Expert: Scott F. Gillman, DC, DACBSP - 3/19/2007

Question
QUESTION: I am a self diagnosed meralgia paresthetica sufferer.  My OD prescribed PT and an antinflammatory.  It has five days since this started and I am not getting any sleep.  The pain is horrific in my right thigh only.  PT treatment has been limited to a tens unit on my lower back, ice packs, and massage.  Nights are the worse in terms of pain.  Cannot find any comfortable position.  Writing to you at 5am, after being up since 1:30.  Same routine for last four nights.  Should I be stretching?  How?  How often?  Pain killer only works during the day...no effect at night for some reason, maybe because I am lying down?
ANSWER: David,

Meralgia paresthetica is caused from frank compression of a nerve (lateral femoral cutaneous nerve) as it passes under the inguinal ligament.  It would be helpful to get it diagnosed.  Did you mean D.O. (osteopath) instead of O.D.?
Classically, the treatment involves wearing loose-fitting clothing, getting modalities such as pulsed ultrasound (with or without electric stimulation) over the nerve area, and manual methods including massaging and stretching the area.  Meralgia paresthetica has nothing to do with your lower back. It comes from the front of your hip and lower abdomen area.   For your own good and safety, you must get your condition more accurately diagnosed before any recommendations can be made.  FYI: Tens doesn't fix anything.

'Good luck,

Dr. G

---------- FOLLOW-UP ----------

QUESTION: Two days after I posted my question, I broke out into a rash on my thigh.  I have shingles.  My doctor (D.O.) said he couldn't make the diagnosis without the rash (he thought it was sciatica but pain was on the front of my leg, not in back).  Too late to start shingles medication becuase it took so long for the rash to surface.  All pain sufferers should be alerted to shingle possibility.  I am physically fit, 41 years old, 5-9 and 150 lbs.  Shingles can happen to anybody who has had chicken pox.  Who knew!

Answer
David,

Shingles! All too common and a poser of other conditions.  Nevertheless, on physical examination, when tests don't match signs and symptoms, conditions like shingles must be considered.  This is one of the limitations of on-line information sites like AllExperts.com.  Without having all the data, it's difficult sometimes to make recommendations.  That's why I urged you to get a more accurate diagnosis. Meralgia paresthetica can easily be diagnosed, and searing thigh pain is not typical of myofascitis or an SI joint problem.  The clue for Shingles is that the pain would follow a "dermatome" pathway along the skin, the zone where the infected nerve ultimately emerges at the skin.  With your initial exam by the D.O., this pain location should have been identified via a pain picture or your verbal description.  That would have been another clue that it could be shingles.   The good news is that shingles is self limiting, though some people have a residual "post herpetic neuralgia" that can last for many years. You need to discuss this with your D.O.

'Regards,

Dr. G