ACNES: The Enigma of Abdominal Pain

May 13th, 2023
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ACNES stands for Abdominal Cutaneous Nerve Entrapment Syndrome, a condition that causes chronic abdominal pain due to the compression of sensory nerves in the abdominal wall. ACNES is often overlooked and misdiagnosed, leading to unnecessary investigations and treatments. However, ACNES can be easily diagnosed by a simple physical examination and confirmed by a nerve block with a local anaesthetic.

A nerve block is a procedure that involves injecting a medication near a nerve to temporarily numb it and stop the pain signals. In ACNES, the nerve block targets the anterior cutaneous branches of the lower thoracic intercostal nerves, which supply sensation to the skin of the abdomen. These nerves run between the internal oblique and transversus abdominis muscles and pierce through the rectus abdominis muscle to reach the skin. The nerve block is performed by inserting a needle through the skin under ultrasound guidance at the point of maximum tenderness and injecting a small amount of local anaesthetic and steroid around the nerve.

A nerve block for ACNES has two main purposes: diagnostic and therapeutic. A diagnostic nerve block helps to confirm the diagnosis of ACNES by providing immediate and complete pain relief. If the pain does not improve or only partially improves after the nerve block, then ACNES is unlikely to be the cause of the pain and other conditions should be considered. A therapeutic nerve block helps to treat the pain of ACNES by interrupting the cycle of nerve irritation and inflammation. A single nerve block may provide lasting pain relief for some patients, while others may require repeated injections or other treatments.

There are different types of nerve blocks for ACNES, depending on the technique and the medication used. The most common type is a simple injection of local anaesthetic, such as lidocaine or bupivacaine, which provides temporary pain relief for a few hours or days. Another type is a pulsed radiofrequency treatment, which involves applying an electric current to the nerve through a needle for a few minutes. This can provide sustained pain relief for several months by modulating the nerve activity without damaging it.

A nerve block for ACNES is generally a safe and effective procedure that can be performed in an outpatient setting by an experienced clinician. The procedure takes about 15 minutes and does not require sedation or anaesthesia. The possible side effects include bruising, bleeding, infection, allergic reaction, or temporary weakness of the abdominal muscles. The benefits include rapid pain relief, improved quality of life, reduced need for medications or surgery, and prevention of central sensitization.

One of the challenges of diagnosing and treating ACNES is that it can mimic other abdominal conditions, such as appendicitis, gallstones, or irritable bowel syndrome. Many patients with ACNES undergo unnecessary tests and procedures before being referred to a pain specialist. Moreover, ACNES is often under-recognized and undertreated by healthcare providers who are not familiar with this syndrome.

That’s why it is important to consult a specialist who has experience and expertise in diagnosing and treating ACNES. Dr Krishna is one of the leading experts in this field and has helped many patients with ACNES find relief from their pain. He has performed hundreds of nerve blocks for ACNES with a high success rate. He is an expert in ultrasound-guided ACNES injections including the Pulsed Radiofrequency ablation technique that can provide long-term pain relief from this condition. Dr Krishna offers a holistic approach to patients with chronic pain.

If you are suffering from ACNES and want to learn more about your treatment options, contact Dr Krishna today at or visit our website