When experiencing unexplained pain in the abdomen or chest, problems with organs such as the stomach, intestines or gallbladder are often thought of. However, these pain complaints can also have another, lesser-known cause. Surgeon Frank Garssen of Medisch Centrum Jan van Goyen specializes in the treatment of those conditions that are often overlooked: ACNES and Xifodynia. In this article he talks about these conditions and how they can be treated.

What is Acnes?

ACNES, short for Anterior Cutaneous Nerve Entrapment Syndrome, is an abdominal wall pain syndrome in which a nerve in the abdominal wall becomes trapped, which can sometimes lead to severe pain in specific parts of the abdomen. 'ACNES is still relatively unknown, but we see that more and more general practitioners and specialists recognize it,' explains Frank Garssen. 'When I started treating ACNES about nine years ago, hardly anyone knew about it. In the meantime, thousands of patients have been treated in the Netherlands, and there are now more specialists throughout the country who can recognize and treat this condition.'

The pain in ACNES is often easy to localize and can be pointed out with one finger. 'Often there is one specific spot in the abdomen where the pain is the most severe. This is caused by a pinched nerve in the abdominal wall. Sometimes it makes the skin around the spot oversensitive (tight clothing is uncomfortable, for example), but it can also do the opposite, making the skin feel duller,' says Garssen.

A similar condition is LACNES, where the pain is located on the side of the body in the flanks. "LACNES is less common than ACNES, but the cause and symptoms are much the same," Garssen said.

The Causes and Diagnosis of ACNES

Although the exact cause of ACNES remains unknown in about 60% of cases, there are some factors that may play a role. 'Sometimes ACNES can develop after surgery (appendectomy, gallbladder surgery or caesarean section), pregnancy or after sports activities (abdominal exercises), but it can also develop without any apparent cause,' says Garssen. 'It occurs in both young and old.'

The diagnosis of ACNES is often missed because many patients and doctors think their pain is coming from their organs. 'The abdominal wall is often overlooked, while it is 7 to 10 cm thick and contains everything: skin, muscles, nerves, fat and blood vessels,' Garssen explains. 'As a result, patients are often referred to a gastroenterologist, while the cause actually lies in the abdominal wall.'

Treatment of ACNES

The first step in treating ACNES and LACNES is recognizing the condition. Many patients have already undergone various tests, such as an ultrasound, CT scan or MRI, without any results. 'If the symptoms point to ACNES, we often propose a test injection with local anesthesia. If the pain decreases or disappears, that is a strong indication that it is indeed ACNES,' Garssen explains.

Some patients benefit from one injection, while others need multiple treatments. 'In 15% of the cases, the pain is completely gone after one injection. However, often multiple injections are needed, or we decide to perform surgery, in which we remove the pinched nerve. This is a simple procedure that takes about 20 minutes,' says Garssen.

Although the treatment is effective, even surgery does not offer a 100% guarantee of success. 'In total, we help approximately 70% to 80% of patients completely get rid of their complaints.'

Xifodynia: A rare but serious pain complaint

In addition to ACNES and LACNES, Frank Garssen also treats Xifodynia, a condition that causes pain in the lower part of the breastbone, the so-called xiphoid. 'About eight years ago, I treated my first patient with Xifodynia. The xiphoid had become detached and moved, which caused a lot of pain. After I removed it, the pain was gone,' says Garssen.

Xifodynia is an even lesser-known condition than ACNES, but pain also plays a major role here. Patients with xiphodynia often experience pressure pain under the breastbone, which can radiate to the back and is sometimes mistaken for a heart attack or gallstone colic. 'Many patients have already undergone extensive tests by a cardiologist or gastroenterologist before the diagnosis of xiphodynia is made,' says Garssen.

Treatment of Xifodynia

As with ACNES, treatment begins Xifodynia with a test injection. 'If the pain decreases after the injection, I suggest surgery to remove the xiphoid appendage. The results are often excellent; most patients recover within a week,' says Garssen. 'Some people have been walking around with complaints for years that can ultimately be resolved with a simple procedure.'

Quality of life back

What Frank Garssen finds most appealing about treating these pain syndromes is the difference he can make in the daily lives of his patients. 'Daily pain has a huge impact on someone's life, and when I talk to patients, I notice that they are often relieved when they hear that their symptoms are explainable and treatable,' Garssen explains. 'Recognizing the pain and offering a solution, whether it's with injections or surgery, gives many patients back their quality of life.'

With his years of experience, Frank Garssen at the Jan van Goyen Medical Center helps people with unexplained pain complaints on their way to a pain-free life.

Do you want to know more about ACNES, LACNES or Xifodynia? Or do you think you suffer from these conditions? Then contact your GP. He or she can refer you to Medisch Centrum Jan van Goyen for a consultation with drs. Frank Garssen.