Determinants of Pain in Patients with Carpal Tunnel Syndrome

Nuñez, Fiesky A.; Vranceanu, Ana‐Maria; Ring, David

doi:10.1007/s11999-010-1551-x

Cited by 68 publications

(45 citation statements)

References 14 publications

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“…This distinction between axon loss and neuropathy symptoms is similar to reports demonstrating that the pain associated with CTS does not correlate with the severity of electrophysiologic abnormalities. 19 In general, scoring systems that rely solely on neurologic examinations have performed poorly in documenting the severity of and following subjects' neuropathy. 20,21 Objective peripheral nerve measures, including IENFD, may therefore complement existing symptom and examination-based scales in ON.…”

Section: Days In Each Subjectmentioning

confidence: 99%

Longitudinal assessment of oxaliplatin-induced neuropathy

Burakgazi¹,

Messersmith²,

Vaidya³

et al. 2011

Neurology

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Objectives:To characterize the natural history of oxaliplatin-associated neuropathy (ON) and determine whether intraepidermal nerve fiber density (IENFD) is a sensitive measure of neuropathy progression. In addition, we sought to assess the potential of ON as a neuroprotection model and gain insight into the relationship between axon loss and neuropathic symptoms.Methods: Eight subjects receiving oxaliplatin for advanced colorectal cancer were prospectively followed prior to starting chemotherapy and at 30, 90, 180, and 360 days (180 days after completing treatment). Electrophysiology, punch biopsies, symptom assessment, and examinations with calculation of a reduced total neuropathy score (rTNS) were performed at each time point. Changes over time were assessed through Poisson regression for IENFD and a mixed effects model for rTNS and electrophysiology measures. Results:The distal leg IENFD, rTNS, peroneal, and sural amplitudes were all significantly reduced over time, while conduction velocity (peroneal and sural) and distal thigh IENFD were not. Measures of axon loss continued to worsen following discontinuation of oxaliplatin. Five of 8 subjects reported prominent symptoms associated with oxaliplatin administration. Conclusions:This study demonstrates that oxaliplatin is associated with mild, sensory, and motor axon loss that may not be reversible. Axonal loss was detected by electrophysiology, rTNS, and distal leg IENFD. Several subjects reported prominent sensory symptoms that were not associated with axon loss, and that may or may not represent neuropathy. ON is an attractive paradigm for neuroprotection studies and the distal leg IENFD is an objective measure that requires minimal subject participation or study site expertise. Neurology ® 2011;77:980-986 GLOSSARY 5-FU ϭ fluorouracil; IENFD ϭ intraepidermal nerve fiber density; NCV ϭ nerve conduction velocity; ON ϭ oxaliplatinassociated neuropathy; PN ϭ peripheral neuropathy; rTNS ϭ reduced total neuropathy score.Oxaliplatin (Sanofi-Aventis; Bridgewater, NJ) is a third-generation platinum derivative that has enhanced inhibition of DNA repair and replication. Oxaliplatin is an antineoplastic agent currently indicated for the treatment of advanced cancer of the colon or rectum.1 A doselimiting toxicity of oxaliplatin is peripheral neuropathy (PN). As oxaliplatin-containing regimens become more successful, the number of long-term survivors will likely increase and neuropathy may emerge as a more important factor limiting quality of life. [1][2][3][4][5] In addition, "stop-and-go" dosing regimens have been adopted in an effort to reduce chronic neuropathy development 1,6,7 and underscores the importance of better understanding this neuropathy. Unpleasant paresthesias in the distal extremities, mouth, and throat are common adverse events associated with acute oxaliplatin administration while a distal length-dependent neuropathy develops with total doses Ն540 -850 mg/m 2 . 2,8The symptoms, functional impairment, and motor axon excitability 9 associate...

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Section: Days In Each Subjectmentioning

confidence: 99%

Longitudinal assessment of oxaliplatin-induced neuropathy

Burakgazi¹,

Messersmith²,

Vaidya³

et al. 2011

Neurology

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“…4 The diagnosis is based on the presence of symptoms, physical findings, positive nerve conduction studies and provocative tests such as Tinel's, and Phalen's signs, taken together. 5,[6][7][8][9][10][11] The clinical diagnosis is most commonly confirmed by electrodiagnostic (EDX) studies as the reliable, differentiating, and the most objective diagnostic test. 5,6,9,12,13 Severity of carpal tunnel syndrome can also be evaluated by EDX, done bilaterally.…”

Section: Introductionmentioning

confidence: 99%

The prevalence of carpal tunnel syndrome among long-term manual wheelchair users with spinal cord injury: A cross-sectional study

Asheghan

Hollisaz

Taheri³

et al. 2015

The Journal of Spinal Cord Medicine

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Context: Use of a handrim wheelchair could force the wrist into extreme excursions and encroachment of the median nerve.Objective: We performed a study of the prevalence of carpal tunnel syndrome in prolonged wheelchair users. Design and setting: A cross-sectional study was conducted for one year in an outpatient clinic of spinal cord injury. Participants: Patients had traumatic injury at the first thoracic level and below, with time since injury of at least 5 years. Outcome measure: The prevalence of carpal tunnel syndrome by history taking, clinical examinations and motor and sensory nerve conduction studies of median nerve performed for both hands. Results: Participants (N = 297) were all male. Mean (SD) age and duration since injury were 48 (8.5) and 23 (6.6) years, respectively. A significant difference in median duration of injury based on the severity of the syndrome (P < 0.001), and a significant trend in time since injury for the severity (P (one tailed) < 0.001) were seen. There was a significant difference in the median age among the groups (P = 0.009), and the median increased with the severity (P (one tailed) = 0.001). Conclusions: Carpal tunnel syndrome is a common side effect of the long time use of wheelchair, and its severity is associated with duration of wheelchair use and age. Alternative methods for wheelchair propulsion should be developed to diminish the likelihood of the syndrome.

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“…Depression and pain catastrophization scores, as measured with the Center for Epidemiologic Studies Depression (CES-D) scale and the Pain Catastrophizing Scale (PCS), are strongly and negatively correlated with patient-rated upper-extremity function as assessed with use of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire 3,5,25,28,29 . However, prior investigations on this effect in hand surgery have mostly focused on cross-sectional data without considering change in patient-rated outcomes over time 25,[29][30][31][32] . This study was designed to determine the impact of depression (as measured with use of the CES-D) and pain catastrophization (measured with use of the PCS) on patient-rated hand function as assessed using a hand-specific measure (the Michigan Hand Outcomes Questionnaire [MHQ]) both before orthopaedic treatment and after (one and three months following treatment).…”

mentioning

confidence: 99%

“…Specifically, two prior studies noted that patients with carpal tunnel syndrome and other atraumatic hand conditions had increased pain intensity prior to treatment when depression and pain catastrophization were present 25,32 . Our data are consistent with these previous studies.…”

mentioning

confidence: 99%