current diagnostic and therapeutic strategies as well as time trends in clinical MP management in Germany. Patients hospitalized in Germany between January 1, 2005, and December 31, 2018, with MP as their primary diagnosis were identified using the International Classification of Disease (ICD-10) code G57.1 and standardized operations and procedures codes (OPS). A total of 5828 patients with MP were included. The rate of imaging studies increased from 44% in 2005 to 79% in 2018 (p < 0.001) and that of non-imaging diagnostic studies from 70 to 93% (p < 0.001). Among non-imaging diagnostics, the rates of evoked potentials and neurography increased from 20%/16% in 2005 to 36%/23% in 2018 (p < 0.001, respectively). Rates of surgical procedures for MP decreased from 53 to 37% (p < 0.001), while rates of non-surgical procedures increased from 23 to 30% (p < 0.001). The most frequent surgical interventions were decompressive procedures at a mean annual rate of 29% (± 5) throughout the study period, compared to a mean annual rate of 5% (± 2) for nerve transection procedures. Between 2005 and 2018, in-hospital MP care in Germany underwent significant changes. The rates of imaging, evoked potentials, neurography, and non-surgical management increased. The decompression of the LFCN was substantially more frequent than that of the LFCN transection, yet both types of intervention showed a substantial decrease in in-hospital prevalence over time.
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Affiliation(s)
- Benn Schönberg
- Vertebral Spine Center Berlin, Breite Straße 46/47, 13187, Berlin, Germany
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Mareen Pigorsch
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Doerte Huscher
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Shlomo Baruchi
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Jennifer Reinsch
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Anna Zdunczyk
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Christoph Scholz
- Department of Neurosurgery, Faculty of Medicine, Medical Center, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Ann-Kathrin Uerschels
- Department of Neurosurgery, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Nora F Dengler
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
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Abstract
OBJECTIVE Meralgia paresthetica is a common condition that is usually diagnosed by its classical clinical presentation and by exclusion of a spinal origin of pain, sensory loss, and/or paresthesias in the anterolateral thigh. Treatment modalities include conservative management, local injections, and surgical therapy. To date, no level 1 evidence exists about treatment options for idiopathic meralgia paresthetica. This review article aims to give a structured overview of epidemiology, history, anatomy, diagnostics, and treatment. It focuses on the existing literature and current developments in clinical management. METHODS A literature search on PubMed/MEDLINE was performed on 20 December 2021, yielding 1412 results. Abstracts were screened and classified in terms of epidemiology, anatomy, diagnostics, and treatment. RESULTS High-quality observational data that was included in recent meta-analyses showed satisfactory results for conservative management, injections, and surgical decompression or neurectomy, but there is some major methodological criticism. For idiopathic meralgia paresthetica, the results of surgical decompression have never been compared to those of neurectomy in a randomized setup. The only study protocol published so far does not consider any extended decompression techniques (dynamic, circumferent, proximal, and distal to the inguinal ligament). A multicenter, prospective design has never been proposed. DISCUSSION Reliable high-quality evidence on the treatment of idiopathic meralgia paresthetica is lacking at the current state, and challenges in clinical decision-making remain.
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Affiliation(s)
- Nora F. Dengler
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Berlin, Germany
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5
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Aureli V, Vat M, Hankov N, Théaudin M, Ravier J, Becce F, Demesmaeker R, Asboth L, Courtine G, Bloch J. Targeted dorsal root entry zone stimulation alleviates pain due to meralgia paresthetica. J Neural Eng 2022; 19. [PMID: 36541540 DOI: 10.1088/1741-2552/aca5f7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/24/2022] [Indexed: 11/27/2022]
Abstract
Objective.Meralgia paresthetica (MP) is a mononeuropathy of the exclusively sensory lateral femoral cutaneous nerve (LFCN) that is difficult to treat with conservative treatments. Afferents from the LFCN enter the spinal cord through the dorsal root entry zones (DREZs) innervating L2 and L3 spinal segments. We previously showed that epidural electrical stimulation of the spinal cord can be configured to steer electrical currents laterally in order to target afferents within individual DREZs. Therefore, we hypothesized that this neuromodulation strategy is suitable to target the L2 and L3 DREZs that convey afferents from the painful territory, and thus alleviates MP related pain.Approach.A patient in her mid-30s presented with a four year history of dysesthesia and burning pain in the anterolateral aspect of the left thigh due to MP that was refractory to medical treatments. We combined neuroimaging and intraoperative neuromonitoring to guide the surgical placement of a paddle lead over the left DREZs innervating L2 and L3 spinal segments.Main results.Optimized electrode configurations targeting the left L2 and L3 DREZs mediated immediate and sustained alleviation of pain. The patient ceased all other medical management, reported improved quality of life, and resumed recreational physical activities.Significance.We introduced a new treatment option to alleviate pain due to MP, and demonstrated how neuromodulation strategies targeting specific DREZs is effective to reduce pain confined to specific regions of the body while avoiding disconfort.
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Affiliation(s)
- Viviana Aureli
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Department of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Molywan Vat
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Department of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland
| | - Nicolas Hankov
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland.,NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneve, Switzerland
| | - Marie Théaudin
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Department of Neurology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jimmy Ravier
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland.,NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneve, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Robin Demesmaeker
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland.,NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneve, Switzerland
| | - Leonie Asboth
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland.,NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneve, Switzerland
| | - Grégoire Courtine
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Department of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland.,NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneve, Switzerland
| | - Jocelyne Bloch
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Department of Neurosurgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,NeuroRestore, Defitech Center for Interventional Neurotherapies, EPFL/CHUV/UNIL, Lausanne, Switzerland.,NeuroX Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Geneve, Switzerland
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6
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Solomons JNT, Sagir A, Yazdi C. Meralgia Paresthetica. Curr Pain Headache Rep 2022; 26:525-531. [PMID: 35622311 DOI: 10.1007/s11916-022-01053-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW This review article summaries the epidemiology, etiology, clinical presentations, and latest treatment modalities of meralgia paresthetica, including the latest data about peripheral and spinal cord stimulation therapy. Meralgia paresthetica (MP) causes burning, stinging, or numbness in the anterolateral part of the thigh, usually due to compression of the lateral femoral cutaneous nerve (LFCN). RECENT FINDINGS There are emerging data regarding the benefit of interventional pain procedures, including steroid injection and radiofrequency ablation, and other interventions including spinal cord and peripheral nerve stimulation reserved for refractory cases. The strength of evidence for treatment choices in meralgia paraesthetica is weak. Some observational studies are comparing local injection of corticosteroid versus surgical interventions. However, more extensive studies are needed regarding the long-term benefit of peripheral and spinal cord stimulation therapy.
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Affiliation(s)
| | - Afrin Sagir
- Beth Israel Deaconess Medical Center, Brookline, MA, USA
| | - Cyrus Yazdi
- Beth Israel Deaconess Medical Center, Brookline, MA, USA.
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7
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Costa Pereira M, Carvalho JL. Ultrasound-Guided Pulsed Radiofrequency Treatment for Meralgia Paresthetica. Cureus 2022; 14:e22015. [PMID: 35282534 PMCID: PMC8908802 DOI: 10.7759/cureus.22015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/24/2022] Open
Abstract
Meralgia paresthetica (MP) is one of the most common mononeuropathies of the lower limb, characterized by injury or compression of the lateral cutaneous femoral nerve at the level of the anterior superior iliac spine and inguinal ligament. Many predisposing factors, such as weight gain, obesity, and restrictive clothing, contribute to the injury of the lateral cutaneous femoral nerve along its course from the pelvis towards the thigh. Although a great number of cases are successfully treated with conservative measures, a subgroup of patients suffer chronic dysesthetic pain with intermittent flare-ups in their lifetime, with a negative impact on quality of life, requiring additional treatment. The purpose of this case report is to describe the successful management of MP with ultrasound-guided pulsed radiofrequency of the lateral cutaneous femoral nerve.
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8
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Dalal S, Berger AA, Orhurhu V, Kaye AD, Hasoon J. Peripheral Nerve Stimulation for the Treatment of Meralgia Paresthetica. Orthop Rev (Pavia) 2021; 13:24437. [PMID: 34745464 DOI: 10.52965/001c.24437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 05/22/2021] [Indexed: 11/06/2022] Open
Abstract
Meralgia paresthetica is a condition caused by entrapment of the lateral femoral cutaneous nerve at the level of the inguinal ligament. This nerve is a purely sensory nerve and provides innervation to the anterolateral portion of the thigh. The condition can lead to numbness, paresthesia, dysesthesia, and pain over the anterolateral aspect of the thigh, which are exacerbated with walking, standing, and hip extension. First-line treatment for MP includes conservative measures such as weight loss and eliminating tight-fitted clothing. Neuropathic pain medications and corticosteroid injections are also treatment options for some patients with significant pain complaints. In more refractory cases, surgical intervention can be considered. Peripheral nerve stimulation has also been shown to be a helpful treatment modality for patients with refractory meralgia paresthetica. Here we report our experience utilizing peripheral nerve stimulation in patients with significant pain complaints related to refractory meralgia paresthetica.
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Affiliation(s)
- Suhani Dalal
- A.T. Still University School of Medicine, Mesa, AZ
| | - Amnon A Berger
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Vwaire Orhurhu
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Alan D Kaye
- Louisiana State University Health Sciences Center, Shreveport, LA
| | - Jamal Hasoon
- Beth Israel Deaconess Medical Center and Harvard Medical School, Department of Anesthesia, Critical Care and Pain Medicine, Boston, MA; Pain Specialists of America, Austin, TX
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9
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Estimulación medular como tratamiento de la meralgia parestésica. ¿Es factible? Reporte de caso. Neurocirugia (Astur) 2021. [DOI: 10.1016/j.neucir.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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10
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Paley CA, Wittkopf PG, Jones G, Johnson MI. Does TENS Reduce the Intensity of Acute and Chronic Pain? A Comprehensive Appraisal of the Characteristics and Outcomes of 169 Reviews and 49 Meta-Analyses. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1060. [PMID: 34684097 PMCID: PMC8539683 DOI: 10.3390/medicina57101060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 12/11/2022]
Abstract
Background and Objectives: Uncertainty about the clinical efficacy of transcutaneous electric nerve stimulation (TENS) to alleviate pain spans half a century. There has been no attempt to synthesise the entire body of systematic review evidence. The aim of this comprehensive review was to critically appraise the characteristics and outcomes of systematic reviews evaluating the clinical efficacy of TENS for any type of acute and chronic pain in adults. Materials and Methods: We searched electronic databases for full reports of systematic reviews of studies, overviews of systematic reviews, and hybrid reviews that evaluated the efficacy of TENS for any type of clinical pain in adults. We screened reports against eligibility criteria and extracted data related to the characteristics and outcomes of the review, including effect size estimates. We conducted a descriptive analysis of extracted data. Results: We included 169 reviews consisting of eight overviews, seven hybrid reviews and 154 systematic reviews with 49 meta-analyses. A tally of authors' conclusions found a tendency toward benefits from TENS in 69/169 reviews, no benefits in 13/169 reviews, and inconclusive evidence in 87/169 reviews. Only three meta-analyses pooled sufficient data to have confidence in the effect size estimate (i.e., pooled analysis of >500 events). Lower pain intensity was found during TENS compared with control for chronic musculoskeletal pain and labour pain, and lower analgesic consumption was found post-surgery during TENS. The appraisal revealed repeated shortcomings in RCTs that have hindered confident judgements about efficacy, resulting in stagnation of evidence. Conclusions: Our appraisal reveals examples of meta-analyses with 'sufficient data' demonstrating benefit. There were no examples of meta-analyses with 'sufficient data' demonstrating no benefit. Therefore, we recommend that TENS should be considered as a treatment option. The considerable quantity of reviews with 'insufficient data' and meaningless findings have clouded the issue of efficacy. We offer solutions to these issues going forward.
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Affiliation(s)
- Carole A. Paley
- Centre for Pain Research, Leeds Beckett University, Leeds LS1 3HE, UK; (C.A.P.); (P.G.W.); (G.J.)
- Research and Development Department, Airedale National Health Service (NHS) Foundation Trust, Skipton Road, Steeton, Keighley BD20 6TD, UK
| | - Priscilla G. Wittkopf
- Centre for Pain Research, Leeds Beckett University, Leeds LS1 3HE, UK; (C.A.P.); (P.G.W.); (G.J.)
| | - Gareth Jones
- Centre for Pain Research, Leeds Beckett University, Leeds LS1 3HE, UK; (C.A.P.); (P.G.W.); (G.J.)
| | - Mark I. Johnson
- Centre for Pain Research, Leeds Beckett University, Leeds LS1 3HE, UK; (C.A.P.); (P.G.W.); (G.J.)
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11
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Kesserwani H. Meralgia Paresthetica: A Case Report With an Update on Anatomy, Pathology, and Therapy. Cureus 2021; 13:e13937. [PMID: 33880277 PMCID: PMC8051538 DOI: 10.7759/cureus.13937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Meralgia paresthetica, a condition characterized by tingling, numbness, and burning pain in the lateral aspect of the thigh, is caused by compression of the lateral femoral cutaneous nerve. The incidence of meralgia paresthetica increases with obesity and diabetes. The unique anatomy of the nerve that tunnels through the inguinal ligament predisposes it to inflammation, trauma, and entrapment. The pathology of meralgia paresthetica parallels that of entrapment neuropathies but with additional inflammatory overlay in certain instances. The clinical diagnosis is relatively simple due to its unique clinical features. The prognosis is generally excellent, and the treatment is straightforward that includes peripheral nerve blocks, neurectomy, nerve decompression, and pulsed radiofrequency neuromodulation. This current case of meralgia paresthetica highlights the salient clinical symptoms and signs. We have also described the electrophysiological studies of the lateral femoral cutaneous nerve, its anatomical variations, and the associations of meralgia paresthetica with bariatric surgery, critical care patients, tight clothing, pregnancy, and posterior spine surgery. We have also outlined the current treatment strategies.
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12
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Calabrò RS, Casella C, Manuli A, Militi D, Gervasi G. Meralgia Paresthetica Successfully Treated with Palmithoylethanolamide. INNOVATIONS IN CLINICAL NEUROSCIENCE 2020; 17:10-11. [PMID: 33520398 PMCID: PMC7839659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Meralgia paresthetica (MP) is an uncommon entrapment mononeuropathy that is characterized by a sudden onset of paresthesia and numbness in the anterolateral surface of the thigh. Palmithoylethanolamide (PEA) is commonly used in the treatment of chronic pelvic pain and compressive neuropathies. Herein, we describe an otherwise healthy 28-year-old patient affected by posttraumatic MP for three months who was successfully treated with PEA (1200mg/day). Further studies are needed to better investigate the potential use of PEA as therapeutic drug in peripheral neuropathies, including MP, to avoid or delay more invasive surgical treatments.
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Affiliation(s)
- Rocco Salvatore Calabrò
- Drs. Calabrò and Manuli are with IRCCS Centro Neurolesi "Bonino Pulejo" in Messina, Italy
- Dr. Casella is with Policlinico University in Messina, Italy
- Dr. Militi is with Stomato-dental Laboratory in Messina, Italy
- Dr. Gervasi is with the Hygiene and Preventive Medicine Department at the University of Tor Vergata in Rome, Italy
| | - Carmela Casella
- Drs. Calabrò and Manuli are with IRCCS Centro Neurolesi "Bonino Pulejo" in Messina, Italy
- Dr. Casella is with Policlinico University in Messina, Italy
- Dr. Militi is with Stomato-dental Laboratory in Messina, Italy
- Dr. Gervasi is with the Hygiene and Preventive Medicine Department at the University of Tor Vergata in Rome, Italy
| | - Alfredo Manuli
- Drs. Calabrò and Manuli are with IRCCS Centro Neurolesi "Bonino Pulejo" in Messina, Italy
- Dr. Casella is with Policlinico University in Messina, Italy
- Dr. Militi is with Stomato-dental Laboratory in Messina, Italy
- Dr. Gervasi is with the Hygiene and Preventive Medicine Department at the University of Tor Vergata in Rome, Italy
| | - David Militi
- Drs. Calabrò and Manuli are with IRCCS Centro Neurolesi "Bonino Pulejo" in Messina, Italy
- Dr. Casella is with Policlinico University in Messina, Italy
- Dr. Militi is with Stomato-dental Laboratory in Messina, Italy
- Dr. Gervasi is with the Hygiene and Preventive Medicine Department at the University of Tor Vergata in Rome, Italy
| | - Giuseppe Gervasi
- Drs. Calabrò and Manuli are with IRCCS Centro Neurolesi "Bonino Pulejo" in Messina, Italy
- Dr. Casella is with Policlinico University in Messina, Italy
- Dr. Militi is with Stomato-dental Laboratory in Messina, Italy
- Dr. Gervasi is with the Hygiene and Preventive Medicine Department at the University of Tor Vergata in Rome, Italy
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13
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Kloosterziel ME, Tavy DLJ, Arends S, Zijdewind JM, van Zwet EW, Wirtz PW. Meralgia paresthetica: Nerve stimulator-guided injection with methylprednisolone/lidocaine, a double-blind randomized placebo-controlled study. Muscle Nerve 2020; 61:788-791. [PMID: 32239737 DOI: 10.1002/mus.26877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Meralgia paresthetica is a mononeuropathy of the lateral femoral cutaneous nerve. A common therapy is injection with corticosteroids. The goal of this study was to analyze the effect of injection with methylprednisolone/lidocaine vs placebo. METHODS After randomization, 10 patients received a nerve stimulator-guided injection with methylprednisolone/lidocaine, and 10 patients received saline. The primary outcome measure was pain (visual analogue scale, VAS). RESULTS In the placebo group, there was a significant pain reduction (baseline VAS, 6.8; VAS week 12, 4.3; P = .014). The VAS score in the methylprednisolone group did not show a significant reduction (baseline VAS, 7.4; VAS week 12, 4.8; P = .053). There was no significant difference in pain reduction between the groups. CONCLUSIONS We found no objective evidence for benefit from nerve stimulator-guided injection with corticosteroids in meralgia paresthetica, although this study is limited by a small sample size. Future placebo-controlled studies using ultrasound-guided injection are warranted.
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Affiliation(s)
| | - Dénes L J Tavy
- Department of Neurology, Haga Hospital, The Hague, The Netherlands
| | - Samuel Arends
- Department of Neurology, Haga Hospital, The Hague, The Netherlands
| | | | - Erik W van Zwet
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
| | - Paul W Wirtz
- Department of Neurology, Haga Hospital, The Hague, The Netherlands
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14
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Caillaud M, Richard L, Vallat JM, Desmoulière A, Billet F. Peripheral nerve regeneration and intraneural revascularization. Neural Regen Res 2019; 14:24-33. [PMID: 30531065 PMCID: PMC6263011 DOI: 10.4103/1673-5374.243699] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Peripheral nerves are particularly vulnerable to injuries and are involved in numerous pathologies for which specific treatments are lacking. This review summarizes the pathophysiological features of the most common traumatic nerve injury in humans and the different animal models used in nerve regeneration studies. The current knowledge concerning Wallerian degeneration and nerve regrowth is then described. Finally, the involvement of intraneural vascularization in these processes is addressed. As intraneural vascularization has been poorly studied, histological experiments were carried out from rat sciatic nerves damaged by a glycerol injection. The results, taken together with the data from literature, suggest that revascularization plays an important role in peripheral nerve regeneration and must therefore be studied more carefully.
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Affiliation(s)
- Martial Caillaud
- University of Limoges, Myelin Maintenance and Peripheral Neuropathies, Faculties of Medicine and Pharmacy, Limoges, France
| | - Laurence Richard
- University Hospital of Limoges, Department of Neurology, "Reference Center for Rare Peripheral Neuropathies", Department of Neurology, Limoges, France
| | - Jean-Michel Vallat
- University Hospital of Limoges, Department of Neurology, "Reference Center for Rare Peripheral Neuropathies", Department of Neurology, Limoges, France
| | - Alexis Desmoulière
- University of Limoges, Myelin Maintenance and Peripheral Neuropathies, Faculties of Medicine and Pharmacy, Limoges, France
| | - Fabrice Billet
- University of Limoges, Myelin Maintenance and Peripheral Neuropathies, Faculties of Medicine and Pharmacy, Limoges, France
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15
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Abstract
Hip and groin pain often presents a diagnostic and therapeutic challenge. The differential diagnosis is extensive, comprising intra-articular and extra-articular pathology and referred pain from lumbar spine, knee and elsewhere in the pelvis. Various ultrasound-guided techniques have been described in the hip and groin region for diagnostic and therapeutic purposes. Ultrasound has many advantages over other imaging modalities, including portability, lack of ionising radiation and real-time visualisation of soft tissues and neurovascular structures. Many studies have demonstrated the safety, accuracy and efficacy of ultrasound-guided techniques, although there is lack of standardisation regarding the injectates used and long-term benefit remains uncertain.
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16
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Abstract
Peripheral neuropathies are diseases of the peripheral nervous system that can be divided into mononeuropathies, multifocal neuropathies, and polyneuropathies. Symptoms usually include numbness and paresthesia. These symptoms are often accompanied by weakness and can be painful. Polyneuropathies can be divided into axonal and demyelinating forms, which is important for diagnostic reasons. Most peripheral neuropathies develop over months or years, but some are rapidly progressive. Some patients only suffer from mild, unilateral, slowly progressive tingling in the fingers due to median nerve compression in the wrist (carpal tunnel syndrome), while other patients can be tetraplegic, with respiratory insufficiency within 1-2 days due to Guillain-Barré syndrome. Carpal tunnel syndrome, with a prevalence of 5% and incidence of 1-2 per 1000 person-years, is the most common mononeuropathy. Population-based data for chronic polyneuropathy are relatively scarce. Prevalence is estimated at 1% and increases to 7% in persons over 65 years of age. Incidence is approximately 1 per 1000 person-years. Immune-mediated polyneuropathies like Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy are rare diseases, with an annual incidence of approximately 1-2 and 0.2-0.5 per 100 000 persons respectively. Most peripheral neuropathies are more prevalent in older adults and in men, except for carpal tunnel syndrome, which is more common in women. Diabetes is a common cause of peripheral neuropathy and is associated with both mono- and polyneuropathies. Among the group of chronic polyneuropathies, in about 20-25% no direct cause can be found. These are slowly progressive axonal polyneuropathies.
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Affiliation(s)
- R Hanewinckel
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M A Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - P A Van Doorn
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
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17
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Klauser AS, Abd Ellah MMH, Halpern EJ, Sporer I, Martinoli C, Tagliafico A, Sojer M, Taljanovic MS, Jaschke WR. Meralgia paraesthetica: Ultrasound-guided injection at multiple levels with 12-month follow-up. Eur Radiol 2015; 26:764-70. [PMID: 26093463 DOI: 10.1007/s00330-015-3874-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 06/02/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the efficacy of ultrasound (US)-guided injections around the lateral femoral cutaneous nerve (LFCN) at different levels in meralgia paraesthetica (MP) patients. METHODS The study was approved by the university ethics committee and informed oral and written consent were obtained from all patients. Between June 2008 and August 2013, 20 patients with symptoms of MP, including nine men (mean age, 61.33 years) and 11 women (mean age 61.18 years), were treated with US-guided injection of steroids along the LFCN at three different levels in a mean of 2.25 sessions. A visual analogue scale (VAS) was used to measure symptoms before, immediately after and 12 months after treatment. RESULTS Complete resolution of symptoms was documented in 15/20 patients (mean VAS decreased from 82 to 0), and partial resolution in the remaining five (mean VAS decreased from 92 to 42), which was confirmed at 12-month follow-up. By using the different levels of injection approach overall significantly better symptom relief was obtained (p < 0.05). CONCLUSION The outcome of US-guided injection along the LFCN can be further improved by injections at different levels (p < 0.05), which was confirmed at 12-month long-term follow-up. KEY POINTS Meralgia paraesthetica is an entrapment neuropathy of the lateral femoral cutaneous nerve. Ultrasound proved effective in diagnosis and in guiding injection therapy. Injection at the anterior superior iliac spine has been used previously. Multiple injections along the nerve course were used in this study. Long-term follow-up (12 months) confirmed the results.
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Affiliation(s)
- Andrea S Klauser
- Diagnostic Radiology Department, Medical University Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Mohamed M H Abd Ellah
- Diagnostic Radiology Department, Medical University Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria.
- Diagnostic Radiology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
| | - Ethan J Halpern
- Departments of Radiology and Urology, Jefferson Prostate Diagnostic Center and Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Isabella Sporer
- Diagnostic Radiology Department, Medical University Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Carlo Martinoli
- Cattedra "R" di Radiologia-DIMI, Università di Genova, Largo Rosanna Benzi 8, 16132, Genoa, Italy
| | - Alberto Tagliafico
- Dipartimento di Medicina Sperimentale (DIMES), Università degli Studi di Genova, Genoa, Italy
| | - Martin Sojer
- Neurology Department, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Mihra S Taljanovic
- Department of Radiology, The University of Arizona Health Network, 1501 N. Campbell Ave., Tucson, AZ, 85724, USA
| | - Werner R Jaschke
- Diagnostic Radiology Department, Medical University Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
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18
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Lipinski LJ, Spinner RJ. Neurolysis, neurectomy, and nerve repair/reconstruction for chronic pain. Neurosurg Clin N Am 2014; 25:777-87. [PMID: 25240664 DOI: 10.1016/j.nec.2014.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neuropathic pain may be a result of focal injury to a peripheral nerve. The treatment algorithm begins with nonoperative, then operative, options. In our practice, first-line surgical treatment should directly treat the injured nerve. Nerve decompression or neurolysis is useful in patients with entrapment syndromes and in cases where the course and/or the function of the nerve is altered by local scar or pathoanatomy. Neurectomy is an option in primary cases where numbness is an acceptable alternative to dysesthetic pain, or as an alternative following failed neurolysis. Nerve repair or reconstruction may improve pain by guiding axons past the neuroma.
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Affiliation(s)
| | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
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19
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Cheatham SW, Kolber MJ, Salamh PA. Meralgia paresthetica: a review of the literature. Int J Sports Phys Ther 2013; 8:883-893. [PMID: 24377074 PMCID: PMC3867081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND AND PURPOSE Meralgia Paresthetica (MP) is a nerve entrapment which may cause pain, paresthesias, and sensory loss within the distribution of the lateral cutaneous nerve of the thigh. When the differential diagnosis of lateral or anterolateral thigh pain is inconclusive, MP should be considered as a potential source. MP produces similar signs and symptoms as those associated with more common diagnoses such as lumbar spine pathology. This clinical commentary will review the most relevant literature on MP with an emphasis on recognition and management of this condition. DESCRIPTION OF TOPIC WITH RELATED EVIDENCE The authors reviewed the most relevant published literature on MP from 1970 to 2013 located using the databases PubMed, CINAHL, and Proquest. DISCUSSION/RELATION TO CLINICAL PRACTICE MP still remains a diagnostic challenge since it can mimic other common diagnoses. Understanding the current literature surrounding the diagnosis and treatment of MP is essential for clinicians practicing in the outpatient environment. The consensus on the most effective non-surgical and surgical interventions is still limited, as is the research on physical therapy interventions for this condition. Perhaps the lack of research and global consensus represents a knowledge deficit that makes MP a challenge to diagnose and successfully treat. Future collaborative studies are needed to improve the clinical diagnostics and understanding of interventions for this pathology. LEVEL OF EVIDENCE 5.
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Affiliation(s)
| | | | - Paul A. Salamh
- Southeastern Orthopedics Physical Therapy, Raleigh, NC, USA
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