Treatment response and central pain processing in Anterior Cutaneous Nerve Entrapment Syndrome: An explorative study

2017 ◽  
Vol 14 (1) ◽  
pp. 53-59 ◽  
Author(s):  
Dagmar C. van Rijckevorsel ◽  
Oliver B. Boelens ◽  
Rudi M. Roumen ◽  
Oliver H. Wilder-Smith ◽  
Harry van Goor
Keyword(s):  
Abdominal Wall ◽  
Nerve Entrapment ◽  
Cutaneous Nerve ◽  
Diagnosis And Treatment ◽  
Pain Processing ◽  
Central Pain ◽  
Pain Thresholds ◽  
Generalized Hyperalgesia ◽  
Central Pain Processing ◽  
Nerve Entrapment Syndrome

AbstractBackground10–30% of chronic abdominal pain originates in the abdominal wall. A common cause for chronic abdominal wall pain is the Anterior Cutaneous Nerve Entrapment Syndrome (ACNES), in which an intercostal nerve branch is entrapped in the abdominal rectus sheath. Treatment consists of local anaesthetics and neurectomy, and is ineffective in 25% of cases for yet unknown reasons.In some conditions, chronic pain is the result of altered pain processing. This so-called sensitization can manifest as segmental or even generalized hyperalgesia, and is generally difficult to treat.ObjectiveThe aim of this study was to assess pain processing in ACNES patients responsive and refractory to treatment by using Quantitative Sensory Testing, in order to explore whether signs of altered central pain processing are present in ACNES and are a possible explanation for poor treatment outcomes.Methods50 patients treated for ACNES with locally orientated treatment were included. They were allocated to a responsive or refractory group based on their response to treatment. Patients showing an improvement of the Visual Analogue Scale (VAS) pain score combined with a current absolute VAS of <40 mm were scored as responsive.Sensation and pain thresholds to pressure and electric skin stimulation were determined in the paravertebral bilateral ACNES dermatomes and at four control areas on the non-dominant side of the body, i.e. the musculus trapezius pars medialis, musculus rectus femoris, musculus abductor hallucis and the thenar. The ACNES dermatomes were chosen to signal segmental hyperalgesia and the sum of the control areas together as a reflection of generalized hyperalgesia. Lower thresholds were interpreted as signs of sensitized pain processing. To test for alterations in endogenous pain inhibition, a conditioned pain modulation (CPM) response to a cold pressor task was determined. Also, patients filled in three pain-related questionnaires, to evaluate possible influence of psychological characteristics on the experienced pain.ResultsPatients refractory to treatment showed significantly lower pressure pain thresholds in the ACNES dermatomes and for the sum of as well as in two individual control areas. No differences were found between groups for electric thresholds or CPM response. Duration of complaints before diagnosis and treatment was significantly longer in the refractory compared to the responsive group, and refractory patients scored higher on the pain-related psychological surveys.Conclusion and ImplicationsIn this hypothesis-generating exploratory study, ACNES patients refractory to treatment showed more signs of sensitized segmental and central pain processing. A longer duration of complaints before diagnosis and treatment may be related to these alterations in pain processing, and both findings could be associated with less effective locally orientated treatment. In order to validate these hypotheses further research is needed.Registration numberNCT01920880 (Clinical Trials Register; http://www.clinicaltrials.gov).

Peripheral nerve field stimulation for peristomal pain

Ból ◽  
2019 ◽  
Vol 19 (4) ◽  
pp. 59-62
Author(s):  
Osman Chaudhary ◽  
Teodor Goroszeniuk ◽  
Christopher Chan
Keyword(s):  
Neuropathic Pain ◽  
Peripheral Nerve ◽  
Abdominal Wall ◽  
Nerve Entrapment ◽  
Cutaneous Nerve ◽  
Field Stimulation ◽  
Pain Clinics ◽  
Surgical Incisions ◽  
Peripheral Nerve Field Stimulation ◽  
Nerve Entrapment Syndrome

Chronic pain attributed to the abdominal wall is seen in 10-30% of patients who present to specialist pain clinics [24]. The most common cause is abdominal cutaneous nerve entrapment syndrome (ACNES). Trauma, including surgical incisions and tissue scarring, are well accepted causes of cutaneous nerve entrapment causing neuropathic pain [24]. The occurrence of peristomal neuropathic pain associated with an ileal-conduit formation is rare. A case of chronic cutaneous peristomal pain of the abdominal wall, refractory to conventional pharmacological therapies is described. The technique of peripheral nerve field stimulation (PNFS) for the successful management of peristomal neuropathic abdominal wall pain is reported.

Misdiagnosis of anterior cutaneous nerve entrapment syndrome as a somatization disorder

2016 ◽  
Vol 33 (S1) ◽  
pp. S387-S388 ◽  
Author(s):  
M. Arts ◽  
J. Buis ◽  
L. de Jonge
Keyword(s):  
Abdominal Pain ◽  
Depressive Symptoms ◽  
Abdominal Wall ◽  
Nerve Entrapment ◽  
Cutaneous Nerve ◽  
Somatization Disorder ◽  
Abdominal Wall Pain ◽  
Chronic Abdominal Wall Pain ◽  
Nerve Entrapment Syndrome

IntroductionAnterior cutaneous nerve entrapment syndrome (ACNES) is a frequently overlooked disease, causing chronic abdominal wall pain due to entrapment of an anterior cutaneous branch of one or more thoracic intercostal nerves. It is often misdiagnosed as a psychiatric condition, particularly under the heading of a somatization disorder.ObjectivesWe describe the case of a patient who developed depressive symptoms after months of suffering from chronic abdominal wall pain.AimsTo report a case-study, describing ACNES as a cause of persistent depressive symptoms.MethodsA case-study is presented and discussed, followed by a literature review.ResultsA 35-year-female was referred to a psychiatrist for her depressive symptoms and persistent cutaneous abdominal pain for months. There she was diagnosed with a depression and possible somatization disorder and she received psychotherapy. Through Internet search, the patient found ACNES as a possible cause for her persistent abdominal pain. Since administration of anesthetic agents only shortly relieved her symptoms, a surgeon decided to remove the nerve end twigs. After surgery, her somatic problems and depressive mood disappeared.ConclusionThe awareness of ACNES is still very limited in medicine. This may lead to incorrect diagnoses, including psychiatric disorders such as somatization disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Bilateral distribution of anterior cutaneous nerve entrapment syndrome (ACNES): are clinical features and outcomes comparable to unilateral ACNES?

2019 ◽  
Vol 44 (4) ◽  
pp. 513-520 ◽  
Author(s):  
Robbert C Maatman ◽  
Mads U Werner ◽  
Marc R M Scheltinga ◽  
Rudi M H Roumen
Keyword(s):  
Neuropathic Pain ◽  
Abdominal Wall ◽  
Mirror Image ◽  
The Body ◽  
Nerve Entrapment ◽  
Cutaneous Nerve ◽  
Neuropathic Pain Syndrome ◽  
Entrapment Syndrome ◽  
Abdominal Wall Pain ◽  
Nerve Entrapment Syndrome

Background and objectivesMirror-image pain may occur in the presence of a one-sided peripheral nerve lesion leading to a similar distribution of pain on the contralateral side of the body (“mirrored”). Anterior cutaneous nerve entrapment syndrome (ACNES) is a neuropathic pain syndrome due to entrapment of terminal branches of intercostal nerves T7–12 in the abdominal wall and sometimes presents bilaterally. This study aims to address specifics of bilateral ACNES and to determine potential differences in clinical presentation and treatment outcomes when compared with the unilateral form of ACNES.MethodsElectronic patient files and questionnaires of a case series of patients who were evaluated for chronic abdominal wall pain in a single center were analyzed using standard statistical methods.ResultsBetween June 1, 2011 and September 1, 2016, 1116 patients were diagnosed with ACNES, of which a total of 146 (13%) with bilateral ACNES were identified (female, n = 114, 78 %; median (range) age 36 (1181) years). Average NRS (Numeric Rating Scale; 0–10) scores were similar (median (range) NRS scores 6 (0–10) although peak NRS scores were significantly higher in the bilateral group (9 (5–10) vs 8 (2–10); p=0.02). After a median of 26 months (1–68), the proportion of patients with bilateral ACNES reporting treatment success was 61%.ConclusionsOne in eight patients with ACNES has bilateral abdominal wall pain. Characteristics are similar to unilateral ACNES cases. Further studies aimed at underlying mechanisms in mirror image pain pathogenesis could provide a more targeted approach in the management of this neuropathic pain.

When it is not a Spigelian Hernia: Abdominal Cutaneous Nerve Entrapment Syndrome

2013 ◽  
Vol 79 (10) ◽  
pp. 1111-1114 ◽  
Author(s):  
Shirin Towfigh ◽  
Shannon Anderson ◽  
Andrea Walker
Keyword(s):  
Chronic Pain ◽  
Abdominal Wall ◽  
Nerve Entrapment ◽  
Spigelian Hernia ◽  
Cutaneous Nerve ◽  
Nerve Blocks ◽  
Delay In Diagnosis ◽  
Entrapment Syndrome ◽  
Abdominal Wall Pain ◽  
Nerve Entrapment Syndrome

Abdominal wall pain at the linea semilunaris is classically the result of a Spigelian hernia. If no hernia is detected, these patients may be left with chronic pain without a diagnosis or treatment. A retrospective review was performed of patients presenting with abdominal wall pain at the linea semilunaris between 2009 and 2012. Of the 14 patients, three (21%) were diagnosed with a Spigelian hernia confirmed by imaging. The remaining patients were eventually diagnosed with abdominal cutaneous nerve entrapment syndrome (ACNES). The average delay in diagnosis was 4 years with patients with ACNES suffering twice as long with chronic pain. Patients with a Spigelian hernia and ACNES had different demographics and presenting complaints. Physical examination findings were nondiagnostic. Of the patients with ACNES, five (50%) had resolution of pain with serial nerve blocks alone; another five proceeded to surgical neurectomy with resolution of their pain. Thus, to prevent delay in diagnosis and treatment, patients with chronic abdominal wall pain at the linea semilunaris should first be ruled out for Spigelian hernia. Then, they should be evaluated and treated for ACNES.

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