Open AccessSuccessful Treatment of Meralgia Paresthetica with Pulsed Radiofrequency of the Lateral Femoral Cutaneous Nerve
Author(s) -
Kenneth D. Candido
Publication year - 2009
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2009/12/881
Subject(s) - medicine , pulsed radiofrequency , inguinal ligament , surgery , femoral nerve , dysesthesia , neuropathic pain , anterior superior iliac spine , lumbosacral plexus , gabapentin , thigh , mononeuropathy , nerve compression syndrome , anesthesia , neuromodulation , fascia lata , sensory loss , pain relief , peripheral neuropathy , stimulation , alternative medicine , pathology , endocrinology , diabetes mellitus
Background: Meralgia paresthetica is a rarely encountered sensory mononeuropathy characterized by paresthesia, pain or sensory impairment along the distributionof the lateral femoral cutaneous nerve caused by entrapment or compression of thenerve as it crosses the anterior superior iliac spine and runs beneath the inguinalligament.Objective: We describe the first reported use of pulsed radiofrequency neuromodulation to relieve the intractable pain associated with meralgia paresthetica.Case Report: A 33-year-old morbidly obese female with a history of lower back painand previous spinal fusion presented with sensory dysesthesias and paresthesias in theright anterolateral thigh, consistent with meralgia paresthetica. Temporary relief occurred with multiple lateral femoral cutaneous nerve and fascia lata blocks at 2 different institutions. The patient expressed dissatisfaction with her previous treatmentsand requested “any” therapeutic intervention that might lead to long-lasting pain relief. At this time, we located the anterior superior iliac spine and reproduced concordant dysesthesia. Pulsed radiofrequency was then undertaken at 42°C for 120 seconds followed by dexamethasone and bupivicaine. The patient reported exceptionaland prolonged pain relief at 6-month follow-up.Limitations: Since this case report is not a prospective, randomized,controlled orblinded study, no conclusions may be drawn from the results attained on behalf ofthis single individual. Additional, larger group analyses studying this technique whileeliminating bias from patient variables would be essential prior to assuming any validity to using pulsed radiofrequency techniques of neuromodulation for managing peripheral neuropathic pain processes.Conclusion: The patient had experienced long-standing pain that was recalcitrantto conservative/pharmacologic therapy and multiple nerve blocks with local steroidinstillations. A single treatment with pulsed radiofrequency resulted in complete andsustained cessation of pain. No side effects were evident. Pulsed radiofrequency ofthe LFCN may offer an effective, low risk treatment in patients with meralgia paresthetica who are refractory to conservative medical management or are unwilling orunfit to undergo surgery.Key words: Meralgia paresthetica, pulsed radiofrequency, lateral femoral cutaneous nerve