Inguinal neuralgia is a painful, relatively rare condition localized in the groin area. It occurs when the nerves in the pelvis become damaged or irritated. One of the most common causes of this chronic condition is ancillary damage during hernia repair surgery, but it may also result when post-surgery scar tissue from staples, sutures or the procedure itself entraps the nerves and compresses them. Less commonly, traumatic injury may produce this condition, and very rarely, it can occur spontaneously.
Signs of inguinal neuralgia include localized tingling sensations, burning pain or, less frequently, numbness in the abdominal area and genitals. These symptoms may extend into the upper thigh but not below the knee. Stretching the lumbar section of the spine is likely to worsen the pain because it exerts pressure on the ilioinguinal nerve. If not treated, inguinal neuralgia may eventually cause bulging in the muscles of the abdominal wall, similar to the presentation of a hernia.
A patient with this neurological condition may tend to bend forward slightly in an effort to ameliorate the pain. He or she may experience a loss of sensation in the inner thigh or weakness in the anterior abdominal wall.
The Inguinal Nerves
Three primary nerves transmit pelvic pain:
These nerves originate in the spinal cord and branch into the lumbar plexus from both sides of the spine. The femoral branch innervates the top section of the thigh while the genital branch regulates feeling in the genital areas in both men and women. Therefore, inguinal neuralgia may present as chronic pain in any of these regions.
Several options are available for treating the pelvic pain of inguinal neuralgia, and consulting with a pain doctor is a critical first step. Due to the location of the nerves, the condition presents such treatment challenges as pinpointing the source of the pain.
Oral pain medication is typically the initial step to symptomatic relief. However, this is a temporary measure that does little to address the cause of inguinal neuralgia. Taking anti-inflammatory drugs and avoiding prolonged periods of sitting or squatting help keep the symptoms from worsening.
If this conservative treatment approach is ineffective, one of the more targeted treatments most physicians suggest is a peripheral nerve block which is a treatment that focuses on the local region of pain rather than its specific point of origin. This is often performed under ultrasound guidance to pinpoint the nerve that is likely causing the pain. Pulsed radiofrequency (PRF) therapy is another option that provides relief for some patients. It does not harm the nerves like traditional radiofrequency therapy can, so PRF is less painful. In a study reported in the Mount Sinai Journal of Medicine, four out of five patients with chronic ilioinguinal neuralgia experienced relief from pain for up to nine months after PRF therapy.
While many patients who develop inguinal neuralgia following hernia repair are pain-free within six months, more persistent or severe symptoms may indicate the need for surgery. Neurectomy, the surgical removal of a section of nerve, often achieves favorable results. Administration of a nerve block helps the neurosurgeon determine the exact source of the pain, enabling accurate removal of scar tissue and relief of nerve pressure. Endoscopic neurectomy is a minimally invasive procedure that can produce significant pain relief in select patients.