Pulsed Radiofrequency or Surgery for Anterior Cutaneous Nerve Entrapment Syndrome: Long-Term Results of a Randomized Controlled Trial

Background Patients with Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) often require a step-up treatment strategy including abdominal wall injections, Pulsed Radiofrequency (PRF) or neurectomy. However, long-term success rates of PRF and neurectomy remain largely unknown. The aim of the current study was to report long-term treatment outcomes of PRF and neurectomy in ACNES patients who have participated in the randomized controlled PULSE-trial, which compared the short-term outcomes of both treatments. Method Patients who completed the PULSE-trial were contacted about pain status and additional treatments in the subsequent years. Treatment success was based on Numerical Rating Scale (NRS) and Patient Global Impression of Change (PGIC) scores. Results A total of 44 of the original 60 patients (73.3%) were eligible for analysis. After a median of 71.5 months, one patient (4.3%) was still pain-free after a single PRF treatment, and five additional patients (21.7%) were pain-free by repetitive PRF treatments. By contrast, 13 patients (61.9%) in the neurectomy group were still pain-free without additional treatments. At the end of follow-up, regardless of additional treatment(s), 35 patients (79.5%) had a significant improvement in pain level based on NRS, while 36 patients (83.7%) scored at least ‘much improvement’ on the PGIC. Conclusion Approximately one in five ACNES patients undergoing PRF treatment reports long-term success obviating the need of surgical intervention. Surgery for ACNES is long-term effective in approximately two of three operated patients. Moreover, about 80% of the ACNES patients have a significant long-term pain reduction after their treatment(s).