General Guideline Principles for Meralgia Paresthetica
for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Meralgia Paresthetica.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Introduction of Meralgia Paresthetica

Meralgia paresthetica is a peripheral entrapment neuropathy of the sensory nerve that supplies the upper lateral portions of the thigh, the lateral femoral cutaneous nerve. Although a nerve entrapment can happen anywhere along the nerve, localised pressure in the vicinity of the inguinal ligament is the most prevalent cause of the ailment.

It has been ascribed to pressure from tight, bulky tool belts or military gear in an occupational situation. The onset could be gradual or quite acute (such after just one night of sleep). Other causes include systemic rheumatological insults, trauma, scarring from earlier trauma or surgery, and scarring. There are tingling and numbness in the area where the nerve is distributed as symptoms. Absence, minor, or (occasionally) severe pain are all possible. No muscle weakness exists.

Diagnostic Studies of Meralgia Paresthetica for workers compensation patients

1. Magnetic Resonance Neurography

   Magnetic Resonance Neurography is recommended for the meralgia paresthetica diagnosis.

   Indications: The majority of cases are successfully diagnosed clinically and treated empirically, without the need for testing. To confirm the diagnosis and more precisely pinpoint the site of entrapment for the operational approach, testing is indicated prior to surgery.

   Rationale: Imaging is typically not necessary because the diagnosis is typically made on the basis of clinical evidence. A nerve conduction investigation is advised to confirm the diagnosis and pinpoint the entrapment for patients in whom there is either a significant doubt regarding the correctness of the diagnosis or for whom surgery is being considered.

    

2. Nerve Conduction

   Nerve Conduction Study is recommended to identify the entrapment and validate the meralgia paresthetica diagnosis.

   Indications: The majority of cases are successfully diagnosed clinically and treated empirically, without the need for testing. To confirm the diagnosis and more precisely pinpoint the site of entrapment for the operational approach, testing is indicated prior to surgery.

   Frequency/Dose/Duration: Once. Should typically wait to be prescribed after symptoms have lasted for at least three weeks in order to give electrical results enough time to develop.

   Rationale: Imaging is typically not necessary because the diagnosis is typically made on the basis of clinical evidence. A nerve conduction investigation is advised to confirm the diagnosis and pinpoint the entrapment for patients in whom there is either a significant doubt regarding the correctness of the diagnosis or for whom surgery is being considered.

Medications of Meralgia Paresthetica

Ibuprofen, naproxen, or other NSAIDs from an earlier generation are suggested as first-line treatments for the majority of patients. For patients who are not candidates for NSAIDs, acetaminophen (or the analogue paracetamol) may be a viable alternative, even if the majority of research indicates it is just marginally less effective than NSAIDs.

There is proof that NSAIDs are less dangerous and just as effective in treating pain as opioids, such as tramadol.

1. Non-Steroidal Anti-inflammatory Drugs (NSAIDs)

   Non-Steroidal Anti-inflammatory Drugs (NSAIDs) is recommended for the treatment of paresthesia pain.

   Indications: NSAIDs are advised as a therapy. First, try over-the-counter (OTC) medications to see whether they work.

   Frequency/Duration: Many patients could find it reasonable to use as needed.

   Indications for Discontinuation: Meralgia paresthetica clearing up, lack of effectiveness, or emergence of side effects requiring discontinuation.

    

2. NSAIDs for Patients at High Risk of Gastrointestinal Bleeding

   NSAIDs for Patients at High Risk of Gastrointestinal Bleeding is recommended Misoprostol, sucralfate, histamine Type 2 receptor blockers, and proton pump inhibitors are commonly used together by individuals who are at high risk of gastrointestinal bleeding.

   Indications: Cytoprotective drugs should be taken into consideration for patients with a high-risk factor profile who also have indications for NSAIDs, especially if a prolonged course of treatment is planned. Patients who have a history of gastrointestinal bleeding in the past, the elderly, diabetics, and smokers are at risk.

   Frequency/Dose/Duration: H2 blockers, misoprostol, sucralfate, and proton pump inhibitors are advised. dosage recommendations from the manufacturer. It is generally accepted that there are no significant differences in effectiveness for preventing gastrointestinal bleeding.

   Signals of Discontinuation Intolerance, the emergence of negative effects, or the stopping of NSAIDs.

    

3. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

   The advantages and disadvantages of NSAID therapy for pain should be explored with patients who have a history of cardiovascular disease or who have several cardiovascular risk factors. It is advised to start with acetaminophen or aspirin as these medications seem to be the least dangerous in terms of cardiovascular side effects.

    

4. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

   NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended If necessary, non-selective NSAIDs are recommended to COX-2-specific medications. To reduce the chance that an NSAID will negate the protective effects of low-dose aspirin in individuals receiving it for primary or secondary cardiovascular disease prevention.

   The NSAID should be taken at least 30 minutes after or eight hours before the daily aspirin. for treatment of meralgia paresthetica, particularly in patients with contraindications for NSAIDs.

   Indications: All patients with meralgia paresthetica pain, including acute, subacute, chronic, and post-operative. Dose/Frequency: Per manufacturer’s recommendations; may be utilized on an as-needed basis. There is evidence of hepatic toxicity when exceeding four gm/day.

   Indications for Discontinuation: Resolution of pain, adverse effects or intolerance.

    

5. Topical Lidocaine of Meralgia Paresthetica

   Topical Lidocaine of Meralgia Paresthetica is not recommended for the treatment of meralgia Paresthetica.

Treatments of Meralgia Paresthetica

1. Hot and Cold Therapies

   Hot and Cold Therapies are recommended meralgia paresthetica.

   Indications: All patients with meralgia paresthetica.

   Frequency/Duration: Approximately three to five self-applications per day as needed.

   Indications for Discontinuation: Resolution, adverse effects, non-compliance.

    

2. Heat Therapy of Meralgia Paresthetica

   Heat Therapy of Meralgia Paresthetica is recommended meralgia paresthetica.

   Indications: All patients with meralgia paresthetica.

   Frequency/Duration: Approximately three to five self-applications per day as needed.

   Indications for Discontinuation: Resolution, adverse effects, non-compliance.

Injection Therapy of Meralgia Paresthetica

Glucocorticosteroid Injections

Glucocorticosteroid Injections is recommended for the treatment of meralgia paresthetica if more conservative treatments are not efficacious.

Indications: Meralgia paresthetica sufficiently severe and not responding to other more conservative, non-invasive treatments.

Frequency/Dose/Duration: One injection. A second injection is not warranted if there is sufficient recovery from the first.

Surgery of Meralgia Paresthetica

Surgical releases

Surgical releases are recommended for treatment of select patients with meralgia paresthetica.

Indications: Patients who both have continued symptoms unresponsive to the above treatments and in whom symptoms are sufficiently severe to warrant invasive treatment. Should have diagnosis and site of entrapment confirmed by either Nerve
conduction study or MR neurography.

Rationale: A nerve conduction study or MR neurography is advised for patients in whom there is either a significant doubt regarding the correctness of the diagnosis or for whom surgery is being considered in order to confirm the diagnosis and locate the entrapment.

Surgery is rarely necessary, however it is advised for people whose symptoms are severe enough to require invasive therapy and who also continue to experience symptoms that are unresponsive to the aforementioned treatments.

Other of Meralgia Paresthetica

Spinal Cord Stimulator

Spinal Cord Stimulators are not recommended for the treatment of people who suffer from paresthetic meralgia.

What our office can do if you have Meralgia Paresthetica

We have the experience to help you with their workers compensation injuries. We understand what you are going through and will meet your medical needs and follow the guidelines set by the New York State Workers Compensation Board.

We understand the importance of your workers compensation cases. Let us help you navigate through the maze of dealing with the workers compensation insurance company and your employer.

We understand that this is a stressful time for you and your family. If you would like to schedule an appointment, please contact us so we will do everything we can to make it as easy on you as possible.