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Bilateral distribution of anterior cutaneous nerve entrapment syndrome (ACNES): are clinical features and outcomes comparable to unilateral ACNES?
  1. Robbert C Maatman1,2,
  2. Mads U Werner3,
  3. Marc R M Scheltinga1,2 and
  4. Rudi M H Roumen1,2
  1. 1 Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands
  2. 2 SolviMáx, Center of Expertise for ACNES, Center of Excellence for Chronic Abdominal Wall and Groin Pain, Máxima Medical Center, Eindhoven, The Netherlands
  3. 3 Multidisciplinary Pain Center, Neuroscience Center, Rigshospitalet, Copenhagen, Denmark
  1. Correspondence to Dr Robbert C Maatman, Department of Surgery, Máxima Medical Center, Veldhoven 5500 MB, The Netherlands; robbertmaatman{at}


Background and objectives Mirror-image pain may occur in the presence of a one-sided peripheral nerve lesion leading to a similar distribution of pain on the contralateral side of the body (“mirrored”). Anterior cutaneous nerve entrapment syndrome (ACNES) is a neuropathic pain syndrome due to entrapment of terminal branches of intercostal nerves T7–12 in the abdominal wall and sometimes presents bilaterally. This study aims to address specifics of bilateral ACNES and to determine potential differences in clinical presentation and treatment outcomes when compared with the unilateral form of ACNES.

Methods Electronic patient files and questionnaires of a case series of patients who were evaluated for chronic abdominal wall pain in a single center were analyzed using standard statistical methods.

Results Between June 1, 2011 and September 1, 2016, 1116 patients were diagnosed with ACNES, of which a total of 146 (13%) with bilateral ACNES were identified (female, n = 114, 78 %; median (range) age 36 (1181) years). Average NRS (Numeric Rating Scale; 0–10) scores were similar (median (range) NRS scores 6 (0–10) although peak NRS scores were significantly higher in the bilateral group (9 (5–10) vs 8 (2–10); p=0.02). After a median of 26 months (1–68), the proportion of patients with bilateral ACNES reporting treatment success was 61%.

Conclusions One in eight patients with ACNES has bilateral abdominal wall pain. Characteristics are similar to unilateral ACNES cases. Further studies aimed at underlying mechanisms in mirror image pain pathogenesis could provide a more targeted approach in the management of this neuropathic pain.

  • abdominal pain
  • chronic pain
  • neuropathic pain
  • sensory dysfunction
  • mirror image

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  • Contributors RCM acquired and analyzed the used data and drafted the manuscript. MUW participated in analyzing used data and critically revised the manuscript. MRMS and RMHR participated in the design of the study and critically revised the manuscript. All authors discussed the results and commented on the manuscript.

  • Funding MUW is supported by the United States National Institutes of Health (NIH) grant number DA37621.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.