Cutaneous Nerve Entrapment Research Articles

Factors predicting outcome after anterior neurectomy in patients with chronic abdominal pain due to anterior cutaneous nerve entrapment syndrome (ACNES)

BackgroundChronic abdominal pain due to anterior cutaneous nerve entrapment syndrome may require surgery to provide long-term pain relief in up to 70% of patients. Factors predicting outcome after an anterior neurectomy are unknown. The aim of the study is to identify factors associated with treatment failure to possibly allow for optimizing patient counselling and selection. MethodsCharacteristics of anterior cutaneous nerve entrapment syndrome patients who were unresponsive to nonsurgical therapies and underwent an anterior neurectomy in a tertiary referral center from 2011 to 2016 were analyzed. Treatment failure was defined as <50% pain reduction using a numeric pain rating scale (numeric pain rating score 0–10) approximately 2 months postoperatively. A prediction model based on a multivariate regression analysis was tested for its discriminative value. ResultsA total of 495 patients (78% female, median age 40 years, range 8–83) undergoing an anterior neurectomy were eligible for analysis. Pain medication use (odds ratio 1.84, P = .027, confidence interval 1.07–3.17), abdominal surgery in the past (odds ratio 1.85, P = .026, confidence interval 1.08–3.18), the presence of paravertebral tender points at exit points of intercostal nerves (odds ratio 2.58, P = .003, confidence interval 1.39–4.80), and failure to favorably respond to a diagnostic rectus sheath block (odds ratio 3.74, P = .000, confidence interval 3.74 – 7.10) were identified as factors predicting surgical failure. However, a prediction model including these 4 factors had poor accuracy with an area under the curve of 0.64 (confidence interval 0.58–0.70). ConclusionThe present study identified risk factors associated with treatment failure that are useful in counseling anterior cutaneous nerve entrapment syndrome patients prior to a surgical intervention.

RETRACTED: Quadratus lumborum block is not effective for anterior cutaneous nerve entrapment syndrome

RETRACTED: Quadratus lumborum block is not effective for anterior cutaneous nerve entrapment syndrome

Anterior Cutaneous Nerve Entrapment Syndrome in Children: A Prospective Observational Study.

Anterior cutaneous nerve entrapment syndrome (ACNES) is often an overlooked cause of abdominal pain. Data for pediatric patients, especially with regard to the treatment modalities are scarce. The aim of this study was to present a treatment modality of ACNES with combined local subfascial anesthetic and corticosteroid injection in a prospectively collected cohort of pediatric patients. This was a prospective observational long-term study that included pediatric patients who were diagnosed with ACNES in a tertiary care pediatric center and who were followed-up for at least 12 months (median: 1.7 y; range: 1 to 2.7 y). All children were treated by ultrasound-guided subfascial injection of 40 mg 1% lidocaine and 4 mg dexamethasone into the rectus abdominis muscle in the place of the most severe pain (trigger point infiltration). The study included 38 children (28, 73.7% female; median age: 15 y). The majority of patients had pain in the lower right abdominal quadrant and were diagnosed in a median of 6 (range: 0.5 to 50) months after symptoms started. Overall, 24 (63%) patients achieved sustained symptom-free remission after a median of 1 (mean: 1.6; range: 1 to 5) trigger point infiltration during the first treatment session. Five (13%) children were surgically treated because of a lack of long-term response. Children who were surgically treated required a higher number of block applications during the first session of treatment, compared with children who were successfully treated conservatively. ACNES in children can be successfully treated by a combined local subfascial anesthetic and corticosteroid trigger point infiltration.

Case-control study on Pi needle for the treatment of the cutaneous nerve entrapment low back pain

To explore a safe and effective method for the treatment of low back pain in the cutaneous nerve, and to clarify the indication of Pi needle to treat it. From January 2003 to December 2004, 278 patients with cutaneous nerve entrapment low back pain were divided into two groups: Pi needle group and electrical stimulation group. In the Pi needle group, there were 68 males and 70 females, ranging in age from 20 to 60 years old, with an average of(41.92±10.88)years old. In the electrical stimulation group, there were 68 males and 72 females, ranging in age from 18 to 60 years old, with an average of(41.44±10.47) years old. The pain, tenderness and soft tissue tension of the two groups were measured and compared before and after treatment. All of the selected cases were qualified. No suspension, culling and shedding cases occurred in either group. In Pi needle group, visual analog scale(VAS) of pain decreased from 8.78±1.52 before treatment to 1.33±1.33 after treatment;and in electrical stimulation group, VASof pain decreased from 8.59±1.76 before treatment to 5.20±2.64 after treatment;and the VAS of pain of the Pi needle group was lower than that of the electrical stimulation group. In Pi needle group, VAS of tenderness decreased from 9.12±1.24 before treatment to 1.60±1.36 after treatment;and in electrical stimulation group, VAS of pain decreased from 8.79±1.60 before treatment to 5.34±2.60 after treatment;and the VAS of pain of the Pi needle group was lower than that of the electrical stimulation group. Once tissue texture changes to pain point, cord, nodules, Pi needle is the first line treatment for the cutaneous nerve entrapment low back pain.

Precise application of Traditional Chinese Medicine in minimally-invasive techniques

Precise application of Traditional Chinese Medicine in minimally-invasive techniques

Su1590 - Anterior Cutaneous Nerve Entrapment Syndrome: An Underrecognized Etiology of Chronic Abdominal Pain

Su1590 - Anterior Cutaneous Nerve Entrapment Syndrome: An Underrecognized Etiology of Chronic Abdominal Pain

Adding steroids to lidocaine in a therapeutic injection regimen for patients with abdominal pain due to anterior cutaneous nerve entrapment syndrome (ACNES): a single blinded randomized clinical trial.

Background and aims Anterior cutaneous nerve entrapment syndrome (ACNES) may result in chronic abdominal pain. Therapeutic options include local injection therapy. Data on the efficacy of adding corticosteroids to these injections is lacking. Methods Patients ≥18 years with ACNES were randomized to receive an injection of lidocaine with (LC-group) or without (LA-group) the addition of methylprednisolone into the point of maximal abdominal wall pain. Pain was recorded using a numeric rating scale (NRS: 0-10) and a verbal rating scale (VRS: 0=no pain, 5=unbearable pain) at baseline and 6 weeks after the start of a bi-weekly injection regimen consisting of a total of three injections. A minimal 50% reduction on NRS and/or two points on VRS were considered successful responses. Results Between February 2014 and August 2016, 136 patients (median age 46 year, range 18-79, 75% females) were randomized (68 vs. 68). The proportion of patients demonstrating a successful response after 6 weeks did not significantly differ between groups (LA 38%, LC 31%, p=0.61). At 12 weeks, the number of patients still experiencing a minimal 50% pain relief had decreased but no group difference was observed (LA 20%, LC 18%, p=0.80). Minor side effects included temporary increase of pain, tenderness at injection sites or transient malaise (LA23/68, LC 29/68, p=0.46). Conclusions Adding corticosteroids to a lidocaine does not increase the proportion of ACNES patients with a successful response to injection therapy. Lidocaine alone can provide long term pain relief after one or multiple injections, in approximately 1 of 5 patients.

Nerve entrapment syndromes in dermatology: Review and practical approach to treatment.

A good understanding of cutaneous nerve entrapment syndromes is important for physicians to provide early and accurate diagnosis and treatment. These syndromes have traditionally been managed with analgesics, antidepressants or antiepileptic medication but this approach is often inadequate and causes frequent adverse medication effects. With early diagnosis and treatment, many nerve entrapment syndromes can be successfully managed with physical, non-pharmacological approaches including stretches, exercises and physiotherapy.

Abdominal Cutaneous Nerve Entrapment Syndrome: The Cause of Localized Abdominal Pain in a Young Pregnant Woman

BackgroundDespite the broad differential diagnosis in any patient referring with symptoms involving the chest or abdomen, a small number of conditions overshadow the rest by their probability. Chest and abdominal wall pain continues to constitute a common and expensive overlooked source of pain of unknown cause. In particular, cutaneous nerve entrapment syndrome is commonly encountered but not easily diagnosed unless its specific symptoms are sought and the precise physical examination undertaken. Case ReportA primigravida woman with unbearable abdominal pain was referred repeatedly seeking a solution for her suffering. Numerous laboratory and imaging studies were employed in order to elucidate the cause of her condition. After numerous visits and unnecessary delay, the diagnosis was finally made by a physician fully versed in the field of torso wall pain. The focused physical examination disclosed abdominal cutaneous nerve entrapment syndrome as the diagnosis, and anesthetic infiltration led to immediate alleviation of her pain. Why Should an Emergency Physician Be Aware of This?Cutaneous nerve entrapment is a common cause of abdominal pain that is reached on the basis of thorough history and physical examination alone. Knowledge dissemination of the various torso wall syndromes is imperative for prompt delivery of suitable care. All emergency physicians should be fully aware of this entity because the diagnosis is based solely on physical examination, and immediate relief can be provided in the framework of the first visit. Wider recognition of this syndrome will promise that such mishaps are not repeated in the future.

Diagnostic characteristics of anterior cutaneous nerve entrapment syndrome in childhood.

A combination of typical findings in history and physical examination allows for diagnosing childhood ACNES. What is Known: • Anterior cutaneous nerve entrapment syndrome (ACNES) is often overlooked in chronic abdominal pain. • Pediatric literature on diagnostic work up for ACNES is poor. What is New: • Two third reported treatment delay due to misdiagnosis as functional abdominal pain. • Medical history and physical examination revealed neuropathic pain characteristic in up to 90% of the cases.

(239) - Chronic abdominal pain due to anterior cutaneous nerve entrapment syndrome, a diagnosis almost missed

Chronic abdominal wall pain due to anterior cutaneous nerve entrapment syndrome is frequently confused with visceral pain which often leads to extensive testing before the correct diagnosis. In this condition, the cutaneous branches of lower thoraco abdominal intercostals nerves are entrapped at the lateral border of rectus abdominis muscle resulting in severe, often refractory chronic pain. This syndrome is often under diagnosed and under treated. It is very well illustrated by case of 16-year-old male who was seen at our Pain clinic for long standing localized right sided upper abdominal pain which was brought on by activity. He had extensive work up performed by Gastroenterologist and Sports Medicine involving multiple Xrays, CT abdomen, endoscopy, colonoscopy, HIDA scan and performance evaluations without a conclusive diagnosis for over a year. Based on the presentation we suspected anterior cutaneous nerve entrapment syndrome and hence right rectus abdominus trigger point injections were attempted. Point of maximal pain was elicited by active jogging on treadmill and ultrasound visualization to inject in and around the muscle belly. It provided significant improvement in his symptoms but was relatively short lived. Plan was then made for cryoablation with which patient was able to achieve more prolonged relief. Hence, significant pain relief after trigger point injection is considered to establish the diagnosis. The current treatment options include ultrasound guided injections, radiofrequency ablation, cryoablation, anterior neurectomy which can provide adequate relief for the patient. To summarize, the diagnostic challenge posed by this condition can be addressed by having higher degree of suspicion on the part of physicians. An early diagnosis can prevent central sensitization, avoid plethora of investigations and successful intervention can be therefore be made.

Pulsed Radiofrequency as a Minimally Invasive Treatment Option in Anterior Cutaneous Nerve Entrapment Syndrome: A Retrospective Analysis of 26 Patients.

BackgroundChronic abdominal pain is occasionally due to entrapped intercostal nerve endings (ACNES, abdominal cutaneous nerve entrapment syndrome). If abdominal wall infiltration using an anesthetic agent is unsuccessful, a neurectomy may be considered. Pulsed radiofrequency (PRF) is a relatively new treatment option for various chronic pain syndromes. Evidence regarding a beneficial effect of this minimally invasive technique in ACNES is lacking. The aim was to assess the effectiveness of PRF treatment in ACNES patients.MethodsA series of ACNES patients undergoing PRF treatment between January 2014 and December 2015 in two hospitals were retrospectively evaluated. Pain was recorded prior to treatment and after 6 weeks using a numerical rating scale (NRS, 0 (no pain) to 10 (worst possible pain)). Successful treatment was defined as > 50% NRS pain reduction. Patient satisfaction was scored by patient global impression of change (PGIC, 1 = very much worse, to 7 = very much improved).ResultsTwenty-six patients were studied (17 women, median age 47 years, range 18 - 67 years). After 6 weeks, mean NRS score had dropped from 6.7 ± 1.2 to 3.8 ± 2.3 (P < 0.001). A mean 4.9 ± 1.4 PGIC score was reported by then. Short term treatment success (6 - 8 weeks) was 50% (n = 13, 95% CI: 29 - 71), while 8% was pain-free on the longer term (median 15 months). Median effect duration was 4 months (range 2 - 26).ConclusionsPRF is temporarily effective in half of patients with ACNES. PRF is safe and may be favored in neuropathic pain syndromes as nerve tissue destruction is possibly limited. A randomized controlled trial determining the potential additional role of PRF in the treatment strategy for ACNES is underway.

Anterior cutaneous nerve entrapment syndrome (ACNES).

The abdominal wall is frequently overlooked as a potential source of chronic abdominal pain. In anterior cutaneous nerve entrapment syndrome (ACNES), irritated intercostal nerves cause severe abdominal pain. Current textbooks fail to acknowledge ACNES. Aim of the present review is to provide detailed information on patient history, physical examination, and a three-step treatment protocol including abdominal wall injections and a localized removal of terminal branches of intercostal nerves.

Neurectomy for anterior cutaneous nerve entrapment syndrome in children

IntroductionAnterior cutaneous nerve entrapment syndrome (ACNES) is an underrecognized etiology of chronic abdominal pain that causes great morbidity to those affected. We sought to determine the outcome of neurectomy for ACNES in children. MethodsDemographic and clinical data on children who underwent neurectomy for ACNES by a single surgeon from 10/2011 to 01/2017 were reviewed. ResultsTwenty-six patients underwent neurectomy for ACNES. Five were male and average age was 15years (10–21). Median (IQR) preoperative pain duration was 15 (8–29) months and 19 reported their pain was 10/10 (6–10). Thirteen patients were taking antidepressants, 12 Gabapentin, and 4 narcotics. Most had been hospitalized at least once secondary to the pain. All 26 had undergone diagnostic studies including: nuclear medicine scan, fluoroscopy, computed tomography, magnetic resonance imaging, sonography, endoscopy and surgery. Once the diagnosis was suspected, all underwent at least one ultrasound-directed nerve block, which provided relief lasting from 6h to 14days. Patients then underwent outpatient surgery with division of the involved nerve(s). There were no perioperative complications. Most patients reported incisional discomfort for 3–14days afterward, and immediate resolution of the nerve pain without cutaneous numbness. Postoperatively, 15 patients (58%) were pain free long-term; pain recurred to a lesser severity in 8 (31%) and recurred to the same extent in 3 (11%), with average time to recurrence of 6.7months. Of those whose pain recurred to a lesser extent, all achieved long term relief, 4 improved with time, 1 through repeat neurectomy, 2 through medical treatment for underlying psychiatric disorders and 1 through treatment for newly diagnosed inflammatory bowel disease. Of those children with pain recurring to the same extent, all underwent repeat neurectomy, none of whom achieved pain relief. ConclusionACNES should be considered in children with chronic abdominal pain. Neurectomy is safe and relieves pain in around 88% of selected children. Further investigation is necessary to optimize patient selection. Level of evidenceIV.

Anterior cutaneous nerve entrapment syndrome with pain present only during Carnett\u2019s sign testing: a case report

BackgroundThe identification of anterior cutaneous nerve entrapment syndrome is often challenging, due to no widely accepted standard guidelines regarding laboratory and imaging tests for the diagnosis of ACNES.Case presentationA 77-year-old Japanese man presented with mild lower abdominal pain that had been present for the past 3 years. Physical examination revealed no abdominal pain during palpation, with normal laboratory and imaging testing; therefore, conservative therapy was initiated. However, the abdominal pain continued. Re-examination 16 days later revealed three tender points in accordance with intercostal nerves Th10, Th11, and Th12, with the pain occurring only during Carnett’s sign testing. A cutaneous injection of 1% lidocaine was administered, and the abdominal pain was resolved about 30 min later. Based on these results, anterior cutaneous nerve entrapment syndrome was diagnosed.ConclusionsIt is sometimes hard to diagnose anterior cutaneous nerve entrapment syndrome without testing for Carnett’s sign. If patients present with chronic abdominal pain, clinicians should test for Carnett’s sign even if no pain is elicited during regular abdominal palpation.

Clinical Vignettes/Case Reports-Practice Management.

Anterior cutaneous nerve entrapment syndrome (ACNES) is a common cause of chronic abdominal pain that often goes undiagnosed and thus undertreated. Here we present a case of a man who was investigated extensively for ‘acute abdomen' and was found to have ACNES. A 62 year old male patient with a past medical history of coronary artery disease and GERD presented to the emergency department with complaints of recurrent abdominal pain of two months duration requiring multiple ED visits. The pain was sharp in nature, located in the left lower quadrant and associated with nausea. The patient denied any association with food or bowel movements. He denied vomiting or any changes in bowel habits. The patient had a left inguinal hernia repair 3 months prior. Vital signs were within normal limits. On physical exam, he was tender to palpation in the left lower abdomen with a clear transition line in the mid abdomen. A focal point of maximum tenderness was appreciated 2 cm distal to the left of the umbilicus. A positive Carnett's sign was elicited. All other physical exam findings were unremarkable. Laboratory work up was within normal limits. A right upper quadrant ultrasound and multiple CT scans of the abdomen showed no acute findings. Gastroenterology were consulted and a triamcinolone plus lidocaine injection was given to the point of maximum tenderness with instantaneous resolution of symptoms. Anterior cutaneous nerve entrapment syndrome (ACNES) is a commonly under-diagnosed and under treated cause of severe abdominal pain. The lower thoracoabdominal nerve roots become entrapped often at the lateral border of the rectus abdominis muscle causing pain. It is believed that the patient's hernia repair surgery was the culprit behind his presentation. Patients typically have pain on palpation of one site at the lateral border of the rectus abdominis muscle and a positive Carnett's sign. A positive Carnett's sign is appreciated if the pain increases or remains the same with the examiner's finger on the point of maximum pain as the patient raises both legs. A positive sign indicates abdominal wall pain. A trigger point injection resolving the symptoms may then confirm the diagnosis. Therefore, with high index of suspicion, it would save not only the patient from multiple unnecessary hospital visits, but also decrease hospital spending on unnecessarily work up like CT scans, ultrasounds and laboratory testing.

Lateral Cutaneous Nerve Entrapment Syndrome (LACNES): A previously unrecognized cause of intractable flank pain

Background and aimsChronic abdominal pain may occasionally be due to terminal endings of intercostal nerves (ACNES, abdominal cutaneous nerve entrapment syndrome) that are entrapped in the abdominal wall. Spontaneous neuropathic flank pain may also be caused by involvement of branches of these intercostal nerves. Aim is to describe a series of patients with flank pain due to nerve entrapment and to increase awareness for an unknown condition coined Lateral Cutaneous Nerve Entrapment Syndrome (LACNES). MethodsPatients possibly having LACNES (constant area of flank tenderness, small point of maximal pain with neuropathic characteristics, locoregional altered skin sensation) presenting between January 2007 and May 2016 received a diagnostic 5–10mL 1% lidocaine injection. Pain levels were recorded using a numerical rating scale (0, no pain to 10, worst possible). A >50% pain reduction was defined as success. Long term effect of injections and alternative therapies were determined using a satisfaction scale (1, very satisfied, no pain – 5, pain worse). Results30 patients (21 women, median age 52, range 13–78) were diagnosed with LACNES. Pain following one injection dropped from 6.9±1.4 to 2.4±1.9 (mean, p<0.001) leading to an 83% immediate success rate. Repeated injection therapy was successful in 16 (pain free n=7, pain acceptable, n=9; median 42 months follow-up). The remaining 14 patients received (minimally invasive) surgery (n=5) or other treatments (medication, manual therapy or pulsed radiofrequency, n=9). Overall treatment satisfaction (scale 1 or 2) was attained in 79%. Conclusions and implicationsLACNES should be considered in patients with chronic flank pain. Injection therapy is long term effective in more than half of the population.

Pulsed radiofrequency or anterior neurectomy for anterior cutaneous nerve entrapment syndrome (ACNES) (the PULSE trial): study protocol of a randomized controlled trial

BackgroundSome patients with chronic abdominal pain suffer from an anterior cutaneous nerve entrapment syndrome (ACNES). This somewhat illusive syndrome is thought to be caused by the entrapment of end branches of the intercostal nerves residing in the abdominal wall. If ACNES is suspected, a local injection of an anesthetic agent may offer relief. If pain is recurrent following multiple-injection therapy, an anterior neurectomy entailing removal of the entrapped nerve endings may be considered. After 1 year, a 70% success rate has been reported. Research on minimally invasive alternative treatments is scarce. Pulsed radiofrequency (PRF) treatment is a relatively new treatment for chronic pain syndromes. An electromagnetic field is applied around the nerve in the hope of leading to pain relief. This randomized controlled trial compares the effect of PRF treatment and neurectomy in patients with ACNES.MethodsAdult ACNES patients having short-lived success following injections are randomized to PRF or neurectomy. At the 8-week follow-up visit, unsuccessful PRF patients are allowed to cross over to a neurectomy. Primary outcome is pain relief after either therapy. Secondary outcomes include patient satisfaction, quality of life, use of analgesics and unanticipated adverse events. The study is terminated 6 months after receiving the final procedure.DiscussionSince academic literature on minimally invasive techniques is lacking, well-designed trials are needed to optimize results of treatment for ACNES. This is the first large, randomized controlled, proof-of-concept trial comparing two therapy techniques in ACNES patients. The first patient was included in October 2015. The expected trial deadline is December 2017. If effective, PRF may be incorporated into the ACNES treatment algorithm, thus minimizing the number of patients requiring surgery.Trial registrationNederlands Trial Register (Dutch Trial Register), NTR5131 (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5131). Registered on 15 April 2015.

Acute Appendicitis, Somatosensory Disturbances (“Head Zones”), and the Differential Diagnosis of Anterior Cutaneous Nerve Entrapment Syndrome (ACNES)

BackgroundAnterior cutaneous nerve entrapment syndrome (ACNES) is a neuropathic abdominal wall pain syndrome typically characterized by locally altered skin sensations. On the other hand, visceral disease may also be associated with similar painful and altered skin sensations (“Head zones”). Aim of the study was to determine if patients with acute appendicitis demonstrated somatosensory disturbances in the corresponding right lower quadrant Head zone. MethodsThe presence of somatosensory disturbances such as hyperalgesia, hypoesthesia, altered cool perception, or positive pinch test was determined in 100 patients before and after an appendectomy. Potential associations between altered skin sensations and various items including age, sex, history, body temperature, C-reactive protein (CRP), leukocyte count, and type of appendicopathy (normal, inflamed, necrotic, or perforated) were assessed. ResultsA total of 39 patients demonstrated at least one right lower abdominal quadrant skin somatosensory disturbance before the laparoscopic appendectomy. However, locoregional skin sensation normalized in all but 2 patients 2 weeks postoperatively. No differences were found concerning patient characteristics or type of appendicopathy between populations with or without altered lower abdominal skin sensations. ConclusionA substantial portion of patients with acute appendicitis demonstrate right lower abdominal somatosensory disturbances that are similar as observed in acute ACNES. Both may be different sides of the same coin and are possibly expressions of segmental phenomena as described by Head. McBurney’s point, a landmark area of maximum pain in acute appendicitis, is possibly a trigger point within a Head zone. Differentiating acute appendicitis from acute ACNES is extremely difficult, but imaging and observation may aid in the diagnostic process.

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