Pain mechanisms in carpal tunnel syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes

Sobeeh, Mohamed Gomaa; Ghozy, Sherief; Elshazli, Rami M.; Landry, Marc

doi:10.1097/j.pain.0000000000002566

Cited by 12 publications

(19 citation statements)

References 103 publications

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“…Importantly, the diffuse loss of small nerve fibers bilaterally can cause the absence of WUR both in the affected and the contralateral regions [ 43 ]. Interestingly, WUR of CRPS type II (with evidence of nerve injury) showed no difference when compared to the control group [ 15 ], similar to the findings of WUR in CTS (median nerve injury) which showed no difference also [ 89 ].…”

Section: Discussionmentioning

confidence: 64%

“…Comparing the sensory phenotype in CRPS with neuropathic pain conditions reveals distinct sensory patterns. In carpal tunnel syndrome, recent study revealed dominant sensory loss localized only to the affected hand area with inconclusive evidence about central sensitization [ 89 ]. Also, in different radiculopathies, the sensory loss was localized to maximum pain area and dermatomal area with inconclusive picture about the presence of hyperalgesia [ 90 – 92 ].…”

Section: Discussionmentioning

confidence: 99%

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Pain mechanisms in complex regional pain syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes

et al. 2023

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Background Complex regional pain syndrome (CRPS) is a chronic condition following inciting events such as fractures or surgeries with sensorimotor and autonomic manifestations and poor prognosis. This review aimed to provide conclusive evidence about the sensory phenotype of CRPS based on quantitative sensory testing (QST) to understand the underlying pain mechanisms and guide treatment strategies. Databases Eight databases were searched based on a previously published protocol. Forty studies comparing QST outcomes (thermal, mechanical, vibration, and electric detection thresholds, thermal, mechanical, pressure, and electric pain thresholds, wind-up ratio, mechanical pain sensitivity, allodynia, flare area, area after pinprick hyperalgesia, pleasantness after C-tactile stimulation, and pain ratings) in chronic CRPS (adults and children) versus healthy controls were included. Results From 37 studies (14 of low quality, 22 of fair quality, and 1 of good quality), adults with CRPS showed: (i) significant loss of thermal, mechanical, and vibration sensations, significant gain of thermal and mechanical pain thresholds, significant elevation of pain ratings, and no difference in wind-up ratio; (ii) significant reduction of pleasantness levels and increased area of pinprick hyperalgesia, in the affected limb. From three fair-quality studies, adolescents and children with CRPS showed loss of cold detection with cold hyperalgesia in the affected limb. There was moderate to substantial overall heterogeneity. Conclusion Diffuse thermal and mechanical hypoesthesia with primary and secondary hyperalgesia, enhanced pain facilitation evidenced by increased area of pinprick hyperalgesia, and elevated pain ratings are dominant in adults with CRPS. Adolescents and children with CRPS showed less severe sensory abnormalities.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Pain mechanisms in complex regional pain syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes

et al. 2023

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“…This plays a significant role in the development of chronic pain. Treating all other etiologies of peripheral nerve pain (ie, migraine headache and carpal tunnel syndrome) can also help reduce centrally-mediated pain [69][70][71][72][73] This proposes a future direction of RPNI surgery in that the treatment of peripherally-mediated pain associated with neuromas may have a role in mitigating centrally-mediated pain. In other words, RPNI may have benefit in treating amputation patients with phantom limb pain, even if there is no severe neuroma pain in the residual limb.…”

Section: Discussionmentioning

confidence: 99%

Regenerative Peripheral Nerve Interface Surgery: Anatomic and Technical Guide

Leach

Dean

Kumar

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Summary: Regenerative peripheral nerve interface (RPNI) surgery has been demonstrated to be an effective tool as an interface for neuroprosthetics. Additionally, it has been shown to be a reproducible and reliable strategy for the active treatment and for prevention of neuromas. The purpose of this article is to provide a comprehensive review of RPNI surgery to demonstrate its simplicity and empower reconstructive surgeons to add this to their armamentarium. This article discusses the basic science of neuroma formation and prevention, as well as the theory of RPNI. An anatomic review and discussion of surgical technique for each level of amputation and considerations for other etiologies of traumatic neuromas are included. Lastly, the authors discuss the future of RPNI surgery and compare this with other active techniques for the treatment of neuromas.

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“…Carpal tunnel syndrome has been traditionally considered a peripheral neuropathy, caused by a local entrapment of the median nerve just at the carpal tunnel; however, current evidence supports that CTS is a complex syndrome associated with excitability of the central nervous system and altered conditioned pain modulation (Fernández‐de‐las‐Peñas & Plaza‐Manzano, 2018; Sobeeh et al, 2022). Most studies investigating the effects of physical therapy modalities against surgery in people with CTS applied localized interventions focused on the wrist/hand (Erickson et al, 2019; Huisstede et al, 2018; Shi et al, 2020), which does not consider the complexity of this pain condition (Fernández‐de‐las‐Peñas & Plaza‐Manzano, 2018; Sobeeh et al, 2022). The presence of altered nociceptive processing may explain the heterogeneity in the clinical outcomes observed in clinical trials.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound‐guided percutaneous electrical nerve stimulation versus surgery for women with unilateral carpal tunnel syndrome: A randomized parallel‐group trial

Fernández‐de‐las‐Peñas

Ortega‐Santiago

de-la-Llave-Rincón

et al. 2023

European Journal of Pain

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Objective: The aim of this clinical trial was to compare the outcomes of the application of ultrasound-guided percutaneous nerve stimulation (PENS) targeting the median nerve versus surgery for improving pain and function in women with CTS. Methods:In this randomized parallel-group trial (Clini calTr ials.gov, NCT04246216), 70 women with CTS were randomly allocated to either PENS (n = 35) or surgery (n = 35) group. Hand pain intensity (mean pain and the worst pain experienced) was the primary outcome. Functional status and symptoms severity (Boston Carpal Tunnel Questionnaire, BCTQ) and self-perceived improvement (Global Rating of Change, GROC) were the secondary outcomes. Outcomes were assessed at baseline and 1, 3, 6 and 12 months after each intervention. Analysis was performed with intention to treat with mixed ANCOVAs adjusted for baseline outcomes.

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Pain mechanisms in carpal tunnel syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 12 publications

References 103 publications

Pain mechanisms in complex regional pain syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes

Pain mechanisms in complex regional pain syndrome: a systematic review and meta-analysis of quantitative sensory testing outcomes

Regenerative Peripheral Nerve Interface Surgery: Anatomic and Technical Guide

Ultrasound‐guided percutaneous electrical nerve stimulation versus surgery for women with unilateral carpal tunnel syndrome: A randomized parallel‐group trial

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