Systematic Approach to the Management of Neuropathic Groin Pain: A 20-year Retrospective Cohort Study

The diagnosis of neuropathic groin pain can be difficult because lumbosacral plexus nerve branches overlap in this anatomically complex region. We reviewed patients over 20 years and present our step-wise approach to the evaluation and management of neuropathic groin pain.

We retrospectively analyzed adults (18 y or older) evaluated between June 2006 and January 2025 for groin pain localized to 1 or more peripheral nerves: iliohypogastric, ilioinguinal, genitofemoral, lateral femoral, femoral, and obturator. Patients were stratified by (1) physical examination findings, (2) symptom duration, (3) response to image-guided diagnostic and/or therapeutic blocks, and (4) operative treatment. Pain was assessed with the numeric rating scale (0-10) and functional scores on a 0%-100% scale (poor <25%, fair <50%, good 50%-74%, excellent ≥75%). Pre- versus postintervention outcomes were compared. Minimum follow-up was 6 months.

Of 501 patients, 386 (77%) underwent diagnostic blocks, and 291 (58%) proceeded to surgery on 686 nerves (lateral femoral = 209; ilioinguinal = 192; iliohypogastric = 163; genitofemoral = 112; femoral = 8; obturator = 2). Mean numeric rating scale scores decreased from 6.1 ± 1.9 to 1.4 ± 2.1 (P <0.001), and mean functional scores improved 80% from baseline (P < 0.001). At last follow-up (mean 47.9 ± 62.2 mo), functional scores were excellent in 71% of patients, good in 17%, fair in 7%, and poor in 4.8% (P < 0.001).

Neuropathic groin pain is frequently multifactorial, but may be approached systematically with an algorithm consisting of diagnostic and therapeutic nerve blocks. This method enables precise nerve-targeted surgery with selective decompression or neurectomy, decreased pain scores, and increased functional scores with minimal morbidity.