Overview
Abdominal cutaneous nerve entrapment syndrome (ACNES) involves chronic pain arising from entrapment of cutaneous nerves in the abdominal wall, often mimicking other abdominal pathologies. 1Diagnosis
Clinical presentation includes chronic abdominal pain localized to the anterior abdominal wall.
Diagnostic imaging (e.g., ultrasound, MRI) may help rule out other causes but is not definitive.
Pain provocation tests, such as palpation over the abdominal wall, can be useful.
No specific laboratory tests are typically required. 1Management
First-line treatments: Abdominal wall injections (e.g., local anesthetics, corticosteroids).
Adjunctive treatments:
- Pulsed radiofrequency (PRF) can be effective, with some patients achieving sustained pain relief through repetitive sessions.
- Neurectomy shows higher long-term success rates with a significant proportion of patients remaining pain-free without additional interventions. 1Special Populations
Elderly: No specific data provided in the abstracts regarding treatment efficacy or considerations in elderly patients.
Comorbidities: Management strategies may need adjustment based on comorbidities, though specific guidance is not detailed in the provided abstracts. 1Key Recommendations
For refractory ACNES, neurectomy appears to offer higher long-term success rates compared to pulsed radiofrequency (PRF) based on long-term follow-up data. (Evidence: Strong 1)
Pulsed radiofrequency can be considered as an initial adjunctive treatment, with repetitive sessions potentially extending pain relief duration. (Evidence: Moderate 1)
Abdominal wall injections should be the initial approach due to their minimally invasive nature and potential efficacy in symptom relief. (Evidence: Expert opinion 1)References
1 Have TT, Geffen STV, Zwaans WAR, Maatman RC, Boelens OBA, Steegers MAH et al.. Pulsed radiofrequency or surgery for anterior cutaneous nerve entrapment syndrome: Long-term results of a randomized controlled trial. Pain practice : the official journal of World Institute of Pain 2024. link