Increased Pain Sensitivity Is Not Associated With Electrodiagnostic Findings in Women With Carpal Tunnel Syndrome

de-la-Llave-Rincón, Ana I; Fernández‐de‐las‐Peñas, César; Laguarta-Val, Sofía; Alonso‐Blanco, Cristina; Martínez-Pérez, Almudena; Arendt-Nielsen, Lars; Pareja, Juan A.

doi:10.1097/ajp.0b013e31821c29d3

Cited by 37 publications

(47 citation statements)

References 36 publications

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“…This means that the symptoms of CTS are correlated more with psychological status of the patient rather than the electrophysiological severity of the disease. The subjective-objective discordance in CTS severity observed here and in few other studies[13] goes in hand with observations stating that illness behavior is a better predictor of pain intensity in CTS and musculoskeletal pain syndromes than demographic factors and objective measures of disease activity. [1516] This is practically important as well since the release of entrapment alone may not alleviate the symptoms of CTS.…”

Section: Discussionsupporting

confidence: 58%

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Subjective symptoms of carpal tunnel syndrome correlate more with psychological factors than electrophysiological severity

Khan

Shehna

Ramesh

et al. 2017

Ann Indian Acad Neurol

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Aim:Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and is one of the most common requests for electrodiagnosis. We aimed to note the relationship of subjective symptom severity of CTS, with objective electrophysiological severity and psychological status of patients.Patients and Methods:One hundred and forty-four consecutive patients of CTS referred to neurophysiology laboratory of a tertiary care hospital over 1 year were prospectively studied. Boston CTS Assessment Questionnaire (BCTSAQ) and visual analog scale (VAS) were used to assess subjective symptom severity. Psychological status was assessed by Hospital Anxiety and Depression Scale (HADS). Electrophysiological severity of CTS was estimated by median motor distal latency and median to ulnar peak sensory latency difference across the wrist. Each parameter in both hands was scored from 0 to 3 depending on the severity grade, and a composite electrophysiological severity score (CEPSS) was calculated for each patient by summing up the scores in both hands. Statistical analysis was done by Spearman's rank correlation test.Results:There was significant correlation of BCTSAQ with VAS (P = 0.001), HADS anxiety score (P < 0.001), and HADS depression score (P = 0.01). CEPSS had no significant correlation with VAS (P = 0.103), HADS anxiety score (P = 0.211), or HADS depression score (P = 0.55). CEPSS had a borderline correlation with BCTSAQ (P = 0.048).Conclusions:While the subjective symptoms of CTS are well correlated with psychological factors, their correlation with objective electrophysiological severity is weak. Hence, prompt treatment of psychological comorbidity is important in symptomatic management of CTS; decision about surgical intervention should be based on electrophysiological severity rather than symptom severity.

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Section: Discussionsupporting

confidence: 58%

“…[12] Although electrophysiology is very important in confirming the diagnosis, electrodiagnostic stratification may not be corroborating with pain sensitivity. [13] Why some patients with milder entrapment have severe symptoms? Does psychological factors have any role in increasing pain sensitivity and hence severity of symptoms?…”

Section: Discussionmentioning

confidence: 99%

Subjective symptoms of carpal tunnel syndrome correlate more with psychological factors than electrophysiological severity

Khan

Shehna

Ramesh

et al. 2017

Ann Indian Acad Neurol

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“…46 Nevertheless, in an earlier study, we found that widespread pressure pain hypersensitivity was not a prognostic factor for physical therapy treatment. 12 Therefore, it is possible that the degree of central sensitization seen in CTS plays an important role in changes in pressure pain sensitivity after the application of any therapeutic intervention.…”

Section: Limitationsmentioning

confidence: 94%

Response of Pain Intensity to Soft Tissue Mobilization and Neurodynamic Technique: A Series of 18 Patients With Chronic Carpal Tunnel Syndrome

de-la-Llave-Rincón

Ortega‐Santiago

Ambite-Quesada

et al. 2012

Journal of Manipulative and Physiological Therapeutics

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“…18,51 In fact, the magnitude of widespread pressure hypersensitivity is not significantly different between minimal, moderate, or severe CTS, suggesting that this may be a common feature in this condition. 12 Further, it has been demonstrated that subjects with signs and symptoms of CTS exhibit increased sensitivity (temporal summation), suggesting the presence of a central mechanism and that changes in sensitivity are directly correlated with clinical outcomes. 5 There is recent scientific evidence suggesting the presence of physical impairments in this population.…”

Section: T T Backgroundmentioning

confidence: 99%

“…The assessed locations have been reported to exhibit mechanical pain hypersensitivity as a sign of central sensitization in individuals with CTS. 12,17,18 The mean of 3 trials was calculated and used for the analysis. A 30-second rest was allowed between each measure.…”

Section: Neurophysiological Outcomesmentioning

confidence: 99%

Clinical, Physical, and Neurophysiological Impairments Associated With Decreased Function in Women With Carpal Tunnel Syndrome

Fernández‐de‐las‐Peñas

Cleland²,

Plaza-Manzano³

et al. 2013

J Orthop Sports Phys Ther

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[ research report ] C arpal tunnel syndrome (CTS) is a disorder characterized by compres sion of the median nerve at the carpal tunnel, often as a result of repetitive activities. 40The clinical presentation of CTS includes motor and sensory deficits in the median nerve distribution and numbness, which may be worse during the night. 31 Women are most often afflicted with CTS, with a reported annual incidence of 139 per 100 000 females, compared to 67 cases per 100 000 males.6 CTS can result in considerable pain, loss of function, and disability. The societal burden of CTS is substantial, and it has been reported that individuals with CTS exhibit loss in productivity and monetary income. 22 Although CTS is primarily considered a peripheral neuropathy, increasing evidence is showing that musculoskeletal disorders and sensitization mechanisms are related in this condition. 16 Previous studies have demonstrated the presence of widespread pressure pain hypersen-T T STUDY DESIGN: Cross-sectional study. T T OBJECTIVE:To examine the associations between clinical (pain), physical (cervical range of motion [ROM] and pinch grip force), and neurophysiological (pressure pain thresholds) outcomes and self-reported function and disability in women with carpal tunnel syndrome (CTS). T T BACKGROUND:The association of physical and physiological variables with self-rated function and disability in patients with CTS has not been fully determined. A better understanding of the association between potentially modifiable risk factors, such as limited cervical ROM, could assist clinicians in optimizing therapeutic programs for this group of patients. T T METHODS:One hundred fifty-four women with CTS were recruited. Demographic information and data on duration of symptoms, pain intensity, depression, cervical ROM, pinch grip force, and pressure pain thresholds over the neck, hand, and leg were collected. Self-reported function and disability were measured with the functional status subscale of the Boston Carpal Tunnel Questionnaire. Correlation and regression analyses were performed to determine associations between variables. T T RESULTS:There were significant positive correlations between the functional status subscale score and pain intensity (r = 0.36, P<.001), depression (r = 0.32, P<.001), and duration of symptoms (r = 0.23, P = .005). Significant negative correlations were also observed between the functional status subscale score and pinch grip force of the index finger (r = -0.25, P = .002) and little finger (r = -0.28, P<.001), ROM in cervical flexion (r = -0.22, P = .003) and lateral flexion away from the side of CTS (r = -0.24, P = .002) and toward the side of CTS (r = -0.16, P = .045), and pressure pain threshold over C5-6 (r = -0.34, P<.001), the carpal tunnel (r = -0.35, P<.001), and the tibialis anterior muscle (r = -0.26, P<.001).Stepwise regression analyses revealed that pain intensity, thumb and little finger pinch grip force, severity of depression, and cervical ROM in lateral flexion away from the side of CTS expla...

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Increased Pain Sensitivity Is Not Associated With Electrodiagnostic Findings in Women With Carpal Tunnel Syndrome

Abstract: The similar widespread pressure and thermal hypersensitivity in patients with minimal, moderate, or severe CTS and pain intensity suggests that increased pain sensitivity is not related to electrodiagnostic findings.

Cited by 37 publications

References 36 publications

Subjective symptoms of carpal tunnel syndrome correlate more with psychological factors than electrophysiological severity

Subjective symptoms of carpal tunnel syndrome correlate more with psychological factors than electrophysiological severity

Response of Pain Intensity to Soft Tissue Mobilization and Neurodynamic Technique: A Series of 18 Patients With Chronic Carpal Tunnel Syndrome

Clinical, Physical, and Neurophysiological Impairments Associated With Decreased Function in Women With Carpal Tunnel Syndrome

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