Table 2.
Evidence table of non-surgical management options of CPIP
| Intervention type | Author | Year | N = | Study design | Conclusion | Comment |
|---|---|---|---|---|---|---|
| Pharmacological topical therapy | ||||||
| Lidocaine patch (5%) | Bischoff [21] | 2013 | 21 | Randomized, double-blind, placebo-controlled, crossover trial: lidocaine patch (5%) versus placebo patch | No difference in summed pain intensity differences between lidocaine and placebo patch treatments in all patients | Small-volume study |
| Capsaicin patch | Bischoff [22] | 2014 | 46 | Randomized, double-blind, placebo-controlled, crossover trial: capsaicin 8% patch versus placebo patch | No statistically significant benefit of the capsaicin patch, although there was a trend toward less pain in the capsaicin group at one month | Small-volume study. Only one month follow-up |
| Pharmacological systemic therapy | ||||||
| Paracetamol, NSAID and gabapentinoid | No evidence | |||||
| Interventions | ||||||
| Nerve blocks and trigger point infiltrations | ||||||
| Ultrasound-guided nerve block | Voorbrood [23] | 2015 | 28 | Prospective study | Permanent pain reduction was achieved in 18 of 28 (62%) patients with neuropathic pain | |
| Ultrasound-guided nerve block | Bischoff [24] | 2012 | 12 | Randomized, double-blind, placebo-controlled, crossover trial: lidocaine versus placebo | 1 lidocaine responder, 6 non-responders, and 5 placebo responders. Ultrasound-guided ilioinguinal nerve and iliohypogastric nerve blocks did not produce pain relief | It is not clear from the study what percentage of patients had improperly-placed nerve blocks despite ultrasound guidance |
| Ultrasound-guided or nerve stimulator-guided nerve block | Thomassen [25] | 2013 | 43 | Retrospective study | Thirty-two percent of the patients were relieved of moderate-to-severe pain and nerve blocks 21 patients (55.3%) no longer reported neuropathic pain Ilioinguinal/iliohypogastric nerve blocks can be effective to treat chronic inguinal pain following surgery of the groin | Nerve stimulator-guided blocks were performed prior to January 2009, and thereafter, ultrasound-guided blocks |
| Ultrasound-guided or landmark-based nerve block | Trainor [26] | 2015 | 36 | Retrospective study | 14 patients (70%) in the landmark-based and 11 patients (79%) in the ultrasound-guided groups experienced at least a 50% reduction in VAS scores (p = 1.0) | Small-volume study. No information on follow-up |
| Ultrasound-guided tender point blockade | Wijaya-Singhe [29] | 2016 | 14 | Randomized, double-blind, placebo-controlled, crossover trial: bupivacaine 0.25% versus placebo | Median pain reduction of 63% (44.1 to 73.6%) after bupivacaine compared with 36% (11.6 to 49.7%; p = 0.003) after placebo | Small-volume study. Short follow-up of 14 days. No difference in movement related pain, summed pain intensity scores, or sleep quality scores |
| Tender point infiltration (TPI) | Verhagen [10] | 2018 | 54 | Randomized controlled trial: tender point infiltration versus neurectomy | TPI was successful in 6 patients (22%), a neurectomy was successful in 17 patients (71%). After unsuccessful TPI, 19 patients crossed over to neurectomy and their median VAS score dropped from 60 to 14 (p = 0.001). A step-up treatment strategy starting with tender point infiltration followed by a tailored neurectomy is advised | Although neurectomy seems superior in this trial, minimally invasive techniques are preferred in a step-based approach |
| CT-guided nerve block | Parris [27] | 2010 | 1 | Case-report | CT-guided transpsoas genitofemoral nerve block is a viable option for safely and selectively blocking the genitofemoral nerve for diagnostic or therapeutic purposes | Case-report |
| CT-guided peri-neural injections | Poh [28] | 2019 | 58 | Retrospective study | Improvement was seen in 84% of the cases | Non-controlled, non-randomized study design and unclear duration of effect |
| Neuroablative techniques and stimulation techniques | ||||||
| Cryoablation | Fanelli [30] | 2003 | 10 | Case series | 77.5% mean overall pain reduction, average follow-up period of eight months | Small-volume study. Short follow-up |
| Peripheral nerve stimulation | Shaw [31] | 2016 | 6 | Retrospective study | Average improvement of 62% in the immediate post-operative follow-up. Eighty-five percent patients were completely satisfied with an average follow-up of 22 months | Small-volume study. Non-controlled, non-randomized study design |
| US-guided microwave ablation | Lee [32] | 2019 | 10 | Retrospective study | Immediate pain reduction in 92% of the subjects, and 69% pain reduction at 12 months follow-up. The average duration of clinically significant pain reduction was 10.5 months | Small-volume study. Non-controlled, non-randomized study design |
| Dorsal Root Gang-lion Stimulation | Schu [33] | 2014 | 12 | Case series | Mean VAS reduction of 76.8% ± 8.2%, pain relief in 10 (83%) patients, follow-up period of 17.4 ± 5.7 weeks | Small-volume study with various etiologies of groin pain. Short follow-up |
| Spinal Cord Stimulation | Yakovlev [34] | 2010 | 15 | Case series | Pain relief of > 75% and reduced pain medication intake, follow-up period of 12 months | Small-volume study |
| Other therapies | ||||||
| Physical therapy, psychotherapy, hypnosis, behavioural therapy, biofeedback, acupuncture, mind–body therapy | No evidence | |||||