Trunk pain is a condition that affects a significant portion of the population, leading to discomfort and reduced quality of life. A recent narrative review highlights the importance of three often-overlooked potential causes: anterior, lateral, and posterior cutaneous nerve entrapment syndromes. These conditions, which can lead to chronic pain and disability, are commonly diagnosed through unique history and examination findings, but the lack of awareness among general practitioners often leads to a delayed diagnosis.
Published on January 14, 2024, in the journal ‘Internal Medicine (Tokyo, Japan)’, the DOI of this review is 10.2169/internalmedicine.2927-23. The review aims to contrast the three cutaneous nerve entrapment syndromes by examining the existing literature on the topic. Authored by experts from various Japanese universities and an international collaboration with the University of Michigan Medical School, USA, the article shines a light on a niche but important area of internal medicine.
The review, authored by Otsuka Yuki and colleagues, gathered data from two literature searches conducted on PubMed and Cochrane Library databases between March and September 2022. The search rendered 16 letters, technical reports, and review articles, with an additional 62, 6, and 3 articles specifically focusing on anterior, lateral, and posterior cutaneous nerve entrapment syndromes, respectively.
Understanding Cutaneous Nerve Entrapment Syndromes
Cutaneous nerve entrapment syndromes occur when the peripheral nerves become pinched or compressed. This can happen due to several factors, including trauma, repetitive movements, or anatomical variations. The three subtypes – anterior, lateral, and posterior – correspond to the area of the trunk where the affected nerves are located.
Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) typically involves the entrapment of the anterior cutaneous branches of the thoracoabdominal nerves. It manifests as sharp, burning pain on the front of the trunk.
Lateral Cutaneous Nerve Entrapment Syndrome (LCNES) involves nerves at the sides of the trunk and presents as pain or sensitivity in the flank area.
Posterior Cutaneous Nerve Entrapment Syndrome (PCNES) affects the back area, leading to pain that can radiate and mimic conditions like herniated discs or kidney stones.
Diagnostic Challenges and Treatments
Due to the particular nature of these conditions, cutaneous nerve entrapment syndromes are primarily diagnosed based on clinical findings. Unfortunately, no definitive imaging or laboratory tests can confirm the diagnosis, often leading to multiple consultations and a prolonged diagnostic journey for patients. Trigger point injections, which involve injecting anesthetics or steroids into the affected areas, are the common first-line treatment. This approach can provide diagnostic clues and symptomatic relief, but managing refractory cases remains a challenge.
Expanding Awareness Beyond General Medicine
The authors emphasize the importance of increasing awareness of cutaneous nerve entrapment syndromes beyond general medicine. They call for better educational resources for healthcare professionals in other specialties who may encounter patients presenting with trunk pain. With improved recognition and understanding of these conditions, the path to an accurate diagnosis and effective treatment can be significantly shortened.
Implications for Future Research and Practice
The review points to the need for further research on cutaneous nerve entrapment syndromes, especially concerning the management of refractory cases. Clinical trials and robust studies could provide insights into alternative treatment options and long-term outcomes. Moreover, there is a need for better diagnostic tools that can reliably identify these conditions.
Conclusion
The article by Otsuka Yuki et al. underlines the complexity of diagnosing and treating anterior, lateral, and posterior cutaneous nerve entrapment syndromes. The significant number of articles scrutinized in their review demonstrates a growing interest in this field. However, the limited data on the posterior subtype and refractory cases highlight areas requiring further investigation and education.
References
1. Otsuka Y, Ishizuka K, Harada Y, et al. Three Subtypes of Cutaneous Nerve Entrapment Syndrome: A Narrative Review. Intern Med. 2024 Jan 13;10.2169/internalmedicine.2927-23.
2. Ducic I, Felder JM 3rd, Iorio ML. The role of peripheral nerve surgery in the treatment of chronic pain associated with peripheral nerve injury. J Neurosurg. 2012 Feb;116(2):291-5.
3. Macgregor J, Greenberg S. Cutaneous nerve entrapment syndrome. Pain Physician. 2001;4(3):285-90.
4. Siu G, Jaffe JD, Rafique M. Anterior cutaneous nerve entrapment syndrome (ACNES): a commonly overlooked cause of abdominal pain. Perm J. 2005 Summer;9(3): 20-7.
5. van Slobbe AM, Bohnen AM, Bernsen RM, Koes BW, Bierma-Zeinstra SM. Incidence rates and determinants in meralgia paresthetica in general practice. J Neurol. 2004 Mar;251(3):294-7.
Keywords
1. Cutaneous nerve entrapment syndromes
2. Trunk pain diagnosis
3. Trigger point injection treatment
4. Anterior cutaneous nerve entrapment
5. Chronic trunk pain management