Chronic Abdominal Pain · ACNES

When Abdominal Pain Isn’t in Your Gut — It May Be a Trapped Nerve

Chronic abdominal pain is frustrating and often misdiagnosed. Many patients cycle through tests, scopes, and medications without relief because the real cause is missed: anterior cutaneous nerve entrapment syndrome (ACNES) — a trapped nerve in the abdominal wall, not a problem inside the abdomen. At The Fascia Institute and Treatment Center, we diagnose it precisely and treat it without surgery.

· Non-surgical    · Ultrasound-guided    · Published research    · Metairie · New Orleans

By Jacques Courseault, MD, CAQSM, FAAPMR · The Fascia Institute and Treatment Center®

Woman holding her abdomen in discomfort, experiencing chronic abdominal pain caused by anterior cutaneous nerve entrapment syndrome (ACNES). The image highlights symptoms of nerve compression, a common yet often misdiagnosed cause of persistent abdominal pain.

01 · Understanding the Condition

What Is ACNES?

ACNES occurs when the anterior cutaneous nerves — which supply sensation to the abdominal wall — become compressed as they pass through the muscle layers. The result is sharp, localized pain that worsens with movement, prolonged sitting, or even light touch, sometimes with nausea or other discomfort.

Because the symptoms mimic digestive disease, ACNES is commonly under-diagnosed and under-treated, and patients often undergo extensive gastrointestinal work-ups without an answer (Chrona et al., 2017). It can even produce visceral-type symptoms such as nausea and bloating, further muddying the picture (Jacobs et al., 2024).

02 · Getting the Right Diagnosis

How ACNES Is Identified

With the right approach, ACNES is very identifiable. Two tools make the difference:

· Carnett’s test — abdominal-wall pain that intensifies when the muscles are tensed points away from an internal organ cause
· High-resolution ultrasound — our ultrasound-guided Fascial Mapping visualizes the entrapped nerve and surrounding fascia in real time

Together, a positive Carnett’s test and targeted imaging let us confirm ACNES and pinpoint the exact nerve involved — the foundation for effective, precise treatment.

03 · The Treatment

Ultrasound-Guided Myofascial Release: A Non-Surgical Option

One of the most effective treatments for ACNES is ultrasound-guided myofascial release (hydrodissection). This minimally invasive procedure targets the entrapped nerve directly, relieving pain without surgery. Under real-time imaging, we:

· Inject a mixture of anesthetics and steroids around the affected nerve
· Release the surrounding tissue to reduce compression
· Decrease inflammation to restore normal nerve function

The evidence supports this approach. A randomized clinical trial found ultrasound-guided abdominal-wall injection to be an effective, well-tolerated ACNES treatment (Mol et al., BJS Open 2021), and hydrodissection is increasingly used to free entrapped peripheral nerves throughout the body (Kaga, 2022).

04 · Our Published Case

A Real Result, Peer-Reviewed

This isn’t just theory — our team published this case. A 17-year-old female came to us after months of persistent abdominal pain, nausea, and vomiting, with multiple evaluations and no clear diagnosis, unable to take part in normal daily life. Through detailed clinical assessment and high-resolution ultrasound, we identified ACNES and performed an ultrasound-guided hydrodissection using a combination of lidocaine, bupivacaine, and betamethasone.

The results were immediate: a 70% reduction in symptoms after the first procedure. Following a second treatment she continued to improve, and by her one-month follow-up she reported significant pain relief, no more nausea, and a full return to normal activities.

Published as: Staka O, Tanguilig S, Malempati M, Chowdhury T, Morrell K, Parau I, Courseault J. Anterior cutaneous nerve entrapment syndrome (ACNES) and hydrodissection treatment: case report. Discover Medicine (2025).

See more of our work on our published research page.

05 · The Benefits

Why Consider Ultrasound-Guided Release?

For patients with ACNES or other forms of chronic abdominal-wall pain, this approach offers several key advantages:

Minimally Invasive

Only a small injection — far less recovery time and risk than surgery.

Immediate Relief

Many patients notice improvement right after the procedure.

Targeted Precision

Ultrasound guidance places the treatment exactly where it’s needed.

Long-Lasting Results

By addressing the root cause, relief is often sustained.

Ready When You Are

Seeking Relief for Chronic Abdominal Pain?

If you or someone you know has persistent abdominal pain without a clear diagnosis, ACNES could be the underlying cause. Under the expertise of Dr. Jacques Courseault, our team specializes in ultrasound-guided myofascial release and other fascia-focused therapies designed for lasting relief.

Get started: Request a consultation or call (504) 704-1254 to explore your treatment options.

References

Staka, O., Tanguilig, S., Malempati, M., Chowdhury, T., Morrell, K., Parau, I., & Courseault, J. (2025). Anterior cutaneous nerve entrapment syndrome (ACNES) and hydrodissection treatment: case report. Discover Medicine. doi.org/10.1007/s44337-025-00494-4

Chrona, E., Kostopanagiotou, G., Damigos, D., & Batistaki, C. (2017). Anterior cutaneous nerve entrapment syndrome: management challenges. J Pain Res, 10, 145–156. PMID: 28144159

Jacobs, M. L. Y. E., Janssen, L., Stassen, L. P. S., Scheltinga, M. R. M., & Roumen, R. M. H. (2024). Visceral symptoms in patients with ACNES: expression of viscerosomatic reflexes? Hernia, 28(1), 127–134. PMID: 37393208

Mol, F. M. U., et al. (2021). Ultrasound-guided abdominal wall infiltration versus freehand technique in ACNES: randomized clinical trial. BJS Open, 5(6), zrab124. doi.org/10.1093/bjsopen/zrab124

Kaga, M. (2022). First case of occipital neuralgia treated by fascial hydrodissection. Am J Case Rep, 23, e936475. PMID: 35578561