The potential cause and mechanism of his pain was explained and the different options for management were discussed. The patient was advised on the importance of a biopsychosocial approach to management which requires not only dealing with the biological aspect but also with the psychosocial aspects. He was educated about the ultimate aim for self-management. The option of conservative management starting with medications and, if this alone is not helpful, then the option of interventions including ilioinguinal nerve injection with local anaesthetic and steroid, Qutenza treatment and external neuromodulation/ pulsed radiofrequency denervation were discussed. Relaxation techniques such as listening to music, starting a new hobby or restarting a hobby which he used to enjoy before were discussed.
He was advised to lose weight and to be active. He was started on Amitriptyline. He was also prescribed capsaicin cream to be applied topically.
He was followed up 3 months later where he reported benefit from the medications but he was still experiencing electric shock sensations going to the groin. An ilioinguinal nerve block with local anaesthetic and steroid was performed under ultrasound guidance, which dampened this sensation.
He was reviewed 3 months after his nerve block. His mood improved after he started playing the guitar and joined a club where he made friends. He began swimming three times a week. Even though his pain was not completely gone, he felt it to be at a tolerable level so that he could self- manage and have a better quality of life.
