Hip / Groin / Leg

Ilioinguinal Neuralgia

Definition

Ilioinguinal neuralgia is a neurological disorder due to lesions or dysfunction of this nerve and is accompanied by pain and neurological deficits in region of the ilioinguinal nerve.

Aetiology

Ilioinguinal neuralgia is caused by a traumatic lesion in lower abdominal incisions, such as the Pfannenstiel incision, appendectomy, 'bone harvesting' of the iliac crest, kidney biopsy, and inguinal hernia surgery. In inguinal hernia surgery 5-53% of patients have severe postoperative pain.

Signs and symptoms

The symptoms in ilioinguinal neuralgia neuropathy usually consist of an unpleasant painful feeling in the lower abdomen and groin, with pain radiating to the inner side of the upper leg, scrotum or greater labia. Patients complain of a characteristic burning, stabbing neuropathic pain.

Diagnostics

Physical Examination

Neurological examinations, particularly in the region of the ilioinguinal nerve, can confirm the diagnosis.

Additional Somatic Diagnostics

  • Diabetes must be excluded.
  • EMG of the ilioinguinal nerve.
  • Referral when there is suspicion of other aetiology.
  • RAND-36 (quality of life)
  • VAS Pain (maximal, minimal, actual, average/week)
  • PCS (catastrophising)
  • HADS (fear and depression)

Additional Psycho-cognitive Diagnostics

Multidisciplinary Treatment

Whether or not somatic treatment is indicated is based on the pain diagnosis.  Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment comprising various non-somatic treatments may be necessary.

Non-somatic Treatment

Somatic Treatment

Pharmacological treatment:

  • Tricyclic antidepressants
  • Anticonvulsives: carbamazepine, oxcarbazepine, gabapentine and pregabaline.

Interventional Pain Treatment