Cutaneous Nerve Entrapment Syndrome Research Articles

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

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

Precise application of Traditional Chinese Medicine in minimally-invasive techniques

Precise application of Traditional Chinese Medicine in minimally-invasive techniques

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

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

Chronic Abdominal Wall Pain.

Chronic abdominal wall pain is a poorly recognized clinical problem despite being an important element in the differential diagnosis of abdominal pain. This review is based on pertinent articles that were retrieved by a selective search in PubMed and EMBASE employing the terms "abdominal wall pain" and "cutaneous nerve entrapment syndrome," as well as on the authors' clinical experience. In 2% to 3% of patients with chronic abdominal pain, the pain arises from the abdominal wall; in patients with previously diagnosed chronic abdominal pain who have no demonstrable pathological abnormality, this likelihood can rise as high as 30% . There have only been a small number of clinical trials of treatment for this condition. The diagnosis is made on clinical grounds, with the aid of Carnett's test. The characteristic clinical feature is strictly localized pain in the anterior abdominal wall, which is often mischaracterized as a "functional" complaint. In one study, injection of local anesthesia combined with steroids into the painful area was found to relieve pain for 4 weeks in 95% of patients. The injection of lidocaine alone brought about improvement in 83-91% of patients. Long-term pain relief ensued after a single lidocaine injection in 20-30% of patients, after repeated injections in 40-50% , and after combined lidocaine and steroid injections in up to 80% . Pain that persists despite these treatments can be treated with surgery (neurectomy). Chronic abdominal wall pain is easily diagnosed on physical examination and can often be rapidly treated. Any physician treating patients with abdominal pain should be aware of this condition. Further comparative treatment trials will be needed before a validated treatment algorithm can be established.

Modified Infiltration Technique for Cutaneous Nerve Entrapment Syndrome

Lateral thoracic or abdominal cutaneous nerve entrapment syndrome (C.N.E.S.) refers to the pain originating from thoracic or abdominal wall. It is a common ailment which is often misdiagnosed as arising from a source inside the abdominal cavity mistakenly leading to inappropriate diagnostic investigations, unsatisfactory treatment, and considerable costs. The thoracoabdominal nerves terminate as the cutaneous nerves at a point from which accessory branches are given off in the rectus channel ending in the skin. Peripheral nerve entrapment occurs at anatomic sites where the nerve changes direction to enter a fibrous or osseofibrous tunnel because mechanically induced irritation is most likely to occur at these locations. Controlled investigations demonstrate that satisfactory alleviation is to be gained by immediate intervention by the most widely adopted technique of a fanning infiltration of the region of maximal point of tenderness with anesthetic and anti-inflammatory agents. Unfortunately, we observe that clinicians inexperienced performing this procedure are deterred from this technique owing to fears of inaccurate medication deposition or penetrating the abdominal cavity and perforating viscera. In this paper we describe a method to provide a safe and accurately targeted injection precisely at the necessary location without risking iatrogenic harm. This is easily achieved by raising a mound of the superficial soft tissue at the point of maximal tenderness and inserting the needle oriented Method Article Naimer; BJMMR, 7(8): 672-677, 2015; Article no.BJMMR.2015.375 673 parallel to the surface of the anterior body surface. Adoption of this method provides a simple, safe and effective solution for C.N.E.S. and will allow recruiting more physicians to join the circle of those actively treating this condition.