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SeLF-HELP reMEDIES
Here are some suggestions from others with ACNES that have helped in managing the pain.
- Icing
- TENS device
- Gel patches
- Anesthetic cream
- Adjusting posture and laying down
- Hemp oil
- Use of heat on abdomen (heat pad)
Medication
There are many different medications that might help manage the ACNES pain. These might include:
- Lyrica (aka Pregabalin)
- Gabapentin
- Amitriptyline
- Cymbalta
Discuss these options with your physician to see if they might be a good option.
Injections
The primary treatment for ACNES are injections. These are intended to treat the entrapped nerve and provide pain relief at the source of the pain. It is possible that one injection cures your pain. It is also possible that a series of injections eventually cures your pain. It is also possible that the injections bring temporary relief for days, weeks, or months, and then the pain returns. If the injections have absolutely no impact, then they were either not done in the right place, or it’s quite possible that you are not suffering from ACNES. Any change in your pain following the injection is a good thing however, as it is an indication that you are on the right track and your anterior cutaneous nerves are the source of your pain. These injections are used both as a diagnostic tool, as well as a treatment. The following are some of the injections that have been used in the treatment of ACNES.
Trigger-point Injections
These involve identifying one or multiple trigger points that seem to be the source of the pain. The provider will use an ultrasound machine to guide the injections so that they are placed in precisely the right spot. The injections will most likely be a mixture of anesthetic and corticosteroids. It is very important to take note of your reaction to the injections. Most pain medicine specialists will provide you with a pain diary to fill out. This involves recording your pain level at various points in time after the injections. It might be something like: 30 minutes, 1 hour, 2 hours, 4 hours, 12 hours, 24 hours, 48 hours, 1 week, and 2 weeks.
A helpful tool might be using a smartphone app to keep track of this. One such app is “My Pain Diary”
iOS – https://itunes.apple.com/us/app/my-pain-diary-symptom-tracker-gold-edition/id1123452738?mt=8
Android – https://play.google.com/store/apps/details?id=com.damonlynn.mypaindiary
TAP Block
This is an injection that is intended to block the nerve along your transverse abdominus plane (TAP). It is a peripheral nerve block designed to anesthetize the nerves supplying the anterior abdominal wall (T6 to L1)
Epidural Steroid Injection
This is an injection placed right next to your spine. It’s not mentioned in a lot of the literature for ACNES, but this author personally found it helpful in neutralizing some of the pain.
Neurolysis
If injections are not effective in the long run, then neurolysis can be considered. This involves the destruction of neural tissue. This can be done chemically with something like Phenol, thermally with radiofrequency, or by freezing via cryoneurolysis. There seems to be very limited documentation about this as a treatment for ACNES, and it can be difficult to find physicians to perform these procedures.
Surgery
If other treatment options fail, then surgery is the final option. The surgery would be an anterior cutaneous neurectomy. It can also be difficult to find a physician to perform this surgery. The specialty that would be most familiar with this type of surgery would be a Peripheral Nerve Surgeon. Ideally they will have experience with this specific surgery in treating of ACNES. Typically they would be in the neurosurgery department of a hospital.