Refractory Meralgia Paresthetica Unresponsive to Cryoneurolysis: A Case Report on Central Sensitization and Psychosocial Factors

Abstract Meralgia paresthetica (MP) is an entrapment neuropathy of the lateral femoral cutaneous nerve (LFCN) that usually responds to conservative management. Refractory cases are rare and may involve central sensitization and psychosocial factors. A 79-year-old man with long-standing diabetes, hypertension, and chronic insomnia presented with right lateral thigh burning pain for 2.5 years. The pain (numerical rating scale 7/10 baseline, 9/10 worst) persisted despite conservative management, pregabalin, three sessions of ultrasound-guided hydrodissection, and cryoneurolysis. Investigations confirmed right LFCN axonal neuropathy with exclusion of lumbar or hip pathology. The course was complicated by chronic insomnia and recent bereavement, coinciding with treatment resistance, which is suggestive of deafferentation pain and central sensitization. This case of refractory MP, not responding to advanced interventions, emphasizes the impact of psychosocial distress and sleep disturbance on neuropathic pain outcomes. A biopsychosocial management approach is hence essential in refractory MP.