Page 122 - Journal of Special Operations Medicine - Spring 2017

264 (88%) of 300 cases, and three surgical studies in- Conclusion
volving neurectomy found benefit in 45 (94%) of 48 Although MP occurs rarely, medical care providers are
combined cases. One case series of 277 patients not likely to encounter cases of MP during their careers, es-
25
reported in the systematic review found that 50% of pecially if they are involved with Soldiers who perform
37
patients responded well to conservative treatment in- regular operations involving load carriage. MP should
volving removal of compression, application of ice to be considered when there is pain, itching, paresthesia,
the affected area, and NSAID medication. For persistent and other sensory changes in the anterolateral thigh.
discomfort, local anesthetic agents and corticosteroids Numerous diagnostic tools are available involving joint
were recommended, but the success of this method was and muscle mobilization, nerve blocks, somatosensory
not reported. 25
evoked potentials, sensory nerve conduction studies,
high-resolution ultrasound, and MRI.
In several studies, pulsed radiofrequency treatment
was shown successful in relieving pain associated with Initial treatment should be conservative, with removal
MP, 38–40 including one involving a female Servicemem- of the compression and use of NSAIDs and topical
ber. More recently, a case series was reported on 11 capsaicin or tacrolimus. If these are unsuccessful in pro-
41
patients with intractable MP who were provided pulsed viding relief, other treatment options, including local
radiofrequency treatment. On the 10-point visual ana- steroid injections, pulsed radiofrequency treatment, and
42
log pain scale (0cm = no pain, 10cm = worst possible surgery, should be considered. Always consider the need
pain), patients rated their pretreatment pain level (mean for further evaluation for such findings such as intra-ab-
± standard deviation) at 6 ± 1. At both posttreatment dominal masses, diabetes or other causes of peripheral
and at 6 months of follow-up, pain was rated at 1 ± 1. neuropathic conditions, and hip or other orthopedic
Seven patients were pain free, three had pain relief, and pathological disorders, particularly if symptoms do not
one had a recurrence of pain. This treatment modality resolve with nonsurgical treatments. The primary goal
provides a nonsurgical alternative for patients with MP should be prevention, but if the condition manifests, the
who have not responded to other conservative therapies.
objective will be to reduce pain and restore the LFCN
function so that the Soldier can perform as a more effec-
Acupuncture was found effective in relieving MP pain tive part of the unit.
in one observational case series involving 10 patients.
43
Two to eight electroacupuncture treatments were as-
sociated with a >90% improvement in pain scores in Acknowledgment
follow-up periods ranging from 2 to 36 months. The We thank Ryan Steelman for assistance with the figures
mechanism by which acupuncture may be effective is and obtaining references.
not clear, although some have strongly argued that
44
it may act by blocking neural impulses. One system-
45
atic review on acupuncture effectiveness included only Disclaimer
46
conditions involving acupuncture, placebo acupuncture,
and no acupuncture studies (N = 13 conditions) and pa- The views expressed in this presentation are those of the
tients with a wide variety of painful conditions. Pain authors and do not necessarily reflect the official policy
reduction amounted to 4mm on a 100mm visual ana- of the Department of Defense, Department of the Army,
log scale (i.e., 4% reduction in pain) in the acupuncture US Army Medical Department or the US Government.
condition compared with the placebo acupuncture, and The use of trademark names does not imply endorse-
10mm (i.e., 10% reduction in pain) in the acupuncture ment by the US Army but is intended only to assist in the
condition compared with the no-acupuncture condition. identification of a specific product.
Thus, acupuncture appears to be another nonsurgical
treatment option, but further research on its effective- Disclosures
ness for pain relief in MP is necessary.
The authors have nothing to disclose.
Finally, a recent review noted that several case reports
26
have been published that describe relief of MP symp-
toms in some patients after soft-tissue manipulation or References
manual therapy applied by a chiropractor or physical 1. National Institutes of Health. Paresthesia information page.
therapist. This soft-tissue therapy was designed to im- https://www.ninds.nih.gov/Disorders/All-Disorders/Paresthe-
prove the mobility of the LFCN through the soft tissues sia-Information-Page. Accessed 14 September 2016.
that surround it. However, the research evidence to sup- 2. Pearce JMS. Meralgia paresthetica (Bernhardt-Roth syn-
drome). J Neurol Neurosurg Psychiatry. 2006;77:84.
port this approach is currently weak and further, more 3. Shalev R, Charniles J, Margaliot S. To the editor. Aviat Space
rigorous research is required. Environ Med. 1982;7:290.

98 Journal of Special Operations Medicine Volume 17, Edition 1/Spring 2017