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.

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.

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).

scholarly journals Abdominal Cutaneous Nerve Entrapment Syndrome, Case Report and Diagnostic Evaluation

2019 ◽  
Vol 38 (02) ◽  
pp. 141-144
Author(s):  
Jose Fernando Guedes-Correa ◽  
Stephanie Oliveira Fernandes de Bulhões
Keyword(s):  
Neuropathic Pain ◽  
Differential Diagnosis ◽  
Case Report ◽  
Clinical Findings ◽  
Nerve Entrapment ◽  
Cutaneous Nerve ◽  
Noninvasive Treatment ◽  
Important Differential Diagnosis ◽  
Anterolateral Wall ◽  
Nerve Entrapment Syndrome

Abdominal cutaneous nerve entrapment is a rarely diagnosed condition that leads to intense neuropathic pain in the anterolateral wall of the abdomen. Generally, it is triggered by some factor implied in the increase of the pressure on the nerve in its passage by the abdominal wall. Its most important differential diagnosis is pain of visceral origin.We present a case in which the clinical findings confirmed on ultrasound and other imaging tests established the diagnosis and in which the noninvasive treatment was effective.

scholarly journals Peripheral trigeminal nerve field stimulation

2013 ◽  
Vol 35 (3) ◽  
pp. E10 ◽  
Author(s):  
Alberto Feletti ◽  
Giannantonio Zanata Santi ◽  
Francesco Sammartino ◽  
Marzio Bevilacqua ◽  
Piero Cisotto ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Peripheral Nerve ◽  
Social Relations ◽  
Nerve Stimulation ◽  
Facial Pain ◽  
Field Stimulation ◽  
Trigeminal Neuropathic Pain ◽  
Persistent Idiopathic Facial Pain ◽  
Pain Reporting ◽  
Peripheral Nerve Field Stimulation

Object Peripheral nerve field stimulation has been successfully used for many neuropathic syndromes. However, it has been reported as a treatment for trigeminal neuropathic pain or persistent idiopathic facial pain only in the recent years. Methods The authors present a review of the literature and their own series of 6 patients who were treated with peripheral nerve stimulation for facial neuropathic pain, reporting excellent pain relief and subsequent better social relations and quality of life. Results On average, pain scores in these patients decreased from 10 to 2.7 on the visual analog scale during a 17-month follow-up (range 0–32 months). The authors also observed the ability to decrease trigeminal pain with occipital nerve stimulation, clinically confirming the previously reported existence of a close anatomical connection between the trigeminal and occipital nerves (trigeminocervical nucleus). Conclusions Peripheral nerve field stimulation of the trigeminal and occipital nerves is a safe and effective treatment for trigeminal neuropathic pain and persistent idiopathic facial pain, when patients are strictly selected and electrodes are correctly placed under the hyperalgesia strip at the periphery of the allodynia region.

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.

scholarly journals Chronic Localized Back Pain Due to Posterior Cutaneous Nerve Entrapment Syndrome (POCNES): A New Diagnosis

2017 ◽  
Vol 3 (20;3) ◽  
pp. E455-E458 ◽  
Author(s):  
Oliver Boelens
Keyword(s):  
Back Pain ◽  
Peripheral Nerve ◽  
Chronic Back Pain ◽  
Treatment Protocol ◽  
Previous Treatment ◽  
Nerve Entrapment ◽  
Cutaneous Nerve ◽  
Local Pressure ◽  
Entrapment Syndrome ◽  
Nerve Entrapment Syndrome

Most patients with chronic back pain suffer from degenerative thoracolumbovertebral disease. However, the following case illustrates that a localized peripheral nerve entrapment must be considered in the differential diagnosis of chronic back pain. We report the case of a 26-year-old woman with continuous excruciating pain in the lower back area. Previous treatment for nephroptosis was to no avail. On physical examination the pain was present in a 2 x 2 cm area overlying the twelfth rib some 4 cm lateral to the spinal process. Somatosensory testing using swab and alcohol gauze demonstrated the presence of skin hypo- and dysesthesia over the painful area. Local pressure on this painful spot elicited an extreme pain response that did not irradiate towards the periphery. These findings were highly suggestive of a posterior version of the anterior cutaneous nerve entrapment syndrome (ACNES), a condition leading to a severe localized neuropathic pain in anterior portions of the abdominal wall. She demonstrated a beneficial albeit temporary response after lidocaine infiltration as dictated by an established diagnostic and treatment protocol for ACNES. She subsequently underwent a local neurectomy of the involved superficial branch of the intercostal nerve. This limited operation had a favorable outcome resulting in a pain-free return to normal activities up to this very day (follow-up of 24 months). We propose to name this novel syndrome “posterior cutaneous nerve entrapment syndrome” (POCNES). Each patient with chronic localized back pain should undergo simple somatosensory testing to detect the presence of overlying skin hypo- and dysesthesia possibly reflecting an entrapped posterior cutaneous nerve. Key words: Chronic pain, back pain, posterior cutaneous nerve entrapment, peripheral nerve entrapment, surgical treatment for pain, anterior cutaneous nerve entrapment

Sign in / Sign up

Export Citation Format

Share Document