Peripheral nerve stimulation (PNS): A valid and definitive therapeutical option for a case of anterior cutaneous nerve entrapment syndrome (ACNES)

Anterior cutaneous nerve entrapment syndrome (ACNES) is a cause of moderate to severe chronic pain, hyperesthesia/hypo-
esthesia, and altered perception of heat/cold in a specific region of the anterior abdominal wall, referable to the territory of
innervation of one or more anterior branches of the intercostal nerves. None of the therapeutic options currently available has
proved to be effective in the long term or decisive. In recent years, we have begun to treat purely sensory neuropathies, such
as this, with the implantation of wireless peripheral nerve stimulators (PNS), achieving the safety of modular and personalized
analgesia. We report the case of a 41-year-old man suffering from ACNES of the 8th intercostal nerve for two years. We first
performed two consecutive ultrasound-guided diagnostic blocks of the anterior cutaneous branch of the 8 th intercostal right
nerve and then elected the patient for ultrasound-guided nerve decompression followed by neuromodulation and pulsed-
radiofrequency (PRF). Taking into account full employment, young age, and the likelihood of having to repeat the treatment
several times, we considered him for Peripheral Nerve Stimulation (PNS) implantation under ultrasound guidance, and we
implanted the wireless lead at the anterior branch of the right 8 th intercostal nerve, and programmed tonic stimulation 100 Hz
PW 200 ms. The patient reported immediate pain relief and never took medication for this problem again, at two years follow-
up. PNS has had an increasing role in the management of chronic neuropathic pain, especially in merely sensitive neuropathi-
es like ACNES. We support future research on this theme