What is the role of sensitization in carpal tunnel syndrome where pain impacts functional capacity?

Yıl 2023, Cilt: 5 Sayı: 4, 311 - 316, 27.10.2023

Emel Güler Musa Polat Gülay Soykök Tuğçe Yavuz Mollavelioğlu

https://doi.org/10.38053/acmj.1322933

Öz

Aims: Expression of carpal tunnel syndrome (CTS) caused by the entrapped median nerve includes pain, paraesthesia and numbness. Extra median spread of pain can furthermore be seen as a clinical requirement defined by neuro inflammation. Central sensitization (CS) constructs a similar mechanism. This study aims to evaluate sensitization in patients diagnosed with CTS.
Methods: A total number of 152 patients diagnosed with CTS were evaluated, prospectively. Patients data such as gender, age, body mass index (BMI), disease duration, pain severity (NRS), painDETECT questionnaire, Boston CTS symptom severity scale (SSS) and functional status scale (FSS), CS scale, electroneuromyography results have been collected by the author and then the patients are divided into three groups.
Results: Regarding the age, BMI and CS rate, there was no statistical difference between the three patient groups (p>0.05). However, a statistically significant difference was found between these groups in disease duration, day-time and night-time NRS, Boston SSS, FSS, and pain DETECT scores (p<0.05). A statistically significant correlation between age, BMI, NRS daytime scores, Boston SSS, FSS, and CS existence was not found (p>0.05). Yet, statistically significant differences were found in a comparison of the patients with and without CS, in disease duration, NRS night scores, and painDETECT scores (p<0.05).
Conclusion: We conclude that the rate of CS is often undervalued in patients with CTS. CS should be considered in CTS patients with extra-median spread of pain.

Anahtar Kelimeler

Carpal tunnel syndrome, functional capacity, central sensitization

Kaynakça

• Genova A, Dix O, Saefan A, Thakur M, Hassan A. Carpal tunnel syndrome: a review of literature. Cureus. 2020; 12(3):e7333.
• Zanette G, Cacciatori C, Tamburin S. Central sensitization in carpal tunnel syndrome with extraterritorial spread of sensory symptoms. Pain. 2010; 148(2):227-236.
• Zanette G, Marani S, Tamburin S. Extra-median spread of sensory symptoms in carpal tunnel syndrome suggests the presence of pain-related mechanisms. Pain. 2006; 122(3):264-270.
• Fernández-de-Las-Peñas C, Arias-Buría JL, Ortega-Santiago R, De-la-Llave-Rincón AI. Understanding central sensitization for advances in management of carpal tunnel syndrome. F1000Res. 2020; 15; 9:F1000 Faculty Rev-605.
• Mayer TG, Neblett R, Cohen H, et al. The development and psychometric validation of the central sensitization inventory. Pain Pract. 2012; 12(4):276-285.
• Jablecki CK, Andary MT, Floeter MK, et al. American Association of Electrodiagnostic Medicine; American Academy of Neurology; American Academy of Physical Medicine and Rehabilitation. Practice parameter: Electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology. 2002; 58(11):1589-1592.
• Levine DW, Simmons BP, Koris MJ, et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993; 75(11):1585-1592.
• Sezgin M, Incel NA, Serhan S, Camdeviren H, As I, Erdoğan C. Assessment of symptom severity and functional status in patients with carpal tunnel syndrome: reliability and functionality of the Turkish version of the Boston Questionnaire. Disabil Rehabil. 2006; 30; 28(20):1281-1285.
• Freynhagen R, Baron R, Gockel U, Tölle TR. painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 2006; 22(10): 1911-1920.
• Alkan H, Ardic F, Erdogan C, Sahin F, Sarsan A, Findikoglu G. Turkish version of the painDETECT questionnaire in the assessment of neuropathic pain: a validity and reliability study. Pain Med. 2013; 14(12):1933-1943.
• Düzce Keleş E, Birtane M, Ekuklu G, et al. Validity and reliability of the Turkish version of the central sensitization inventory. Arch Rheumatol. 2021; 36(4):518-526.
• Nijs J, Leysen L, Vanlauwe J, et al. Treatment of central sensitization in patients with chronic pain: time for change? Expert Opin Pharmacother. 2019; 20(16):1961-1970.
• Genova A, Dix O, Saefan A, Thakur M, Hassan A. Carpal tunnel syndrome: a review of literature. Cureus. 2020; 12(3):e7333.
• Becker J, Nora DB, Gomes I, et al. An evaluation of gender, obesity, age and diabetes mellitus as risk factors for carpal tunnel syndrome. Clin Neurophysiol. 2002; 113(9):1429-1434.
• Adebayo PB, Mwakabatika RE, Mazoko MC, Taiwo FT, Ali AJ, Zehri AA. Relationship between obesity and severity of carpal tunnel syndrome in Tanzania. Metab Syndr Relat Disord. 2020; 18(10):485-492.
• Bigal ME, Lipton RB, Holland PR, Goadsby PJ. Obesity, migraine, and chronic migraine: possible mechanisms of interaction. Neurology. 2007; 68(21):1851-1861.
• Torensma B, Thomassen I, van Velzen M, In ‘t Veld BA. Pain experience and perception in the obese subject systematic review (revised version). Obes Surg. 2016; 26(3):631-639.
• Suzuki K, Haruyama Y, Kobashi G, et al. Central sensitization in neurological, psychiatric, and pain disorders: a multicenter case-controlled study. Pain Res Manag. 2021; 15; 2021:6656917.
• Ji RR, Nackley A, Huh Y, Terrando N, Maixner W. Neuroinflammation and Central Sensitization in Chronic and Widespread Pain. Anesthesiology. 2018; 129(2):343-366.
• Jiménez-Del-Barrio S, Cadellans-Arróniz A, Ceballos-Laita L, et al. The effectiveness of manual therapy on pain, physical function, and nerve conduction studies in carpal tunnel syndrome patients: a systematic review and meta-analysis. Int Orthop. 2022; 46(2):301-312.
• Matesanz L, Hausheer AC, Baskozos G, Bennett DLH, Schmid AB. Somatosensory and psychological phenotypes associated with neuropathic pain in entrapment neuropathy. Pain. 2021; 162(4):1211-1220.
• Finnerup NB, Kuner R, Jensen TS. Neuropathic pain: from mechanisms to treatment. Physiol Rev. 2021; 101(1):259-301.
• Meacham K, Shepherd A, Mohapatra DP, Haroutounian S. Neuropathic pain: central vs. peripheral mechanisms. Curr Pain Headache Rep. 2017; 21(6):28.
• Lluch Girbés E, Dueñas L, Barbero M, et al. Expanded distribution of pain as a sign of central sensitization in individuals with symptomatic knee osteoarthritis. Phys Ther. 2016;96(8):1196-1207.
• Kim SH, Yoon KB, Yoon DM, Yoo JH, Ahn KR. Influence of centrally mediated symptoms on postoperative pain in osteoarthritis patients undergoing total knee arthroplasty: a prospective observational evaluation. Pain Pract. 2015; 15(6):E46-53.
• Nystrom NA, Freeman MD. Central sensitization is modulated following trigger point anesthetization in patients with chronic pain from whiplash trauma. A double-blind, placebo-controlled, crossover study. Pain Med. 2018; 19(1):124-129.
• Halili A. Temporal model for central sensitization: a hypothesis for mechanism and treatment using systemic manual therapy, a focused review. MethodsX. 2022;10:101942
• Fernández-de-Las-Peñas C, Falla D, Palacios-Ceña M, De-la-Llave-Rincón AI, Schneebeli A, Barbero M. Perceived pain extent is not associated with physical, psychological, or psychophysical outcomes in women with carpal tunnel syndrome. Pain Med. 2019; 20(6):1185-1192.