Rare severe refractory chronic pain syndrome - T9 anterior cutaneous nerve entrapment syndrome (ACNES) - significantly improved with MC5-A (scrambler therapy-ST)

Anterior cutaneous nerve entrapment syndrome (ACNES) is a commonly overlooked source of chronic abdominal wall pain. A diagnosis of ACNES should be considered in cases of severe, localized abdominal pain that is accentuated by physical activity. Providers should consider diagnosing ACNES once a patient has both a positive result from a Carnett’s test and precise localization of pain. We describe the use of transversus abdominus plane (TAP) blocks to treat ACNES in the pediatric patient population. TAP blocks are a treatment modality which have been described less frequently in the management of this syndrome, with rectus sheath blocks being used more commonly. TAP blocks can be used effectively for ACNES by targeting the site of maximal tenderness, which was identified using ultrasound guidance. Moreover, TAP blocks are an attractive procedure option for ACNES as they are less invasive than other commonly used techniques. We present 3 case series reports of pediatric patients evaluated at our institution for severe abdominal pain to describe the clinical manifestations, sequelae, and outcome of ACNES. Though the exact incidence of ACNES in the pediatric population is unknown, this condition has significant implications from chronic pain. Chronic pain can lead to significant emotional and social impacts on these pediatric patients, as well as their on their families. Further, the extensive utilization of health care resources is impacted when children with undiagnosed ACNES undergo invasive treatments when ACNES is not in the early differential. The purpose of this case series report is to prompt better recognition of the condition ACNES, and to highlight the efficacy of TAP blocks as a management strategy. Key words: TAP block, pediatric patients, abdominal pain, ACNES

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Misdiagnosing Abdominal Myofascial Pain Syndrome as Anterior Cutaneous Nerve Entrapment Syndrome: Are we Failing Patients with Nonspecific Abdominal Pain?

Pain Management Case Reports ◽

10.36076/pmcr.2019/3/91 ◽

2019 ◽

pp. 91-97

Author(s):

Niraj G

Keyword(s):

Abdominal Pain ◽

Myofascial Pain ◽

Trigger Point ◽

Case Series ◽

Pain Syndrome ◽

Myofascial Pain Syndrome ◽

Nerve Entrapment ◽

Cutaneous Nerve ◽

Entrapment Syndrome ◽

Nerve Entrapment Syndrome

Background: Chronic abdominal wall pain (CAWP) is often undiagnosed and results in significant health care use as well as patient suffering. There are two main types: abdominal myofascial pain syndrome (AMPS) and anterior cutaneous nerve entrapment syndrome (ACNES). Although the 2 conditions share clinical similarities, they have subtly distinct unique features. Objectives: To highlight the current practice, elucidate the characteristics of the 2 types of CAWP, and direct the spotlight on abdominal myofascial pain. Study Design: Prospective case series. Setting: Tertiary pain medicine clinic in a university hospital. Methods: As a part of a prospective audit of management of chronic abdominal pain, patients completed brief pain inventory-short form questionnaires at baseline and at 3 months posttrigger point treatment. Results: All 3 patients were misdiagnosed with ACNES. Patient 1 was attending the emergency department once every 5 days prior to being correctly diagnosed with AMPS. Following trigger point treatment, there was a significant reduction in emergency department attendance. Patient 2, with a 10-year history of lower abdominal pain that resulted in severe disability, was able to mobilize following trigger point treatment. Patient 3, with a high opioid use (360 mg per day), was able to discontinue opioids following ultrasound-guided trigger point injection with depot steroids. Limitations: Open label case series in a small cohort. Conclusions: AMPS is as common as the various visceral inflammatory diseases. Lack of awareness, ignoring its existence, and misdiagnosing it may not benefit patients with chronic abdominal pain. Key words: Chronic abdominal wall pain, abdominal myofascial pain syndrome, anterior cutaneous nerve entrapment syndrome, viscerosomatic convergence

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

The American Surgeon ◽

10.1177/000313481307901032 ◽

2013 ◽

Vol 79 (10) ◽

pp. 1111-1114 ◽

Cited By ~ 7

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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