A Case For Ultrasound-Guided Peripheral Nerve Stimulation In Intractable Anterior Cutaneous Nerve Entrapment Syndrome

Abstract

Aim: This case report documents the use of peripheral nerve stimulation in the setting of entrapment of the anterior cutaneous branches of the intercostal nerves, with pain rated by the patient as severe during exacerbation episodes. Materials&methods: Under ultrasound guidance, two permanent leads were implanted caudad to cephalad, along and superficial to the lateral aspect of the rectus abdominis, distal to the umbilicus (1 lead per side). Results: At the 6 month follow-up, the patient reported near complete resolution of baseline pain, as well as fewer, sporadic pain exacerbation episodes, rated as mild-to-moderate. Conclusion: This case report suggests that peripheral nerve stimulation might be a valuable treatment option for previously intractable abdominal pain due to entrapment of the anterior cutaneous branches.

Plain language summary

Anterior cutaneous nerve entrapment syndrome is a peculiar, a largely disregarded pain condition. Current management algorithms rely mostly on local injections followed by surgical anterior neurectomy. This case report presents a case of longstanding, anterior cutaneous nerve entrapment syndrome, unresponsive to first-line treatment, that was successfully treated with peripheral nerve stimulation technology targeting the anterior cutaneous branches.

Keywords::

• anterior cutaneous nerve entrapment syndrome
• neuromodulation
• pain medicine
• peripheral nerve stimulation
• ultrasound

Author contributions

N Ferreira-Silva is the first author. He was the physician who wrote the draft of the manuscript. G Ferreira-dos-Santos provided support and guidance in the elaboration of the manuscript. MFB Hurdle, S Gupta and CL Hunt were the physicians who provided treatment to the patient. They also provided intellectual input to the final version of the manuscript to be submitted for consideration for publication. SR Clendenen provided intellectual and technical expertise during the preparation for the case. MJ Pingree provided intellectual input for both the first and second versions of the manuscript, following the first peer-review process. All authors approved the final version of the manuscript, to be submitted for consideration for publication.

Financial&competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Informed consent disclosure

The authors state that they have obtained verbal and written informed consent from the patient for the inclusion of their medical and treatment history within this case report.