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

Background: 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. Methods: 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. Results: 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). Conclusions: 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.