Anterior cutaneous nerve entrapment syndrome: management challenges

Abstract

Anterior cutaneous nerve entrapment syndrome (ACNES) is a commonly underdiagnosed and undertreated chronic state of pain. This syndrome is characterized by the entrapment of the cutaneous branches of the lower thoracoabdominal intercostal nerves at the lateral border of the rectus abdominis muscle, which causes severe, often refractory, chronic pain. This narrative review aims to identify the possible therapeutic strategies for the management of the syndrome. Seventeen studies about ACNES therapy were reviewed; of them, 15 were case–control studies, case series, or case reports, and two were randomized controlled trials. The presently available management strategies for ACNES include trigger point injections (diagnostic and therapeutic), ultrasound-guided blocks, chemical neurolysis, and surgical neurectomy, in combination with systemic medication, as well as some emerging techniques, such as radiofrequency ablation and neuromodulation. An increased awareness of the syndrome and the use of specific diagnostic criteria for its recognition are required to facilitate an early and successful management. This review compiles the proposed management strategies for ACNES.

DRG Spinal Cord Stimulation as Solution for Patients With Severe Pain Due to Anterior Cutaneous Nerve Entrapment Syndrome: A Case Series

“…A therapeutic algorithm has been developed consisting of infiltrations with local anesthetics, pulsed radio frequency treatment or TENS and finally surgical resection of the intercostal nerve endings at the level of the anterior rectus sheath . However, a small portion of patients does not respond to any of these currently available treatment modalities.…”

Diagnostic dilemma: think about anterior cutaneous nerve entrapment syndrome (ACNES) in patients with atypical abdominal pain and Crohn’s disease

“…Chrona et al describe the different management strategies for ACNES 9. A literature review suggests that systemic therapies likes anti-inflammatories, weak opioids, antiepileptics and antidepressants are not effective in managing ACNES because the cause of pain is mechanical.…”

Abdominal pain related to pathology of peripheral nervous system

“…В обзоре рассмотрены причины нейропатической боли, обусловленные поражением периферических нервов. У 2-5 % пациентов с хронической болью в животе она исходит из брюшной стенки [14], причем если на основании предшествующего обследования органическая патология внутренних органов исключена, вероятность такого происхождения боли достигает 15-30 % [14,15,16]. При этом жалобы больного могут трактоваться как «функциональные», а настоящая причина оставаться нераспознанной [16].…”

“…Боль провоцируют чихание, кашель, смех, физическая нагрузка, ношение тугих поясов и корсетов. При этом отсутствуют признаки иных заболеваний органов брюшной полости [14,15]. При нажатии указательным пальцем по латеральному краю прямой мышцы живота определяется четко локализованный участок болезненности размером примерно 2 см 2 («триггерная точка»).…”