meralgia paresthetica and lidoderm patches
 

Hi there!
I've been suffering from meralgia paresthetica since October 2010. My doctor told me that this condition will disappear by itself within 1 year. I hope he's right because I hate this pain!!!
I've bought some expensive lidoderm patches and they bring me some relief when I apply them at the painful areas.
Now I've read that mrsD applies them at the root of the nerve, not at the leaves. This sounds reasonable for me. But where is the root? Is it the same point where the nerve block with lidocaine is done? Must I use the whole patch in this area? Or is a little peace directly placed over the root enough? (then I could use the rest of the patch for my painful areas)
mrsD, could you give me some advice? your're the specialst in lidoderm patches:)
I'm quite desperate:-( and would love to talk to other persons with the same problem:grouphug:

Hi Penny, and welcome to NeuroTalk.

It took me several patches to find my "sweet spot"...

I used this picture to help me place my patch:

http://www.aafp.org/afp/20000401/2109.html
scroll down to Fig. 2b.

It shows the nerve emerging from the abdomen in two places.

I used to cut the patch in half, and place each over that spot in the upper thigh/groin.

You can also try your back in the lumbar area...this would need a full patch, put on vertically.

This link has a link in it to a graphic at Healthonline:
http://neurotalk.psychcentral.com/sh...light=Lidoderm

Showing the nerve paths. Lidocaine works by blocking the transmission of the signal up to the spine. Placed at the end points where you feel pain, is not very effective because of those nerve endings and how they work. You want to intercept at a point where the little branches coalesce into one solid nerve.

It takes a few days to get going...it is not an instant result. It may be a couple of hours before the drug diffuses deeply enough to reach the nerve. I found that 2 weeks every day finally suppressed my pain. I had it for YEARS, and it did not go away by itself. Also I discovered HEAT set it off quite a bit, so no more hot baths, or steam room visits. In fact you could try an ice pack on your back during your off times with the patch.

Thank you so much for your quick answer!
I must confess, I'm not a native English speaker (I'm German) and I still don't understand which 2 places you mean...:confused: I've read all your posts about lidoderm placement, but I still don't get it:confused:
I can only find one place for the patch, not two. I've made a picture that shows where I place my patch. Could you please explain (for Germans :D) where the second place is? Thank you very much in advance!
This forum is really great - we don't have such a forum in Germany....

On that picture is a second nerve exiting the groin, called the femoral nerve. Place the other half of the patch over that area.

In other words, because people have different anatomies, you might have the nerve not exactly in the place shown on the photo. Place the 2 halves of the patch next to each other, in that area to assure you hit the nerve spot. I put mine more on the thigh part, and not the lower abdomen, because the thick ligament may be a barrier for the drug to penetrate.

The nerve goes UNDER that ligament and exits into the thigh.
Where is comes out, is where you put the patch. If you put the patch too high up into the abdomen, the ligament may be in the way.

I know it sounds complicated, but once you do it, it will be easier.

Also make sure you do not have lotion or oils on your skin, or the adhesive may not stick. Lidoderms are trickey. You may have to use tape to make sure they do not move around, if there is any sweating present too. That is just the way they have been made.

On this picture the red areas are marked for the patches.
(ignore the green area-- as that is something else)

Thanks!!
 

Thank you so much for your answer and the picture! Now I got it!:cool:
I didn't know that you numb two nerves. I always thougt that only the cutaneus femoris lateralis is damaged when you have meralgia paresthetica. I didn't know that the femoral nerve is affected, too. That explains why I have pain in the front side of my leg, too.
I've placed my two patch pieces on the areas you've marked in your picture. I'll keep you posted how it works!
Thanks a lot!!!

Normally the femoral nerve is not affected... BUT...

Every person has slightly different anatomy. One person's Lateral Femoral nerve may be closer to the side of the thigh, and another's may be more toward the center of the thigh.

So since we cannot see inside of ourselves, we don't know the precise exact spot where that nerve comes out of the deeper portion of the abdomen.

I just had more luck with the two halves placed lengthwise over that half of the thigh, than one big patch on the side. I had alot of pain in the top center of my thigh. That is where I had a shot of demerol and phenergan after my C-section surgery. It has been learned that phenergan is very destructive to tissue, and perhaps it damaged me there as well. (it can cause necrosis in worst case scenarios).

In any event, that nerve comes to the surface from deeper in the abdomen, and it is easy to intercept with the Lidocaine at that spot.

Over the years, I have read patients on forums complain of muscle issues too with MP. Either they are misdiagnosed or the femoral nerve is affected sometimes too. I just go with what I know works, that's all.

Yeah, now I understand!! You place your patches at this two areas to be sure you hit the nerve.
Luckily I got a nerve block from an anesthesist two weeks ago. He searched for the exact place with ultrasonic and than injected lidocain. There's still a little red point on my hip from this injection. So... when I place my patch over this little red point - I think I'll hit excactly the nerve, don't I?:-)
btw thanks for your general lidoderm advice. Luckily I have very dry skin so the patch sticks like glue.
Sadly my insurance doesn't pay for the patches. But when you are in pain you pay nearly every amount for relieve...

It is possible the doctor injected deeply at your red dot point.
The needle allows for penetration.

The patches work better on shallow places...so use that point as a locator but if it is over that ligament, move down a bit to the thigh.

I think repeated use of Lidocaine can turn off a nerve that was irritated, in the past. Lidocaine is a sodium channel blocker so it closes off the impulse as it moves along the nerve.

If a person had an injury, or like me a surgery that irritated it, that person may see a remission. But if the trigger or compression continues....like tight clothing or a tumor or swelling internally, success may be limited and surgery needed ultimately. I don't think EVERYONE needs surgery, but some might. I have 90% resolution...but heat will still provoke a stab now and then. Or overextension, by using exercise like a bike.
But before the patches, I had pain 24/7 and sometimes it was so bad it would stop me cold from doing anything!

I had a vertical long incision in my abdomen for my C-section because the doctors thought I had a tumor, so an exploratory was done at the same time...lots of pressure and moving things around. I had terrible ileus too, afterword, which happens when they move intestines around. That is when the nerve got compressed I think, and/or that injection of Mepergan into the thigh in recovery.

lidoderm patches
 

You are right about Lidoderm patches - they are generally only effective when the affected nerve is superficial. Therefore, for the ilioinguinal or the genitofemoral (or their distal branches) the patch can be very effective symptom management. However, even in those cases the patch is not a permanent solution as the underlying problem (nerve compression or a neuroma from a nerve injured during your expolratory laparotomy procedure) is still present. In addition, as noted by others on this thread, lidoderm patches are ineffective in other areas, because the nerves that are affected are simply too deep and the lidocaine dermal preparation isn't designed to penetrate that far through the skin. For example, those who have posted trying to put the patches in a paraspinal (i.e. along the spine) location are unlikely to find success as the nerve roots are very deep in those locations and lidocaine in the patch will never get there.

need no surgery
 

Thanks for the information, drp. I know that surgery is a good option for MP.
But my doctor told me that I'm not a candidate for the surgery. My MRT was normal and the nerve conduction velocity test, too. My doctor told me that my nerve is not compressed, but irritaded. And this condition will go away by itself within 3-12 months. During this time I can use the lidoderm patches for relief.

You seem to be a MP specialist. Is my doctor right? Are there really cases in which MP disappears by itself?I have MP since October 2010 with various pane levels.

I really don't think MP goes away by itself. I had it for over 15 yrs before the Lidoderms came out. It got worse each year!
Now it is just a light numbness... I rarely get the 100 bee sting pain anymore. (Heat and over-extending the leg can bring back twinges). I have to wonder at the definitions of MP..on some sites.. tingling... ppppfffffftttttt. I never had tingling. It started with a feeling of hot water running down my leg while standing, and progressed from there to PAIN.

Of course reading forums like this, for over a decade only brings those who are hurting still. But I have NEVER seen a person come back and say --its all gone by itself!

In fact I've seen some who did surgery and it came back even then!

About 7-8 yrs ago, there was a wonderful site on the net from a university, that gave all the medical papers published on the causes of MP.... it was a fabulous site! You wouldn't imagine all the causes! But they ran into cost and maintenance issues, and whoever maintained the site, moved on, so it was closed.
Surgeries, biopsies, diabetes, falls, blood clots, tight clothing, leg length disparities, sitting on a wallet in the back hip pocket, sports injuries, car accidents, harvesting ilium bone for bone grafts, etc etc etc.

Thanks for your quick replies!!
 

Thank you so much for your quick reply. It's wonderful that you help so many people in this forum. :hug:
MP can definitly go away by itself. I've found a person in a German forum which reported that after 9 month it disappeared over night. My pain doctor told me the same. Nearly every doctor I've seen told me that I don't have to worry - it will disappear by itself. That's the reason why the doctors don't think that MP is a real disablling problem. All doctors tell me that I sould just wait. Nobody prescribed the lidoderm patches - I get them on a private prescription and must pay for them by myself. Thats frustrating!!!

Hi penny.
I would be grateful if you update about your condition.
I had a laparoscopic bilateral inguinal hernia repair surgery 18 days ago,
and the moment i woke up after the surgery i had a terrible burning pain in my left thigh above the knee.
I went to a neurologist and was diagnosed with MP but he says it will go by itself.
He prescribed Lyrica but i still have the shooting pain when i bend my knee in a certain position.
Now i saw a neurosurgeon and he asked for an MRI.
He says it may go by itself and it may not, so it may need a nerve decompression surgery if it does not get better in one or two months.

Can you please belp me?

Yes, this is probably THE question on the minds of all Meralgia sufferers! Perhaps there is a poll somewhere? I'd like to hear from folks who are now pain-free. Especially if they have tips to pass on.

I answered you on the other thread.;)

Pain patch
 

I find it odd that you placed the patch on the nerve like that. My neuro told me to place the patch on the painful area, so I place it on the side of my leg, close to my knee. This helps me the most, as it blocks the pain at the point of pain, not at the source.

I'll have to try your method. :)

The MP pain in most people, is generated not where you feel it.
Many people have compression of the nerve as it exits the abdomen...or at the back near the L4-L5 exit. (varies anatomically for people genetically).

Using Lidoderms on the bottom of the feet, for peripheral neuropathy is less effective than on the instep, where the nerves are, even though felt at the bottoms.

I found Lidoderms ineffective for my MP pain, where felt in the thigh muscle.

So it depends on what your MP is from. Mine was from abdominal surgery. (C-section with exploratory).

Numbing the tips of the nerves therefore is useless because the lidocaine in the patch does not move far from that location.

I would wonder if you have MP at all...but some other pain condition?
I never had side pain at all, only front thigh pain. Some people call any thigh pain MP... and there are other causes. Such as trochanteric bursitis or myofascial pain of the thigh.

I went to 3 back surgeons and 1 neuro to get the diagnosis confirmed, so yeah, I have it. :(

My pain is down the outer front of my thigh, from the hip to the knee, but right above the knee is the worst. Some days I can't have anything light such as slacks touch me, but I can lie in bed on my side. Firm pressure is much less painful than light.

The nerve is probably pinched in my back. I have a confirmed diagnosis of a bulge in L4/L5. I've been for nerve block shots, PT, acupuncture... you name it, I've done it.

I sleep on a heating pad every night either on my lower back, or on my thigh, and that really helps me I think.

Heat makes it worse! It inflames the nerve and makes for overfiring! I cannot do steam rooms or hot tubs... much much worse.

So if you suspect a back compression, that is where to put your patch. It took 2 weeks of everyday patching on my upper thigh, where the nerve exits the abdomen to block the excessive firing of that nerve. After almost a decade of pain, I was in a remission, which continues today. But HEAT -- that is a big no no. Some rare times if I over extend the leg, I will get twingey reminders of what used to be...I consider that a warning and back off that activity right away!

Some people who have bone marrow grafts taken from the iliac crest get MP from damage there. But you can have it from compression in the spine as well, and damage in the abdomen from surgeries there.

Heat is the one thing that makes mine feel better. I've tried ice, compression, you name it, but heat works for me. Granted, I'm quite sensitive to it, but it seems to calm everything down for me.

I tried putting the patch on the back, and I'm paying dearly for it this morning. So much pain! :(

I can do heat, but Ice feels like someone poured acid on my leg. Luckly Lidoderm works locally for me. I have most of the tearing sensation from the hair follicles, so I shave my outer thigh and move the lidoderm patch around as needed. It does two things, I don't jump out of my skin when my pants touch my leg, and it does block the touch sensation that is converted into tearing burning scabbed flesh from my body.

My rule of thumb for the past 10 years is 1 hour on my feet = 1 day of recovery. Now with the lidoderm I get a free hour after the second hour I need 1 day of recovery, and then x-1 hours on feet = y days recovery now :)