title: Heightened pain sensitivity in individuals with signs and symptoms of carpal tunnel syndrome and the relationship to clinical outcomes following a manual therapy intervention.
abstract: Neurophysiological responses related to lessening of pain sensitivity are a suggested mechanism of manual therapy. Prior studies have observed generalized lower pain thresholds associated with carpal tunnel syndrome (CTS) in comparison to healthy controls. The present study sought to determine whether similar findings were present in suprathreshold measures and measures specific to central integration of pain (temporal summation and after sensations). Additionally, we wished to determine whether measures of pain sensitivity were related to clinical outcomes in participants with signs and symptoms of CTS receiving a manual therapy intervention. Individuals with signs and symptoms of CTS reported greater pain sensitivity to suprathreshold measures of mechanical pain, temporal summation, and after sensation in comparison to healthy controls. Immediate lessening of mechanical pain sensitivity and after sensations in response to a manual therapy intervention and 3-week attenuation of temporal summation following a 3-week course of manual therapy were associated with 3-week changes in clinical pain intensity in participants with signs and symptoms of CTS. These findings suggest heightened pain sensitivity across several parameters may be associated with CTS. Furthermore, changes in mechanical pain, after sensation, and temporal summation may be related to improvements in clinical outcomes.
authors.affiliation: Department of Physical Therapy, University of Florida, Gainesville, FL 32610-0154, USA. bialosky@phhp.ufl.edu
authors.forename: Joel E
authors.initials: JE
authors.lastname: Bialosky
authors.forename: Mark D
authors.initials: MD
authors.lastname: Bishop
authors.forename: Michael E
authors.initials: ME
authors.lastname: Robinson
authors.forename: Donald D
authors.initials: DD
authors.lastname: Price
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: George
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002349:Carpal Tunnel Syndrome / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000379:methods*; D059352:Musculoskeletal Pain / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D010147:Pain Measurement; D017288:Pain Threshold / Q000502:physiology*; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult