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Licensed Unlicensed Requires Authentication Published by De Gruyter April 30, 2018

Adding steroids to lidocaine in a therapeutic injection regimen for patients with abdominal pain due to anterior cutaneous nerve entrapment syndrome (ACNES): a single blinded randomized clinical trial

Frédérique M.U. Mol, Claire Heukelsfeldt Jansen, Oliver B. Boelens, Dirk L. Stronks, Percy Van Eerten, Frank J.P.M. Huygen, Marc R. Scheltinga and Rudi M. Roumen


Background and aims

Anterior cutaneous nerve entrapment syndrome (ACNES) may result in chronic abdominal pain. Therapeutic options include local injection therapy. Data on the efficacy of adding corticosteroids to these injections is lacking.


Patients ≥18 years with ACNES were randomized to receive an injection of lidocaine with (LC-group) or without (LA-group) the addition of methylprednisolone into the point of maximal abdominal wall pain. Pain was recorded using a numeric rating scale (NRS: 0–10) and a verbal rating scale (VRS: 0=no pain, 5=unbearable pain) at baseline and 6 weeks after the start of a bi-weekly injection regimen consisting of a total of three injections. A minimal 50% reduction on NRS and/or two points on VRS were considered successful responses.


Between February 2014 and August 2016, 136 patients (median age 46 year, range 18–79, 75% females) were randomized (68 vs. 68). The proportion of patients demonstrating a successful response after 6 weeks did not significantly differ between groups (LA 38%, LC 31%, p=0.61). At 12 weeks, the number of patients still experiencing a minimal 50% pain relief had decreased but no group difference was observed (LA 20%, LC 18%, p=0.80). Minor side effects included temporary increase of pain, tenderness at injection sites or transient malaise (LA23/68, LC 29/68, p=0.46).


Adding corticosteroids to a lidocaine does not increase the proportion of ACNES patients with a successful response to injection therapy. Lidocaine alone can provide long term pain relief after one or multiple injections, in approximately 1 of 5 patients.

  1. Authors’ statements

  2. Research funding: None declared.

  3. Conflict of interest: The authors declare no conflict of interest in performing this trial and preparing the manuscript.

  4. Informed consent: Informed consent was obtained once individuals complied with all study requirements.

  5. Ethical approval: The Medical Ethics Committee of MMC approved study design, protocol and informed consent procedures. The study was registered in the Dutch Clinical Trial Register (NTR 4141). Design and reporting of this trial were performed according to the CONSORT guidelines.


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Received: 2018-01-05
Revised: 2018-02-26
Accepted: 2018-03-06
Published Online: 2018-04-30
Published in Print: 2018-07-26

©2018 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston. All rights reserved.

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