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Abdominal pain

  • Chronic abdominal pain can occur after surgery. It can be associated with chronic bowel issues like irritable bowel syndrome (IBS), with an infection, or it can seemingly happen for no reason at all. In some cases (both after surgery and in patients who have not had surgery), a nerve becoming caught in the abdominal wall (called “entrapment”) can cause pain.

What is abdominal cutaneous nerve entrapment syndrome

  • Abdominal cutaneous nerve entrapment syndrome (ACNES) is a condition where patients develop pain of the abdominal wall. The incidence is estimated to be 1:1800 individuals and this condition is more common in women.
  • This type of pain can usually be localized to a small spot on the abdomen, typically to the side of the rectus abdominus muscle (your “six pack” muscles).
  • It can be chronic but can start with severe pain, severe enough to cause some patients to go to the emergency room.
  • The pain is typically worse with any activity that uses your abdominal wall muscles like laughing, coughing, walking. It is typically better lying on your back and can be brought on by sitting up.
  • However, other conditions can cause abdominal wall pain including gynecological conditions, hernias, rib conditions and even disc herniations in the thoracic spine.

What services does the pain clinic offer?

  • Help with the diagnosis of abdominal pain (however patients have typically had a work up with a gastroenterologist before considering this option)
  • Medication management
  • Nerve blocks
  • Peripheral nerve stimulation
  • Spinal cord stimulation (dorsal root ganglion stimulation)

Is this treatable?

  • The first step to treating this type of pain is diagnosis, which will typically be made through physical exam and possibly a nerve block or muscular injection.
  • If ACNES is suspected based on nerve block, the nerve may sometimes be “lesioned” using a chemical like alcohol to provide longer lasting pain relief
  • At times, activity modification may also be very helpful with controlling symptoms and both physical therapy and pelvic floor physical therapy can provide a role for training or re-training the abdominal muscles

Last updated 12/29/2025