1. 2025;28;197-205A Comprehensive Review of Treatment Approaches to Ilioinguinal Neuralgia
   Narrative Review
   Anand S. Patil, DO, Mayank Gupta, MD, Nebojsa Nick Knezevic, MD, PhD, Whitman Oehlermarx, DO, Sudhir Diwan, MD, Rany T. Abdallah, MD, PhD, Mahendra Sanapati, MD, Amol Soin, MD, and Alaa A. Abd-Elsayed, MD.

BACKGROUND: Ilioinguinal neuralgia is a frequent cause of pain in the lower abdomen, genitals, and upper thighs and is commonly caused iatrogenically. Patients with ilioinguinal neuralgia often have a history of surgical interventions such as hernia repairs, appendectomies, or hysterectomies.

OBJECTIVES: The objective of this narrative literary review is to catalog and provide an organized level of evidence for the available interventions for treating ilioinguinal neuralgia.

METHODS: Research databases, including PubMed, CINAHL and Google Scholar, were searched for characterization, diagnosis, and treatment of ilioinguinal neuralgia. The included results comprised case studies, randomized trials, and meta-analyses. Interventions were organized from least to most invasive and sorted into 3levels (A-C). Level A consisted of data derived from multiple randomized clinical trials or meta-analyses. Level B consisted of data derived from single randomized trials or nonrandomized studies. Level C was composed of consensus opinions of experts, case studies, or standards of care.

RESULTS: The review finds the greatest level of evidence in support of the conservative management of pain through various classes of medications and topical treatments. Although injection-based interventions and neuromodulation approaches have been developed in the past few years, these techniques lack level A evidence from studies such as multiple randomized clinical trials or meta-analyses. The most invasive treatment discussed is surgical neurectomy, which also lacks level A evidence but has garnered support from retrospective reviews and prospective studies.

LIMITATIONS: Attempts were made to gather studies from large databases. However, we acknowledge that our efforts do not cover all known publications on the management of ilioinguinal neuralgia.

CONCLUSIONS: Based on the present literary review, the method of ilioinguinal neuralgia management with the strongest level of evidence in its favor is taking conservative measures, including topical and oral medications. The paper and accompanying original Table 2 provide a good summary of what current literature supports which treatment options.

KEY WORDS: Ilioinguinal neuralgia, thigh pain, spinal cord stimulation, peripheral nerve, dorsal root ganglion