Meralgia paresthetica

Diagnosis

In most cases, your doctor can make a diagnosis of meralgia paresthetica based on your medical history and a physical exam. He or she might test the sensation of the affected thigh, ask you to describe the pain, and ask you to trace the numb or painful area on your thigh. Additional examination including strength testing and reflex testing might be done to help exclude other causes for the symptoms.

To rule out other conditions such as a nerve root problem or femoral neuropathy, your doctor might recommend:

• Imaging studies. Although no specific changes are evident on X-ray if you have meralgia paresthetica, images of your hip and pelvic area might be helpful to exclude other conditions as a cause of your symptoms.

  A CT scan or MRI might be ordered if your doctor suspects that a tumor could be causing your pain.

• Electromyography. This test measures the electrical discharges produced in muscles to help evaluate and diagnose muscle and nerve disorders. A thin needle electrode is placed into the muscle to record electrical activity. Results of this test are normal in meralgia paresthetica, but the test might be needed to exclude other disorders when the diagnosis isn't clear.
• Nerve conduction study. Patch-style electrodes are placed on your skin to stimulate the nerve with a mild electrical impulse. The electrical impulse helps diagnose damaged nerves. A comparison of the lateral femoral cutaneous nerve on each side may be performed. This test might be done primarily to exclude other causes for the symptoms.
• Nerve blockade. Pain relief achieved from anesthetic injection into your thigh where the lateral femoral cutaneous nerve enters into it can confirm that you have meralgia paresthetica. Ultrasound imaging might be used to guide the needle.

Treatment

For most people, the symptoms of meralgia paresthetica ease in a few months. Treatment focuses on relieving nerve compression.

Conservative measures

Conservative measures include:

• Wearing looser clothing
• Losing excess weight
• Taking OTC pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or aspirin

Medications

If symptoms persist for more than two months or your pain is severe, treatment might include:

• Corticosteroid injections. Injections can reduce inflammation and temporarily relieve pain. Possible side effects include joint infection, nerve damage, pain and whitening of skin around the injection site.
• Tricyclic antidepressants. These medications might relieve your pain. Side effects include drowsiness, dry mouth, constipation and impaired sexual functioning.
• Gabapentin (Gralise, Neurontin), phenytoin (Dilantin) or pregabalin (Lyrica). These anti-seizure medications might help lessen your painful symptoms. Side effects include constipation, nausea, dizziness, drowsiness and lightheadedness.

Surgery

Rarely, surgery to decompress the nerve is considered. This option is only for people with severe and long-lasting symptoms.

Lifestyle and home remedies

The following self-care measures can help treat and prevent meralgia paresthetica:

• Avoid wearing tight clothing.
• Maintain a healthy weight, or lose weight if you're overweight.

Preparing for your appointment

Here's some information to help you get ready for your appointment.

What you can do

Make a list of:

• Your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment, and when they began
• Key personal information, including medical conditions and major stresses or recent life changes
• All medications, vitamins or supplements you take, including doses
• Questions to ask your doctor

For meralgia paresthetica, basic questions to ask include:

• What is likely causing my symptoms?
• What tests do I need?
• Is my condition likely temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach you're suggesting?
• I have other health conditions. How can I best manage them together?
• Are there restrictions I need to follow?
• Should I see a specialist?

Don't hesitate to ask any other questions.

What to expect from your doctor

Your doctor likely will have questions, too, including:

• What part of your leg is affected?
• Have you had recent surgeries?
• Have you had recent injuries to your hip area, such as from a seat belt in a motor vehicle accident?
• Do you regularly do repetitive activities that affect your hip area, such as cycling?
• Have you gained weight?
• Have you recently been pregnant?
• Do you have diabetes?
• Is the burning or tingling occasional or continuous?
• How severe is your discomfort?
• Are there activities that worsen your symptoms?
• Is there weakness in your leg?

What you can do in the meantime

If your pain is bothersome, OTC pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or aspirin may be helpful. Also, avoid tight clothing.