The Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) 3.0
Randomized single-blind controlled trial of conservative treatment by local injection therapy (with or without corticosteroids) for entrapment of the anterior intercostal cutaneous nerve through the rectus abdominis muscle.

ACNES is the anterior cutaneous nerve entrapment syndrome, characterized by
(chronic) abdominal wall pain caused by entrapment of the end branches of these
intercostal nerves at the level of the rectus abdominis fascia.
One of the therapies is local injections with anesthetics sometimes combined
with corticosteroids like 40 mg methylprednisolonacetate. From our own
retrospective data it seems advantageous to inject the combination. However, no
randomized data exist on this subject and literature on other pain syndromes is
controversial with reference to the use of corticosteroids locally.
Therefore we conduct this randomized trial

The main question is: results addition of 40mg of corticosteroids to 10 cc
lidocaine 2% for local trigger point injection in a significant pain reduction
compared to 10 cc lidocaine 2% alone. Pain reduction is defined as more than
50% decrease on a VAS scale and/or 2 points reduction on a 5 points VRS
(McGill) pain questionnaire.

Single blind randomized controlled two center study (Maxima MC Veldhoven and
Maas Hospital Boxmeer)

Group A: trigger point injection with10 cc lidocaine 2% combined with 40mg of
corticosteroids 2-3 weeks after diagnosis and repeated once more 2-3 weeks
later.

Group B (control): trigger point injection with 10 cc lidocaine 2% only 2-3
weeks after diagnosis and repeated once more 2-3 weeks later.

Since trigger point injection is normal standard treatment, there is no extra
burden for these patients.