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Anterior cutaneous nerve entrapment syndrome: management challenges

Authors Chrona E, Kostopanagiotou G, Damigos D, Batistaki C

Received 19 August 2016

Accepted for publication 18 November 2016

Published 13 January 2017 Volume 2017:10 Pages 145—156

DOI https://doi.org/10.2147/JPR.S99337

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Michael Schatman

Eleni Chrona,1,2 Georgia Kostopanagiotou,1 Dimitrios Damigos,3 Chrysanthi Batistaki1

1Second Department of Anesthesiology, School of Medicine, National and Kapodistrian University of Athens, “Attikon” Hospital, Athens, 2Department of Anesthesiology, General Hospital of “Ag. Panteleimon,” Piraeus, 3Department of Medical Psychology, Medical School of Ioannina, University of Ioannina, Ioannina, Greece

Abstract: Anterior cutaneous nerve entrapment syndrome (ACNES) is a commonly underdiagnosed and undertreated chronic state of pain. This syndrome is characterized by the entrapment of the cutaneous branches of the lower thoracoabdominal intercostal nerves at the lateral border of the rectus abdominis muscle, which causes severe, often refractory, chronic pain. This narrative review aims to identify the possible therapeutic strategies for the management of the syndrome. Seventeen studies about ACNES therapy were reviewed; of them, 15 were case–control studies, case series, or case reports, and two were randomized controlled trials. The presently available management strategies for ACNES include trigger point injections (diagnostic and therapeutic), ultrasound-guided blocks, chemical neurolysis, and surgical ­neurectomy, in combination with systemic medication, as well as some emerging techniques, such as radiofrequency ablation and neuromodulation. An increased awareness of the syndrome and the use of specific diagnostic criteria for its recognition are required to facilitate an early and successful management. This review compiles the proposed ­management strategies for ACNES.

Keywords: anterior cutaneous nerve entrapment syndrome, intercostal, neuralgia, management

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