Pulsed Radiofrequency as a Minimally Invasive Treatment Option in Anterior Cutaneous Nerve Entrapment Syndrome: A Retrospective Analysis of 26 Patients

Maatman, Robbert C; Steegers, Monique; Kallewaard, Jan-Willem; Scheltinga, Marc R.; Roumen, R. M. H.

doi:10.14740/jocmr3354w

Cited by 17 publications

(24 citation statements)

References 34 publications

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“…A previous sham‐controlled randomized controlled trial on neurectomy in patients with ACNES showed a 70% rate of success in the neurectomy group . Based on our retrospective case series and the available literature on PRF treatment, a 30% success rate was expected in the PRF group; almost one third of patients could be spared a neurectomy . The targeted effect size is a difference in proportion responding to treatment (neurectomy vs. PRF) of 40% (ie, 70% responding in the neurectomy group vs. 30% in the PRF group).…”

Section: Methodsmentioning

confidence: 71%

“…In recent literature, only 2 case reports suggested that PRF at the dorsal root ganglion (DRG) was successful in patients with ACNES (eg, reduction of pain and improving quality of life) . Recently, a retrospective case series of 26 patients with ACNES found that PRF administered just underneath the anterior fascia of the rectus abdominis was effective in half of the patients . These encouraging results resulted in the execution of the present randomized controlled trial comparing PRF treatment with an anterior neurectomy.…”

Section: Introductionmentioning

confidence: 94%

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A Randomized Controlled Trial to Evaluate the Effect of Pulsed Radiofrequency as a Treatment for Anterior Cutaneous Nerve Entrapment Syndrome in Comparison to Anterior Neurectomy

et al. 2019

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& AbstractBackground: Chronic abdominal pain can be due to entrapped intercostal nerves (anterior cutaneous nerve entrapment syndrome [ACNES]). If abdominal wall infiltration using an anesthetic agent is unsuccessful, a neurectomy may be considered. Pulsed radiofrequency (PRF) applies an electric field around the tip of the cannula near the affected nerve to induce pain relief. Only limited retrospective evidence suggests that PRF is effective in ACNES.Methods: A multicenter, randomized, nonblinded, controlled proof-of-concept trial was performed in 66 patients. All patients were scheduled for a neurectomy procedure. Thirty-three patients were randomized to first receive a 6minute cycle of PRF treatment, while the other 33 were allocated to an immediate neurectomy procedure. Pain was recorded using a numeric rating scale (NRS, 0 [no pain] to 10 [worst pain possible]). Successful treatment was defined as >50% pain reduction. Patients in the PRF group were allowed to cross over to a neurectomy after 8 weeks.Results: The neurectomy group showed greater pain reduction at 8-week follow-up (mean change from baseline À2.8 (95% confidence interval [CI] À3.9 to À1.7) vs. À1.5 (95% CI À2.3 to À0.6); P = 0.045) than the PRF group. Treatment success was reached in 12 of 32 (38%, 95% CI 23 to 55) of the PRF group and 17 of 28 (61%, 95% CI 42 to 72) of the neurectomy group (P = 0.073). Thirteen patients were withdrawn from their scheduled surgery. Adverse events were comparable between treatments.

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Section: Methodsmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 94%

A Randomized Controlled Trial to Evaluate the Effect of Pulsed Radiofrequency as a Treatment for Anterior Cutaneous Nerve Entrapment Syndrome in Comparison to Anterior Neurectomy

et al. 2019

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“…Sensations such as paresthesia, numbness, or the recognizable pain should occur at <0.5 V if the needle’s position is correct 43. This technique was not used in the presented case series but may potentially diminish low volumes of local anesthetics for diagnostic nerve blockades as also observed in ACNES patients 44. In our series, 11 of 14 patients reported a temporary pain relief of days to weeks after the diagnostic injection.…”

Section: Discussionmentioning

confidence: 84%

<p>Chronic localized back pain due to entrapment of cutaneous branches of posterior rami of the thoracic nerves (POCNES): a case series on diagnosis and management</p>

Maatman¹,

Boelens²,

Scheltinga³

et al. 2019

JPR

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Introduction and aim Chronic back pain (CBP) may be caused by a variety of conditions including dysfunctional muscles, ligaments or intervertebral discs, improper movement of vertebral column joints, or nerve root compression. Recently, CBP was treated successfully in a patient having an entrapment of cutaneous branches of the posterior rami of the thoracic nerves, termed posterior cutaneous nerve entrapment syndrome (POCNES). Our aim is to describe clinical presentation, differential diagnosis, and management of patients with such a neuropathic pain syndrome. Methods This study analyzed prospectively obtained data from consecutive patients suspected of having POCNES, presenting to two Dutch hospitals between January 2013 and September 2016. Patients received a diagnostic 2–5 mL 1% lidocaine injection just below the thoracolumbar fascia. Pain was scored using a numerical rating scale (0 = no pain to 10 = worst possible pain). A >50% pain reduction was defined as success. A neurectomy was proposed if pain reduction was temporary or insufficient after one to three injections. Long-term treatment effect was determined using a verbal rating scale (VRS; 1 = very satisfied, no pain, to 5 = pain worse). Results Fourteen patients (12 women, median age 26, age range 18–73) were diagnosed with POCNES. Eighty-one percent (n=11) reported a >50% pain drop after injection (NRS pain scores of median 8.0 [IQR 7.0–8.0] to median 3.0 [IQR 1.5–3.5], P <0.001). In one patient, repeated injections were successful long-term (VRS score of 2). Two patients declined surgery, whereas the remaining eleven underwent a neurectomy that was successful in seven (64%). A 57% long-term efficacy (median 29 months follow-up, range 5–48, VRS score 1–2) was attained in the entire study population. Conclusion POCNES should be considered in the differential diagnosis of chronic localized back pain. A treatment regimen including injections and neurectomy of the specific cutaneous branch results in long-term pain relief in more than half of these patients.

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“…An alternative, relatively painless, nonsurgical treatment option is pulsed radiofrequency (PRF), which, in adults, has a short-term treatment success of 38% to 50% 6-8 weeks after PRF [41,42]. Treatment success in these studies was defined as decrease in pain of more than 50%.…”

Section: Discussionmentioning

confidence: 99%

Treatment strategies for anterior cutaneous nerve entrapment syndrome in children: A systematic review

Markus

Sibbing

Ket

et al. 2021

Journal of Pediatric Surgery

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Background: Anterior cutaneous nerve entrapment syndrome (ACNES) is a frequently overlooked cause of chronic abdominal pain in children. Currently, both nonsurgical and surgical treatment options are available to treat this disease. The objective was to give insight into the success rate of different treatment strategies for children with ACNES, and provide treatment recommendations for physicians based on the published evidence. Method: A literature search of PubMed, Embase.com and the Wiley/Cochrane Library was conducted for studies published up to 25 February 2020. Randomized controlled trials, prospective or retrospective cohort studies, meta-analyses and literature reviews describing the outcome of different treatment strategies for children (b18 years old) with ACNES with a follow-up duration of at least four weeks were included. Results: Six studies, involving 224 patients, were included with an overall quality reported to be between fair and poor. Treatment success of local injections with an anesthetic agent into the trigger point ranged from 38% to 87% with a follow-up ranging from 4 weeks to 39 months. In addition, treatment success of anterior neurectomy ranged from 86% to 100%, with a follow-up duration ranging from 4 weeks to 36 months. Conclusion: A step-up treatment strategy should be applied when treating pediatric patients with ACNES. This strategy starts with an injection with a local anesthetic agent, reserving surgery (anterior neurectomy) as a viable option in case of persistent pain. Level of evidence: II.

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Pulsed Radiofrequency as a Minimally Invasive Treatment Option in Anterior Cutaneous Nerve Entrapment Syndrome: A Retrospective Analysis of 26 Patients

Cited by 17 publications

References 34 publications

A Randomized Controlled Trial to Evaluate the Effect of Pulsed Radiofrequency as a Treatment for Anterior Cutaneous Nerve Entrapment Syndrome in Comparison to Anterior Neurectomy

A Randomized Controlled Trial to Evaluate the Effect of Pulsed Radiofrequency as a Treatment for Anterior Cutaneous Nerve Entrapment Syndrome in Comparison to Anterior Neurectomy

<p>Chronic localized back pain due to entrapment of cutaneous branches of posterior rami of the thoracic nerves (POCNES): a case series on diagnosis and management</p>

Treatment strategies for anterior cutaneous nerve entrapment syndrome in children: A systematic review

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