CHRONIC LOCALIZED BACK PAIN DUE TO ENTRAPMENT OF CUTANEOUS BRANCHES OF POSTERIOR RAMI OF THE THORACIC NERVES (POCNES): A CASE SERIES ON DIAGNOSIS AND MANAGEMENT

BACKGROUND/OBJECTIVES

This case series is authored by Dutch surgeons with a specialization in abdominal wall and groin pain. Currently, persistent back pain is increasingly managed from a biopsychosocial perspective and recognised to be a complex phenomenon. This paper is from the lens of the traditional biomedical surgical paradigm, however explores the under recognised role of the cutaneous nervous system in chronic back pain presentations. The aim of the study was to describe the clinical presentation, differential diagnosis, and management of patients with a neuropathic pain syndrome driven by posterior cutaneous nerve entrapment syndrome (POCNES).

Pain is characterized by a constant and predictable site of local fingertip size tenderness.In POCNES this area is in the lower back 2-3cm lateral to the spinous processes.

METHODS

This prospective case series ran from 2013-2016 in two Dutch hospitals with a special interest in abdominal wall and groin pain syndromes. Patients suspected to have POCNES were assessed as to history with inclusion criteria being:

• greater-than 3-month history of locoregional back pain
• localized circumscript area of tenderness lateral to the spinous process, covering a small and predictable point of maximal pain
• larger area of skin somatosensory abnormalities (such as hypoesthesia, hyperesthesia, and/or altered cool perception) overlying this maximal pain point
• Local pressure on the tender point resulting in a predictable severe pain response
• N4 Questionnaire >3 (indicating neuropathic pain syndrome)
• Normal laboratory testing and imaging
• No previous surgical scar pain syndromes
• No previous spinal surgeries
• Normal communication ability

14 subjects (F12-M2, 18-73yrs) were diagnosed with POCNES and offered lidocaine (+ prednisolone) injection. Pain relief (numeric rating scale 0-10) > 50% was considered success. If there was insufficient ongoing pain relief traditional therapy or day patient neurotomy was offered.

RESULTS

Pre–post injection pain scores: 93% dropped from 8 to 3/10 (p

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