22nd Annual Pain Medicine Meeting 2023

A Novel Treatment for Anterior Cutaneous Nerve Entrapment Syndrome: Peripheral Nerve Stimulation

•Chronic abdominal pain has a prevalence of 2%, 23 million ED visits1,2

•Functional abdominal pain is pain for 6 months without evidence of underlying physiologic disease

•Anterior Cutaneous Nerve Entrapment Syndrome (ACNES)

•Intercostal nerves become entrapped and irritated between internal oblique and transverse abdominis

•Prevalence: 15-30%2

•Diagnosis: well localized pain, + Carnett’s test, response to TPI

•Traditional treatment: medications, TPI, nerve blocks, neurolysis and neurectomy

•50-year-old woman with a history of depression, osteoporosis, pancreatitis, diverticulitis, ulcerative colitis, and GERD presented with abdominal pain

•Surgical history: Nissen fundoplication, C-section, cholecystectomy, Ex-lap 2/2 gastric perforation

•Physical exam: healed midline incision with scarring and fibrosis causing some skin tension

•Pain at the midline incision, TTP, + Carnett’s test

•Failed medications: acetaminophen, gabapentin, pregabalin, amitriptyline, duloxetine, tizanidine

•Intervention: TAP block with 2% lidocaine, 0.5% bupivacaine, and triamcinolone 80 mg

•Significant short-term relief, repeated every 3-6 months

•Developed adrenal suppression requiring systemic steroids

•Options: medications only, TAP with local only, or peripheral nerve stimulation (PNS) trial

•Anterior cutaneous PNS trial for one week with 85% pain relief

•Underwent permanent anterior cutaneous PNS implant July 2022

•95% pain relief immediately following the implant, continues to have more than 80% pain relief to this day

22nd Annual Pain Medicine Meeting 2023

A NOVEL TREATMENT FOR ANTERIOR CUTANEOUS NERVE ENTRAPMENT SYNDROME: PERIPHERAL NERVE STIMULATION

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