Definition and Diagnosis

Groin pain secondary to damage or irritation of the ilioinguinal, iliohypogastric, and/or genitofemoral nerves in the pelvis or groin. Inadvertent damage or scar tissue from previous operations, especially hernia repairs, is often the cause. Although history and examination is important, it often is not possible to determine which nerve is injured. Point tenderness, however, is quite useful in localizing the problem. Imaging and electrical tests have limited utility in confirming this diagnosis, and are performed on a case-by-case basis. Diagnostic nerve blocks at the hip and near the spine are important for diagnosis.

Treatment Options

Radiograph of spinal nerve stimulator on the L1 nerve root (courtesy of Alon Mogilner, MD, PhD, Harvey Cushing Institutes of Neuroscience)

Trigger point injections, peripheral nerve blocks, and spinal nerve blocks are useful for initial management of the pain. No FDA-approved medications specifically for this type of nerve injury are available. The majority of patients with inguinal neuralgia after hernia surgery have a resolution of their pain in three to six months.

If the pain persists, exploratory surgery is an option. Traditionally, the affected nerves are removed from scar and cut, which replaces the pain with an area of numbness. Although the majority of patients who under go this surgery have relief or improvement, its long-term efficacy is uncertain. If this surgery fails, the next option is a selective L1 spinal nerve stimulator, which is becoming a more popular treatment.