Abstract
Patients with carpal tunnel syndrome (CTS) often show bilaterally increased pain sensitivity and widespread symptoms. We evaluated the influence of centrally mediated symptoms on functional outcomes of carpal tunnel release (CTR). A total of 120 patients with surgically treated CTS were enrolled. Centrally mediated symptoms were preoperatively measured by administering a self-reported central sensitization inventory (CSI) questionnaire and peripheral sensitization was measured by assessing patient’s pressure pain thresholds (PPT) in the forearm. Boston Carpal Tunnel Questionnaires (BCTQ) were assessed preoperatively and postoperatively at 3 and 12 months. CSI scores slightly correlated with symptom duration and moderately correlated with preoperative BCTQ scores, while PPT slightly correlated with the BCTQ scores. At 3 months, BCTQ symptom and function scores moderately correlated with lower PPTs and higher CSI scores. At 12 months, only severe electrophysiological grade was associated with BCTQ function scores. Multivariable analysis revealed that preoperative PPT, CSI, and female gender were associated with BCTQ scores at 3 months; these factors failed to be associated for 12-month outcomes. Centrally mediated symptoms measured by CSI and peripheral sensitization measured by PPTs correlated with symptom severity and duration. They were associated with poorer functional outcomes after CTR up to 3 months. However, they did not show persistent effects in the long term.
Highlights
Carpal tunnel syndrome (CTS) is the most common cause of pain due to peripheral nerve entrapment and occurs when the median nerve under the transverse carpal ligament is compressed at the wrist[1]
central sensitization inventory (CSI) scores slightly correlated with symptom duration (R = 0.34, p = 0.03) and moderately correlated with Boston Carpal Tunnel Questionnaires (BCTQ) symptom and function scores (R = 0.45, p = 0.01; R = 0.43, p = 0.01, respectively); pressure pain thresholds (PPT) slightly correlated with BCTQ symptom and function scores (R = 0.39, p = 0.02; R = 0.36, p = 0.02, respectively)
Results of our study suggest that pain sensitization measured by CSI and PPT that manifests at different degrees over a continuum correlates with preoperative symptom severity and duration
Summary
Carpal tunnel syndrome (CTS) is the most common cause of pain due to peripheral nerve entrapment and occurs when the median nerve under the transverse carpal ligament is compressed at the wrist[1]. Symptoms of CTS are typically restricted to median nerve distribution, yet a significant number of patients with CTS show bilaterally increased pain sensitivity (hyperalgesia) and widespread symptoms[4,5], demonstrating a generalized disturbance of somatosensory function. CTS might be associated with pain sensitization both at peripheral level and central level[5,6]. Generalized decrease in pressure pain threshold in patients with CTS is associated with pain intensity and duration of symptoms, supporting a role of peripheral drive in initiating and maintaining central sensitization[5]. The severity of central sensitization in patients with CTS might have contributed to postoperative outcomes of carpal tunnel release (CTR), clinical studies addressing the relationship between preoperative measures of central sensitization and surgical outcomes are lacking. Characteristics Participants Mean age (years) Male/female Body mass index (kg/m2) Less than a high school education Affected side (dominant:nondominant)* Bilaterality (bilateral: unilateral) Symptom duration (months) Electrophysiological grade Mild Moderate Severe Preoperative functional scores BCTQ symptom BCTQ function Pain sensitization measures PPT (KPa) CSI Postoperative functional scores 3 month BCTQ symptom 3 month BCTQ function 6 month BCTQ symptom 6 month BCTQ function
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