Skip to main content
SpringerLink
Log in

Ilioinguinal Neuropathy

  • Neuropathic Pain (A Abd-Elsayed, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this review is to present an overview of ilioinguinal (IL) neuralgia and evaluate the current literature.

Recent Findings

Treatment of IL neuralgia includes pharmacotherapies, perineural injections, radiofrequency ablation, cryoablation, neuromodulation, and neurectomy. The efficacy of these therapies varies considerably.

Summary

IL neuralgia is a common pain disorder characterized by pain in the lower abdomen and upper thigh. While various modalities can be used in the treatment of IL neuralgia, the efficacy of these modalities is at times limited. Dorsal root ganglion stimulation exhibits promise in the treatment of IL neuralgia. More research is needed to better address the needs of patients suffering from this disorder.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Stewart J. Focal peripheral neuropathies. New York: Raven Press; 1993. p. 411–8.

    Google Scholar 

  2. Knockaert DC, D’Heygere FG, Bobbaers HJ. Ilioinguinal nerve entrapment: a little-known cause of iliac fossa pain. Postgrad Med J. 1989;65(767):632–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Kopell HP, Thompson WA, Postel AH. Entrapment neuropathy of the ilioinguinal nerve. N Engl J Med. 1962;266:16–9.

    CAS  PubMed  Google Scholar 

  4. Hall M. National Center for Health Statistics. National Health Statistic Report. 2017. Available at: https://www.cdc.gov/nchs/data/nhsr/nhsr102. pdf. Accessed January 29, 2019.

  5. Loos MJ, Roumen RM, Scheltinga MR. Chronic sequelae of common elective groin hernia repair. Hernia. 2007;11:169–73.

    CAS  PubMed  Google Scholar 

  6. Bjurstrom MF, Nicol AL, Amid PK, Chen DC. Pain control following inguinal herniorrhaphy: current perspectives. J Pain Res. 2014;7:277–90.

    PubMed  PubMed Central  Google Scholar 

  7. Kopell HP, Thompson WA, Postel AH. Entrapment neuropathy of the ilioinguinal nerve. N Engl J Med. 1962;266:16–9.

    CAS  PubMed  Google Scholar 

  8. Alfieri S, Amid PK, Campanelli G, Izard G, Kehlet H, Wijsmuller AR, et al. International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery. Hernia. 2011;15:239–49.

    CAS  PubMed  Google Scholar 

  9. Friedman T, Richman D, Adler R. Sonographically guided cryoneurolysis: preliminary experience and clinical outcomes. J Ultrasound Med. 2012;31:2025–34.

    PubMed  Google Scholar 

  10. Byrd D, Mackey S. Pulsed radiofrequency for chronic pain. Curr Pain Headache Rep. 2008;12:37–41.

    PubMed  PubMed Central  Google Scholar 

  11. Elsakka KM, Basit H, Allam AE. Ilioinguinal Neuralgia. [Updated 2019 Jun 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538256/

  12. Cesmebasi A, Yadav A, Gielecki J, Tubbs RS, Loukas M. Genitofemoral neuralgia: a review. Clin Anat. 2014;28(1):128–35. https://doi.org/10.1002/ca.22481.

    Article  PubMed  Google Scholar 

  13. Amid PK. Radiologic images of meshoma a new phenomenon causing chronic pain after prosthetic repair of abdominal wall hernias. JAMA Surg. 2004;139(12):1297–8.

    Google Scholar 

  14. Andresen K, Rosenberg J. Management of chronic pain after surgery repair. J Pain Res. 2018;11:675–81.

    PubMed  PubMed Central  Google Scholar 

  15. Poobalan A, Bruce J, King P, et al. Chronic pain and quality of life following open inguinal hernia repair. Br J Surg. 2001;88:1122.

    CAS  PubMed  Google Scholar 

  16. Reinpol W, Nehls J, Eggert A. Nerve management and chronic pain after open inguinal hernia repair: a prospective two phase study. Ann Surg. 2011;254:163.

    Google Scholar 

  17. Banh D, Moujan P, Haqu Q, Han T. Permanent implantation of peripheral nerve stimulator for combat injury-related ilioinguinal neuralgia. Pain Physician. 2013;16:E789–91.

    PubMed  Google Scholar 

  18. Lichtenstein IL, Shulman AG, Amid PK, Montllor MM. Cause and prevention of postherniorrhaphy neuralgia: a proposed protocol for treatment. Am J Surg. 1988 Jun;155(6):786–90.

    CAS  PubMed  Google Scholar 

  19. Gofeld M, Christakis M. Sonographically guided ilioinguinal nerve block. J Ultrasound Med. 2006 Dec;25(12):1571–5.

    PubMed  Google Scholar 

  20. Kehlet H, Jensen T, Woolf C. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367:1618.

    PubMed  Google Scholar 

  21. • Cho HM, Park DS, Kim DH, Nam HS. Diagnosis of ilioinguinal nerve injury based on electromyography and ultrasonography: a case report. Ann Rehabil Med. 2017;41(4):705–8 Use of ultrasound and electromyography to diagnose IL neuralgia.

    PubMed  PubMed Central  Google Scholar 

  22. Aasvang EK, Gmaehle E, Hansen JB, Gmaehle B, Forman JL, Schwarz J, et al. Predictive risk factors for persistent postherniotomy pain. Anesthesiology. 2010;112(4):957–69.

    PubMed  Google Scholar 

  23. • Lange JF, Kaufmann R, Wijsmuller AR, et al. An international consensus algorithm for management of chronic postoperative inguinal pain. Hernia. 2015;19(1):33–43 Algorithm for treating inguinal pain.

    CAS  PubMed  Google Scholar 

  24. Bischoff J, et al. Lidocaine patch (5%) in treatment of persistent inguinal postherniorrhaphy pain. A randomized, double-blinded, placebo-controlled, crossover trial. Anesthesiology. 2013;119:1444–152.

    CAS  PubMed  Google Scholar 

  25. Bischoff JM, Ringsted TK, Petersen M, Sommer C, Uceyler N, Werner MU. A capsaicin (8%) patch in the treatment of severe persistent inguinal postherniorrhaphy pain: a randomized, double-blind, placebo-controlled trial. PLoS One. 2014;9(10):e109144.

    PubMed  PubMed Central  Google Scholar 

  26. Ilioinguinal/Iliohypogastric Nerve Block. Retrieved from http://www.usra.ca/regional-anesthesia/specific-blocks/trunk/ilioinguinalnerve.php

  27. Waldman RA, Willis S. A simplified approach to ultrasound guided ilioinguinal nerve block. Phys Med Rehabil Res 2016;1 https://doi.org/10.15761/PMRR.1000104

  28. • Khan JS, Raj A, Rajan S, Jackson TD, Bhatia A. A scoping review of perineural steroids for the treatment of chronic postoperative inguinal pain. Hernia. 2016;20(3):367–76 Review of perineural steroids.

    CAS  PubMed  Google Scholar 

  29. Bischoff JM, Koscielniak-Nielsen ZJ, Kehlet H, Werner MU. Ultrasound-guided ilioinguinal/iliohypogastric nerve blocks for persistent inguinal postherniorrhaphy pain: a randomized, double-blind, placebo-controlled, cross-over trail. Anesth Analg. 2012;114(6):1323–9.

    PubMed  Google Scholar 

  30. Thomassen I, van Suiklekon JA, van de Gaag A, et al. Ultrasound-guided ilioinguinal/iliohypogastric nerve blocks for chronic pain after inguinal hernia repair. Hernia. 2013;17(3):329–32.

    CAS  PubMed  Google Scholar 

  31. Randhawa K, Soumian S, Kyi M, Khaira H. Sonographic assessment of the conventional ‘blind’ ilioinguinal block. Can J Anaesth. 2010;57:94–5.

    PubMed  Google Scholar 

  32. Kastler A, Aubry S, Piccand V, Hadjidekov G, Tiberghien F, Kastler B. Radiofrequency neurolysis versus local nerve infiltration in 42 patients with refractory chronic inguinal neuralgia. Pain Physician. 2012;15:237–44.

    PubMed  Google Scholar 

  33. Lee K, Sin J, Patil P, Hanna A, Greenberg J, Zea R, et al. Ultrasound-guided microwave ablation for the management of inguinal neuralgia: a preliminary study with 1-year follow-up. J Vasc Interv Radiol. 2019;30:242–8.

    PubMed  Google Scholar 

  34. Makharita MY, Amr YM. Pulsed radiofrequency for chronic inguinal neuralgia. Pain Physician. 2015;18(2):E147–55.

    PubMed  Google Scholar 

  35. Werner MU, Bischoff JM, Rathmell JP, et al. Pulsed radiofrequency in the treatment of persistent pain after inguinal herniotomy: a systematic review. Reg Anes Pain Med. 2012;37(3):340–3.

    Google Scholar 

  36. Campos N, Chiles J, Plunkett A. Ultrasound-guided cryoablation of genitofemoral nerve for chronic inguinal pain. Pain Physician. 2009;12:997–1000.

    PubMed  Google Scholar 

  37. Kastler A, Aubry S, Barbier-Brion B, Jehl J, Kastler B. Radiofrequency neurolysis in the management of inguinal neuralgia: preliminary study. Radiology. 2012;262(2):701–7. https://doi.org/10.1148/radiol.11110727.

    Article  PubMed  Google Scholar 

  38. • Kale A, Aytuluk G, Cam I, Sunnetc B. Selective spinal nerve block in ilioinguinal, iliohypogastric, and genitofemoral neualagia. Turk Neurosurg. 2019;29(4):530–7 Use of selective nerve root block in the treatment of IL neuralgia.

    PubMed  Google Scholar 

  39. Rauchwerger J, Giordano J, Rozen D, Kent JL, Greenspan J, Closson CW. On the therapeutic viability of peripheral nerve stimulation for ilioinguinal neuralgia: putative mechanisms and possible utility. Pain Pract. 2008;8(2):138–43.

    PubMed  Google Scholar 

  40. Shaw A, Sharma M, Zibly A, Ikeda D, Deogaonkar M. Sandwich technique, peripheral nerve stimulation and hybrid stimulation for inguinal region and genital pain. Br J Neurosurg. 2016;30:631–6.

    PubMed  Google Scholar 

  41. • Schu S, Gulve A, ElDabe S, et al. Spinal cord stimulation of the dorsal root ganglion for groin pain-a retrospective review. Pain Pract. 2015;15(4):293–9 Dorsal root ganglion stimulation in the treatment of IL neuralgia.

    PubMed  Google Scholar 

  42. Levine AB, Steven DA, Parrent AG, MacDougall KW. Successful long-term nerve root stimulation for chronic neuropathic pain: a real world, single center Canadian experience. Pain Physician. 2017;20(2):95–106.

    PubMed  Google Scholar 

  43. Elias M. Spinal cord stimulation for post-herniorrhaphy pain. Neuromodulation. 2000;3(3):155–7.

    CAS  PubMed  Google Scholar 

  44. Lepski G, Vahedi P, Tatagiba MS, et al. Combined spinal cord and peripheral nerve field stimulation for persistent post-herniorrhaphy pain. Neuromodulation. 2013;16(1):84–8 discussion 88–89.

    PubMed  Google Scholar 

  45. • Morgalla MH, Fortunato M, Lepski G, Chander BS. Dorsal root ganglion stimulation used for the treatment of chronic neuropathic pain in the groin: a single center study with long-term prospective results in 34 cases. Neuromodulation. 2017;20(8):753–60 Prospective DRG stimulation study.

    PubMed  Google Scholar 

  46. Mol FMU, Roumen R, Scheltinga M. Comparing the efficacy of targeted spinal cord stimulation (SCS) of the dorsal root ganglion with conventional medical management (CMM) in patients with chronic post-surgical inguinal pain: the SMASHING trial. BMJ. 2018;18:18.

    Google Scholar 

  47. Zacest AC, Magill ST, Anderson VC, Burchiel KJ. Long-term outcome following ilioinguinal neurectomy for chronic pain. J Neurosurg. 2010;112(4):784–9. https://doi.org/10.3171/2009.8.jns09533.

    Article  PubMed  Google Scholar 

  48. Verhagen T, Loos MJA, Scheltinga MRM, Roumen RMH. The groin pain trial. Ann Surg. 2018;267(5):841–5. https://doi.org/10.1097/sla.0000000000002274.

    Article  PubMed  Google Scholar 

  49. • Liem L, Mekhail N. Management of postherniorrhaphy chronic neuropathic groin pain: a role for dorsal root ganglion stimulation. Pain Pract. 2016;7:915–23 Algorithm for treatment.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Division of Pain Medicine, University of Virginia, Charlottesville, VA, 22908, USA

    Lynn Kohan MD, Colleen McKenna MD & Anna Irwin DO

Authors
  1. Lynn Kohan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Colleen McKenna MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anna Irwin DO
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lynn Kohan MD.

Ethics declarations

Conflict of Interest

The authors declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Neuropathic Pain

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kohan, L., McKenna, C. & Irwin, A. Ilioinguinal Neuropathy. Curr Pain Headache Rep 24, 2 (2020). https://doi.org/10.1007/s11916-020-0833-6

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11916-020-0833-6

Keywords

Search

Navigation