Treatment of idiopathic meralgia paresthetica - is there reliable evidence yet?

ObjectiveMeralgia 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.MethodsA 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.ResultsHigh-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.DiscussionReliable high-quality evidence on the treatment of idiopathic meralgia paresthetica is lacking at the current state, and challenges in clinical decision-making remain.