523: The Pain Everyone Missed: A Suspicious, Elusive Neuralgia Revealed By A Pain Physician

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary visceral / pelvic pain, Treatment/management

Background and Aims: Chronic genital pain in young women presents a diagnostic challenge, often involving multiple specialties due to its complex and overlapping aetiologies. Neuralgic causes such as genitofemoral and inguinal neuralgia are rare and frequently overlooked, leading to delayed diagnosis and prolonged patient suffering.

Methods: A 25-year-old woman presented with persistent right-sided genital and groin pain for six months, described as burning, stabbing, and radiating from the lower abdomen to the labia majora. The pain significantly impaired her mobility, sleep, and psychological well-being. Initial evaluations by gynecology and urology ruled out pelvic inflammatory disease, ovarian pathology, and urinary tract disorders. Surgical consultation excluded hernia and other abdominal wall causes, while psychiatric assessment addressed the possibility of somatic pain disorder. Despite extensive investigations and multiple therapeutic trials, her pain persisted, causing profound distress and functional limitation.

Results: Finally, referral to the pain medicine department led to a focused neuropathic assessment. Careful sensory mapping revealed hyperesthesia in the genitofemoral and ilioinguinal nerve territories. A diagnostic nerve block of these nerves produced immediate and sustained relief, confirming the diagnosis of combined genitofemoral and inguinal neuralgia. The patient was subsequently managed with targeted nerve blocks, neuropathic analgesics, and physiotherapy, achieving substantial and lasting improvement.

Conclusions: This case underscores the complexity of diagnosing chronic genital pain and the critical role of multidisciplinary collaboration. It highlights that neuralgic etiologies, though rare, must be considered early—especially when conventional investigations are inconclusive. The decisive intervention by the pain physician not only established the correct diagnosis but also restored the patient’s quality of life, illustrating the pivotal value of pain specialists in multidisciplinary care.

References: Cross AL. Pregabalin. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470341/

Elahwal L, et al. Ilioinguinal and iliohypogastric nerve block for acute and chronic inguinal pain: ultrasound-guided techniques and outcomes. [PMCID article]. 2022. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9375958/

Sahoo RK, et al. Effect of ultrasound-guided ilioinguinal-iliohypogastric nerve block: randomized double-blind study. E-Pain. 2024;37:332–341.

Gupta M, et al. A comprehensive review of treatment approaches to ilioinguinal and genitofemoral neuralgia. Pain Physician. 2025;28:xx–xx.

Presenting Author: MUHAMMAD AASAM MASOOM MAAN
Submitting Author: Muhammad Aasam Masoom Maan

Senior Author: MUHAMMAD AASAM MASOOM MAAN

IASP 2026 Global Year theme of Neuropathic Pain: Yes