PhD defence Monica Louisa Yvonne Edwina Jacobs

Keywords: ACNES, Abdominal wall pain, Visceral symptoms, Diagnostics

"Novel Aspects of Diagnostics, Treatment and Pathophysiology In Acnes"

This thesis investigated new ways to better recognize and treat ACNES, an often overlooked cause of chronic abdominal pain. In ACNES, small branches of the intercostal nerves become trapped in the abdominal wall, causing neuropathic abdominal pain. The research shows that a simple physical examination, the Scratch Collapse Test, may help diagnose the condition. Different treatment strategies were also studied. A single tender point injection with a local anaesthetic can provide long-lasting pain relief in some patients. Furthermore, these injections can be performed without ultrasound just as safely and effectively. When similar nerve pain in the flank does not respond sufficiently to other treatments, surgery may offer an effective alternative. Finally, this thesis shows that ACNES can also be accompanied by gastrointestinal symptoms, including nausea, reduced appetite and weight loss. These symptoms may improve after successful treatment of the pain. The findings therefore suggest of a connection between nerves in the abdominal wall and the function of internal organs.

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