From the Research
Anterior cutaneous nerve entrapment syndrome (ACNES) should be treated with a conservative, non-invasive approach, utilizing sequenced osteopathic manipulation techniques, active release techniques, instrument-assisted soft tissue mobilization, directional cupping, stretching, and strengthening exercises, as this approach has been shown to result in 100% pain reduction and complete resolution of functional limitations in a recent case study 1.
Diagnosis of ACNES
The diagnosis of ACNES is primarily clinical, based on three key findings:
- Localized abdominal pain in the distribution of the intercostal nerves
- Pain that increases with tensing of the abdominal muscles
- A positive Carnett's sign (increased pain when the rectus muscle is tensed)
Treatment Options
Treatment options for ACNES include:
- Conservative measures such as NSAIDs and physical therapy
- Local anesthetic injections with lidocaine, which may provide diagnostic confirmation and therapeutic benefit 2
- Surgical neurectomy, which involves resection of the affected nerve endings, may be considered for patients who do not respond to conservative treatment
- Peripheral nerve stimulation (PNS) has also been shown to be effective in managing ACNES, with one case study reporting immediate pain relief and no need for medication at two years follow-up 3
Conservative Treatment Approach
The conservative treatment approach, as described in the recent case study 1, involves a sequenced treatment-based diagnostic approach, which allows for the identification of all involved anatomic regions of pain and anatomic segments of pathology contributing to the abdominal pain. This approach includes:
- Osteopathic manipulation techniques
- Active release techniques
- Instrument-assisted soft tissue mobilization
- Directional cupping
- Stretching and strengthening exercises This approach has been shown to be effective in resolving the contributing pain conditions and providing patients with tools and strategies to prevent recurrence.
Prioritizing Conservative Treatment
Given the recent evidence supporting the effectiveness of conservative treatment approaches for ACNES, it is recommended to prioritize this approach over more invasive treatments, such as surgical neurectomy or PNS, unless conservative treatment has been tried and failed. This approach is supported by the most recent and highest quality study available 1.