Many patients suffering from chronic abdominal pain spend years searching for answers. They undergo GI testing, scans, medications, and sometimes even unnecessary surgeries — yet the pain continues.According to Dr. Tim Tollestrup, one commonly overlooked cause of abdominal pain is ACNES, or Anterior Cutaneous Nerve Entrapment Syndrome.
What Is ACNES?
ACNES occurs when tiny terminal branches of the intercostal nerves become trapped as they pass through the tough fascial tissue of the abdominal wall.These nerves travel around the rib cage and eventually pass through the rectus muscles (“six-pack muscles”) before reaching the skin. The nerve can become compressed or tethered where it exits the muscle and passes through the fascia. This nerve entrapment can produce severe localized abdominal pain.
Common Symptoms of ACNES
Symptoms may include:
- Severe abdominal pain
- Pain in one precise location
- Pain triggered by eating
- Nausea
- Tenderness to touch
- Pain that spreads across the abdomen during flare-ups
- Fear of eating due to pain
- Chronic symptoms after illness or vomiting
Dr. Tollestrup notes that many patients can point directly to the exact spot where the pain is most intense.
Why ACNES Is Often Misdiagnosed
Because the pain is located in the abdomen, many patients are initially evaluated for gastrointestinal conditions. Some undergo extensive GI workups or even surgeries such as appendectomy without relief.
However, ACNES is not caused by the internal organs — it is a nerve problem involving the abdominal wall itself.
What Causes ACNES?
In many cases, patients report symptoms beginning after:
- A severe GI illness
- Violent vomiting
- Physical strain
- Abdominal trauma
The increased pressure or strain may contribute to nerve irritation and entrapment.
Diagnosing ACNES
Diagnosis often includes:
- Physical examination
- Identifying the point of maximal tenderness
- Diagnostic nerve blocks
If the nerve block relieves the pain, it strongly supports the diagnosis of ACNES.
Surgical Treatment for ACNES
When conservative treatments fail, surgery may help relieve the entrapped nerve.
Dr. Tollestrup explains that surgery involves carefully identifying the tiny entrapped nerve, releasing it from scar tissue or fascial tethering, and removing the damaged distal portion of the nerve.
This procedure can provide significant relief for properly selected patients.
Living with chronic pain that won’t go away? Surgery may help when nothing else has.
Book a consultation: nevadanervesurgery.org/contact-us/
Call: (702) 666-0463
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