Abstract
DesignRandomized clinical trial.ObjectiveTo investigate the association of the Val158Met polymorphism with pain and function outcomes in women with carpal tunnel syndrome (CTS) who received surgery or manual therapy including desensitization manoeuvres of the central nervous system.MethodsA pre-planned secondary analysis of a randomized controlled trial investigating the efficacy of manual therapy including desensitization manoeuvres of the central nervous system vs. surgery in 120 women with CTS was conducted. Women were randomized to receive 3 sessions of manual therapy (n = 60) or decompression of the carpal tunnel (n = 60). The primary outcome was intensity of pain (mean pain and the worst pain), and secondary outcomes included function and symptoms severity subscales of the Boston Carpal Tunnel Questionnaire. Outcomes were assessed at baseline, and 1, 3, 6, and 12 months after the intervention. Rs4680 genotypes were determined after amplifying the Val158Met polymorphism by polymerase chain reactions. We classified subjects according to their Val158Met polymorphism: Val/Val, Val/Met, or Met/Met. The primary aim (treatment group*Val158Met*time) was examined with repeated measures ANCOVA with intention-to-treat analysis.ResultsAt 12 months, 111 (92%) women completed the follow-up. No interaction was observed between the Val158Met genotype and any outcome: mean pain intensity (F = 0.60; P = 0.69), worst pain intensity (F = 0.49; P = 0.61), function (F = 0.12; P = 0.88) or symptom severity (F = 0.01; P = 0.98).ConclusionThe current clinical trial did not show an association between the Val158Met polymorphism and changes in pain and function outcomes after either surgery or physical therapy in women with CTS.
Highlights
Carpal tunnel syndrome (CTS) is a common entrapment neuropathy of the upper extremity which can cause considerable pain and disability resulting in significantly costs for the society [1]
Since the Val158Met polymorphism modulates the phenotypic expression of CTS [11], we considered that there may exist a genetic influence on long-term treatment outcomes
Our results showed that variations in the Val158Met genotype were not associated to longterm treatment outcomes in pain and function in a sample of women with CTS who received surgery or physical manual therapy
Summary
Carpal tunnel syndrome (CTS) is a common entrapment neuropathy of the upper extremity which can cause considerable pain and disability resulting in significantly costs for the society [1]. Management of CTS can be conservative or surgical in nature. There is some controversy on the optimal treatment strategies for CTS since both approaches are effective, surgery has shown to be slightly superior than localized conservative treatment at long term [3,4]. It is important to note that individuals undergoing surgery exhibit a higher rate of complications than those receiving conservative therapy (pooled RR 2.03, 1.28–3.22) [4], which may explain why several patients with CTS attempt to avoid surgery [5]. CTS has been traditionally considered a local peripheral neuropathy, there is evidence suggesting that CTS represents a complex pain syndrome presenting an altered nociceptive pain processing [6,7], and, therapeutic approaches should include nociceptive pain rational for proper management of this condition [8]
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