Functional recovery after trigger point injection in pediatric anterior cutaneous nerve entrapment syndrome: clinical implications for multidisciplinary management.

Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) is an under-recognized cause of chronic abdominal pain in children. Although trigger point injections (TPI) provide pain relief, their relationship with functional recovery remains unclear, particularly in patients with coexisting comorbidities. This study aimed to evaluate the association between pain relief and functional recovery in pediatric ACNES, stratified according to comorbid conditions. This study was a retrospective cohort study. We retrospectively reviewed 27 pediatric patients with ACNES who underwent TPI between 2020 and 2025. The patients were categorized into three groups: ACNES-only (n = 5), functional gastrointestinal disorders with or without orthostatic dysregulation (FGIDs ± OD, n = 17), and somatic symptom disorder (SSD, n = 5). Functional recovery was defined as as normalization of school attendance and cessation of pain-related avoidance behaviors. Among evaluable patients with baseline NRS data (n = 19/27), TPI significantly reduced pain intensity (median numerical rating scale [NRS]: 6-2; p < 0.001). However, time to functional recovery differed significantly according to comorbidity (p = 0.01). All patients in the ACNES-only group achieved functional recovery within 100 days, whereas no patient with comorbid SSD achieved functional recovery during follow-up despite repeated TPIs. Patients with SSD required significantly more TPI sessions than those in the other groups (median, 19 vs. 2; p = 0.004). Among patients requiring ≥ 4 TPI sessions, repeated injections were generally directed to previously identified tender points rather than newly emerging sites.

conclusionsImmediate pain relief following TPI does not necessarily translate into functional recovery in pediatric ACNES. Patients with comorbid SSD showed persistent functional impairment despite repeated TPIs. Requiring four or more TPI sessions may serve as a practical clinical indicator prompting reassessment for coexisting SSD and consideration of multidisciplinary management. Functional recovery should therefore be evaluated alongside pain intensity when assessing treatment outcomes. WHAT IS KNOWN: • Anterior cutaneous nerve entrapment syndrome (ACNES) is an under-recognized cause of chronic abdominal pain in children. • Trigger point injections (TPI) can provide pain relief, but functional recovery may be influenced by psychosocial factors and comorbid conditions. WHAT IS NEW: • Functional recovery after TPI in pediatric ACNES varies according to comorbid conditions, and immediate pain relief does not necessarily predict subsequent functional recovery. • Requiring four or more TPI sessions may serve as a practical clinical indicator prompting reassessment for coexisting somatic symptom disorder and consideration of multidisciplinary management.