How Do You Treat Meralgia Paresthetica?

Causes of meralgia paresthetica include anything that can cause the lateral femoral cutaneous nerve to become entrapped.

Meralgia paresthetica is burning nerve pain, numbness, and tingling on the outer thigh caused by compression of the nerve that runs from the spinal column to the thigh (lateral femoral cutaneous nerve). 

Symptoms of meralgia paresthetica include:

• Pain, numbness and tingling, and diminished sensation on the upper outer thigh
• Pain may be described as burning, stinging, or "pins and needles"
• Pain may worsen with prolonged walking or standing, and is relieved by sitting
• There may be itching 
• Light touch (such as from clothing) may cause unpleasant sensations
• Symptoms are usually present on one side, though they can occur on both sides in about 20% of cases

Causes of meralgia paresthetica include anything that can cause the lateral femoral cutaneous nerve to become entrapped, such as:

• Obesity
• Tight clothing, waistbands, or belts
• Pregnancy
• Work-related equipment such as tool belts worn by carpenters, duty belts worn by policemen, and body armor worn by soldiers 
• Compression from a wallet
• Lying in the fetal position for prolonged periods
• Remaining in the prone position after certain surgeries
• A prolonged leaning of a thigh against a table, bench, or other surfaces
• Diabetes mellitus
• Ascites (excess fluid in the abdomen)
• Carrying heavy objects supported by the thigh
• Groin trauma such as a seat belt injury in a car crash
• Distance walking, cycling, or circuit training
• Masses (tumors, hematomas) (rare)

The condition is more common in people as they age, with symptoms appearing at an average age of 50 years. 

To diagnose meralgia paresthetica, a doctor will get a medical history and ask about any risk factors such as recent weight gain, wearing tight-fitting clothing, or exercise habits that may indicate compression of the lateral femoral cutaneous nerve.

A neurologic examination of the lower extremities should be performed:

• Sensory examination with pinprick and a light touch of the affected thigh
• Motor examination including muscle strength testing of lower extremity major muscle groups such as hips, thighs, knees, ankles, and feet
• Testing reflexes in the legs 

Additional testing to diagnose meralgia paresthetica may include:

• Imaging 
  • Magnetic resonance imaging (MRI) of the lumbosacral spine 
  • Pelvic MRI 
  • Computed tomography (CT) 
• Nerve conduction studies (NCS)/electromyography (EMG)

The foundation of treatment for meralgia paresthetica is removing the compression that is causing the symptoms. This may involve: 

• Weight loss in obese patients
• Wearing loose-fitting clothing
• Over-the-counter (OTC) medications such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for pain
• Focal nerve block for severe pain
• Neurogenic pain medications such as carbamazepine or gabapentin (not always helpful but may benefit some patients)

In rare and painful cases of meralgia paresthetica unresponsive to a nerve block, surgery may be indicated:

• Surgical release – Decompression of the nerve 
• Nerve transection – Completely cures symptoms, but results in permanent loss of feeling (anesthesia)

Most cases of meralgia paresthetica go away slowly on their own over time. In a minority of cases, nerve pain, numbness, and tingling may persist despite treatment. 

Meralgia paresthetica may be prevented by:

• Wearing loose-fitting clothing
• Maintaining a healthy weight
• Exercising regularly
• Taking breaks from long periods of standing, walking, cycling, circuit training, or any activity that aggravates the nerve
• Not carrying heavy objects supported by the thigh
• Managing diabetes