Anterior Cutaneous Nerve Entrapment Syndrome

Anterior Cutaneous Nerve Entrapment Syndrome

Anterior cutaneous nerve entrapment syndrome is a condition which brings chronic pain within the abdominal region. It is surprisingly common, having in mind how often it is overlooked during diagnosis. A recent study showed that 1 patient in about 2000 of them actually suffers from anterior cutaneous nerve entrapment syndrome.

Diagnosing it accurately allows suitable treatment and prevents procedures which are completely unnecessary, expensive and often intrusive. Many physicians often misdiagnose anterior cutaneous nerve entrapment syndrome as different functional disorders, or irritable bowel syndrome. This causes medical procedures and treatments which bring no improvement, but prolong the adverse condition.

Anterior cutaneous nerve entrapment syndrome is most commonly found in young women, but it is not limited by gender or age. It has been diagnosed and treated in men and women, children and the elderly.

What is anterior cutaneous nerve entrapment syndrome?

Anterior cutaneous nerve entrapment syndrome is produced when entrapment of terminal branches of the lower thoracic intercostals nerves into the abdominal muscles happens. This entrapment causes severe pain in the abdomen. However, it also causes other signs, as you will see in the section about the symptoms that accompany anterior cutaneous nerve entrapment syndrome.

As already mentioned, diagnosing anterior cutaneous nerve entrapment syndrome is often a problem, but the reason for this is that it is rarely considered. Diagnosing the condition is actually rather easy, once anterior cutaneous nerve entrapment syndrome has become an option.

Patient with ACNES
Patient with ACNES – Image powered by Sciencedirect.com

In this case, physical examination leads to the answer. It can start with Carnett’s sign, which is used to determine if tensing the muscles of the abdominal wall leads to increased acute pain. The procedure is very simple, since all the patient needs to do is lift the head and shoulders while lying on the examination table and report on any changes regarding the pain. Even if the results are positive, this does not necessarily mean that the patient can be diagnosed with anterior cutaneous nerve entrapment syndrome immediately. However, it is one of the signs.

Anterior cutaneous nerve entrapment syndrome is very commonly associated with the patient experiencing a limited area of maximal pain sensation which is covered by a more widely spread area of increased sensibility of skin. It comes with a number of changes within the somatosensory system, which is responsible for responding to various kinds of changes on or in the body.

These somatosensory changes can include the likes of hypoesthesia (reduction or partial loss of sense of touch), hyperesthesia (increase in the sense of touch) or hyperalgesia (increased sensitivity to pain).

Alterations can also include changes in the way patients perceive temperatures in that area of the body.

In order to confirm the diagnosis, some physicians require infiltration of the abdominal wall near the painful area. This is usually accompanied by administering a local anesthetic.

Anterior cutaneous nerve entrapment syndrome symptoms

Chronic abdominal pain is the most common symptom. However, other symptoms are also present, although not in all patients. These symptoms include changes in the functioning of the autonomic nerve system and often lead to abdominal swelling and bloating, nausea, loss of appetite, problems within the defecation process and weight reduction.

ACNES explenation
Speaking of pain, it comes from tensing the muscles of the abdominal wall. This means that almost any kind of a movement can make the pain worse. Sleep is also impaired and vast majority of patients report that they cannot sleep on the side which is painful.

The symptoms are greatly detrimental to the everyday life and almost constant pain often calls for immediate treatment.

Anterior cutaneous nerve entrapment syndrome treatment

Treatment covers two different things – managing pain and other symptoms and dealing with the nerves entrapment.

Speaking of the latter, the last resort is surgery in the form of anterior neurectomy. It provided 73% of success, according to a recent study. For the patients who have no success with the anterior neurectomy, there is an option of a secondary surgery in the form of a posterior neurectomy, which provides benefits for about half of the patients.

When we talk about managing pain, most analgesic medicines provide very limited relief. Some patients resort to anesthetic injections which can be used together with corticosteroids. About 60% of patients experience significant pain relief from this combination. However, corticosteroids  have numerous side effects and some of them can be very adverse, including psychosis, anxiety, depression, hypertension, moon face and buffalo hump (both due to the movement of body fat from the limbs to the face and torso), muscle wasting, insulin resistance, diabetes mellitus, hyperglycemia, retinopathy, cataract, reduced immunity and more.

However, there is another way of managing chronic pain stemming from anterior cutaneous nerve entrapment syndrome. And it is completely devoid of the side effects associated with corticosteroids.

It is palmitoylethanolamide (PEA). It helps against anterior cutaneous nerve entrapment syndrome in two ways.

First of all, it affects numerous receptors within the endocannabinoid system, thus managing pain, relieving inflammation and improving cell recovery.

This latter feature is also responsible for relieving damage caused by the nerves entrapment.

Additional benefit of PEA is that the entire pain-relieving, cell recovering and anti-inflammatory process is completely natural. It is the way the body deals with these issues on its own. The problem is that, when a condition is chronic, the body fails to produce enough palmitoylethanolamide to provide the mentioned benefits. Supplementing it resolves the issue and provides the mechanism with the necessary power.

Lastly, PEA is completely safe. It is a fatty acid amide which is broken down by enzymes quickly when not absorbed. There is no overdose level, no habituation issues of any kind and no negative interactions with any medicines you might be taking at the same time. It is the best way to manage pain and avoid the terrible side effects that many people consider compulsory with painkilling solutions. PEA is a game changer in this respect.