EXPLORING PULSED RADIOFREQUENCY ABLATION FOR ANTERIOR CUTANEOUS NERVE ENTRAPMENT SYNDROME: INSIGHTS FROM A FIVE-PATIENT CASE SERIES

Abstract

Background- Anterior cutaneous nerve entrapment syndrome (ACNES) is an underrecognized cause of chronic abdominal pain resulting from entrapment of the anterior cutaneous branches of thoracoabdominal intercostal nerves. While conservative management with local anesthetics and corticosteroids offers temporary relief for many patients, a subset remains refractory to these interventions. Pulsed radiofrequency (PRF) ablation has emerged as a minimally invasive neuromodulatory technique for various neuropathic pain conditions. Objective- To evaluate the clinical outcomes of ultrasound-guided PRF ablation in five patients with refractory ACNES. Methods- Five patients with chronic localized abdominal pain (duration >6 months), positive Carnett's sign, and temporary relief from diagnostic nerve blocks underwent two ultrasound-guided PRF sessions targeting the affected anterior cutaneous nerve branches. The sessions were performed two weeks apart, each consisting of a 10-minute application (42°C, 45V). Pain intensity was assessed using the Numeric Rating Scale (NRS, 0-10) at baseline, 2 weeks, 4 weeks, and 8 weeks post-procedure. Secondary outcomes assessed were sleep quality (measured by NRS) and the Patient Global Impression of Change (PGIC). Results- At 4 and 8-week follow-up, four of five patients (80%) demonstrated clinically meaningful pain reduction (≥50% from baseline). In these responders, mean NRS of pain decreased from 6.8 to 2.3. Pain relief was accompanied by corresponding improvements in sleep quality and PGIC scores indicating moderate to marked benefit. No significant adverse events were observed. Conclusion- These findings suggest that PRF ablation may represent a safe and effective minimally invasive option for patients with refractory ACNES, warranting further investigation in larger controlled studies.