Painful neuropathy of the lateral cutaneous nerve of the thigh in patients with AIDS: successful treatment by injection with bupivacaine and triamcinolone

Treatment for meralgia paraesthetica

BACKGROUND

Meralgia paraesthetica is a clinical syndrome for which a number of treatments are in common use, including conservative measures, injection of corticosteroid with local anaesthetic and surgery. We aimed to examine the evidence for the relative efficacy of these interventions. This review was first published in 2008. Searches were updated in 2010 and 2012.

OBJECTIVES

To assess the relative efficacy of commonly used treatments for meralgia paraesthetica.

SEARCH METHODS

We searched the Cochrane Neuromuscular Disease Group Specialized Register (1 October 2012), CENTRAL (2012, issue 9 in The Cochrane Library), MEDLINE (January 1966 to October 2012), EMBASE (January 1980 to October 2012) and CINAHL Plus (January 1937 to October 2012) for randomised controlled studies. Non-randomised studies were identified by searching MEDLINE (January 1966 to October 2012) and EMBASE (January 1980 to October 2012). We also inspected the reference lists of these studies.

SELECTION CRITERIA

We were unable to identify any randomised controlled trials (RCTs) or quasi-RCTs. We therefore looked for high quality observational studies meeting the following criteria: (1) At least five cases of meralgia paraesthetica. (2) Follow-up of at least three months after intervention (if any). (3) At least 80% of cases followed up.

DATA COLLECTION AND ANALYSIS

Three authors independently extracted relevant data from each study meeting the selection criteria and transferred into a data extraction form.

MAIN RESULTS

We found no RCTs or quasi-RCTs in the original review or updates in 20011 and 2012. Cure or improvement have been described in high quality observational studies: (1) A single study describes spontaneous improvement of meralgia paraesthetica in 20 (69%) of 29 cases. (2) Four studies evaluating the injection of corticosteroid and local anaesthetic found cure or improvement in 130 (83%) out of a combined total of 157 cases. (3) Surgical treatments have been found to be beneficial in 264 (88%) out of 300 cases treated with decompression (nine studies); and 45 (94%) out of 48 cases treated with neurectomy (three studies). (4) Ninety-nine (97%) out of 102 patients with iatrogenic meralgia paraesthetica recovered completely (three studies).

AUTHORS' CONCLUSIONS

In the absence of any published RCTs or quasi-RCTs, the objective evidence base for treatment choices in meralgia paraesthetica is weak. High quality observational studies report comparable high improvement rates for meralgia paraesthetica following local injection of corticosteroid and surgical interventions (either nerve decompression or neurectomy). However, a similar outcome has been reported without any intervention in a single natural history study.

Pain Challenges at the End of Life - Pain and Palliative Care Collaboration

Pain and symptom management at the end of life remains suboptimal.Pain physicians are uniquely placed to provide interventions for patients with difficult to manage pain.Interventions such as acupuncture, radiofrequency ablation, neurolysis together with regional analgesia including neuraxial techniques and spinal cordotomy may provide the patient with improved analgesia.

Treatment for meralgia paraesthetica

BACKGROUND

Meralgia paraesthetica is a clinical syndrome for which a number of treatments are in common use, including conservative measures, injection of corticosteroid with local anaesthetic and surgery. We aimed to examine the evidence for the relative efficacy of these interventions.

OBJECTIVES

To assess the relative efficacy of commonly used treatments.

SEARCH STRATEGY

We searched the Cochrane Neuromuscular Disease Group Trials Register (April 2008), MEDLINE (January 1 1966 to April 18 2008), EMBASE (January 1 1980 to May 12 2008) and CINAHL (January 1 1980 to May 12 2008) for randomised controlled studies. Non-randomised studies were identified by searching MEDLINE (January 1 1966 to April 18 2008) and EMBASE (January 1 1980 to May 12 2008). We also inspected the reference lists of these studies to identify further studies.

SELECTION CRITERIA

We were unable to identify any randomised controlled or quasi-randomised controlled trials. We therefore looked for high quality observational studies meeting the following criteria:(1) At least five cases of meralgia paraesthetica.(2) Follow-up of at least three months after intervention (if any).(3) At least 80% of cases followed up.

DATA COLLECTION AND ANALYSIS

Relevant data from each study meeting the selection criteria were extracted independently by all three authors and transferred into a data extraction form created for the review.

MAIN RESULTS

We found no randomised controlled or quasi-controlled trials. Cure or improvement have been described in high quality observational studies:(1) A single study describes spontaneous improvement of meralgia paraesthetica in 20 (69%) out of 29 cases.(2) Four studies evaluating the injection of corticosteroid and local anaesthetic found cure or improvement in 130 (83%) out of a combined total of 157 cases.(3) Surgical treatments have been found to be beneficial in 264 (88%) out of 300 cases treated with decompression (nine studies); and 45 (94%) out of 48 cases treated with neurectomy (three studies).(4) Ninety-nine (97%) out of 102 patients with iatrogenic meralgia paraesthetica recovered completely (three studies).

AUTHORS' CONCLUSIONS

In the absence of any published randomised controlled or quasi-randomised controlled trials, the objective evidence base for treatment choices in meralgia paraesthetica is weak. High quality observational studies report comparable high improvement rates for meralgia paraesthetica following local injection of corticosteroid and surgical interventions (either nerve decompression or neurectomy). However, a similar outcome has been reported without any intervention in a single natural history study.