ACNES Pain syndrome

ACNES Pain Syndrome

Anterior Cutaneous Nerve Entrapment Syndrome (ACNES)

ACNES stands for Anterior Cutaneous Nerve Entrapment Syndrome. The pain is caused by a compression (entrapment) of the cutaneous branches (cutaneous) of the anterior nerve endings (nerve) of the intercostal areas. In other words: abdominal wall pain due to a compression of a sensory nerve. The pain can be present in a mild form, but most people experience an annoying unbearable pain.


The exact cause of ACNES is still unclear. In most cases it occurs suddenly. Some patients indicate that the pain complaints arose after an operation or through sports activities, such as abdominal exercises. It can also occur during or after pregnancy.

Source: NPO program Doctors vs. Internet

Common complaints with ACNES

  • The pain worsens with exertion. When the abdominal muscles tense, the pain usually increases. Lying on the painful side usually also causes the pain to increase. Radiation to the back can also occur.
  • Dull, nagging and sometimes stabbing pain. Pinching of the sensory nerve branches can lead to hypersensitivity of the piece of abdominal skin that belongs to this nerve.
  • Problems with bowel movements and/or (full) bladder
  • Posture can change. Some patients adjust their posture due to pain. Sometimes patients find it helpful to press their hand against the painful spot.
  • Clothes are uncomfortable
  • It can cause non-specific complaints, such as nausea and vomiting

Research

Before a specialist diagnoses ACNES, a lot of research has often been done, such as an ultrasound, MRI scan or blood test. This is often the case because ACNES is not immediately thought of, because this is a relatively unknown condition. If necessary, an ultrasound of the abdomen is made in the hospital before the appointment at the ACNES clinic.


The nerve(s) causing the symptoms are not visible with imaging (such as ultrasound or CT/MRI scan). The diagnosis is usually made based on the symptoms, the physical examination and sometimes a diagnostic injection

Treatments for ACNES

Physiotherapy / Laser treatment

There are 2 treatments that can contribute to the recovery or influence of ACNES and to postpone "more serious" interventions such as repeated injections and/or surgery.

1.       Fasciatherapie

2.       Deep Tissue laser behandeling


Ad.1.:

Treating ACNES with Fascia Therapy - The suspected cause of ACNES is a compression of an abdominal skin nerve in the fascia (connective tissue membranes) of the abdominal wall. This compression in the connective tissue can be treated very well without injections or operations (!). In our so-called conservative [= non-invasive] treatment we influence the surrounding fascia with specific soft techniques and fascia tools. (IASTM). In addition, we also pay attention to the physical and mental consequences of the intense and often long-term pain in the abdomen. From the experiences of our patients and from the ACNES Foundation it appears that the mental consequences of the chronic abdominal pain, in combination with a long-term course of multiple invasive examinations/operations, should not be underestimated. However, the conservative treatment of ACNES by means of Fascia Therapy has not yet received much publicity.


In particular the 'Fascia Gliding' and Fascia-ACNES technique to loosen the connective tissue, the fascia, in and around the probable adhesion in the abdominal wall. With this technique the therapist moves the connective tissue in the area with the fingers with a predetermined direction, amount of pressure and measured inertia. When performed correctly the connective tissue reacts by becoming 'looser';


Ad.2.

The Deep Tissue Laser Treatment - High Power Laser Therapy (also called Photo Bio Modulation) is the application of red and near infrared light (810 AND 980 Nanometer wavelength) to injuries or lesions. This locally improves blood circulation and metabolism enormously, and therefore generates a faster recovery, faster healing of wounds and tissues, reduces inflammation and irritation in tissue and ensures a rapid reduction of pain in acute and chronic pain.


High Power LASER is used for:

  • To increase the speed of tissue repair, the quality and tensile strength of tissue
  • To resolve inflammation
  • Pain relief (analgesia) in acute or chronic injuries

 

How does LASER Therapy work?

Our High Power Laser Therapy has a thermal and photochemical effect; just like photosynthesis in plants. When the right intensity and treatment times are used, this Laser will reduce oxidative stress and increase ATP production [energy in the cell]. This ensures an improvement of cell metabolism and a decrease of inflammation, and therefore a rapid decrease of pain.

Injections

In most cases, a diagnostic injection will be placed in the painful area during the first outpatient appointment at the hospital. An anesthetic fluid is used to anesthetize the abdominal wall where the nerve passes through the capsule of the abdominal muscle. The anesthetic usually wears off after a few hours. In some patients, the pain-relieving effect lasts for days to weeks. In some cases, the patient is even permanently pain-free after this injection. But more often, it has a moderate success. In patients whose pain returns, the injections are repeated several times, after which a large proportion of patients experience relief from the pain.

Operation

When [also] the injections do not help or do not help sufficiently, it is discussed whether an operation would be an option. During this operation under general anesthesia, the nerve branch that most likely causes the complaints is removed. Unfortunately, this therapy also has a moderate success rate.

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