title: Activation in the hypothalamic-pituitary-adrenocortical axis and sympathetic nervous system in women with carpal tunnel syndrome.
abstract: OBJECTIVE
  The aim of this study is to investigate the differences in salivary cortisol (hypothalamic-pituitary-adrenocortical [HPA] axis), α-amylase activity (sympathetic nervous system [SNS]), and immunoglobulin A (IgA; immune system) concentrations between women with carpal tunnel syndrome (CTS) and healthy women.
  
  
  METHODS
  A cross-sectional study.
  
  
  METHODS
  Activation of HPA, SNS, and immune system in CTS has not been clearly determined.
  
  
  METHODS
  One hundred two women (age: 45 ± 7 years) with electrodiagnostic and clinical diagnosis of CTS and 102 matched healthy women.
  
  
  METHODS
  The intensity of the pain was assessed with a Numerical Pain Rating Scale (0-10), and disability was determined with Boston Carpal Tunnel Questionnaire. Salivary cortisol concentration, α-amylase activity, salivary flow rate, and IgA concentration were collected from nonstimulated saliva.
  
  
  RESULTS
  Women with CTS exhibited lower salivary flow rate (P < 0.001) and higher α-amylase activity (P < 0.01) than controls. No significant differences for cortisol and IgA concentrations (P > 0.2) were found between groups as a total. Women with severe CTS exhibited lower salivary flow rate (P < 0.001), higher α-amylase activity (P = 0.002), and higher cortisol concentration (P = 0.03) than healthy women and than those with minimal/moderate CTS (P < 0.05). Within women with CTS, significant positive associations between α-amylase activity and the intensity of pain were found: the highest the level of pain, the higher the α-amylase activity, i.e., higher SNS activation.
  
  
  CONCLUSIONS
  These results suggest that women with severe CTS exhibit changes in activation in the HPA axis and SNS but not in the humoral immune system. Activation of the SNS was associated with the intensity of pain. Future studies are needed to elucidate the direction of this relationship.
authors: Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Madrid, Spain; Esthesiology Laboratory, Universidad Rey Juan Carlos, Madrid, Spain.
authors: César
authors: C
authors: Fernández-de-Las-Peñas
authors: Lourdes
authors: L
authors: Díaz-Rodríguez
authors: Jaime
authors: J
authors: Salom-Moreno
authors: Noelia
authors: N
authors: Galiano-Castillo
authors: Lis
authors: L
authors: Valverde-Herreros
authors: Javier
authors: J
authors: Martínez-Martín
authors: Juan A
authors: JA
authors: Pareja
mesh_terms: D000328:Adult; D002349:Carpal Tunnel Syndrome / Q000276:immunology / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis / Q000378:metabolism; D007030:Hypothalamo-Hypophyseal System / Q000276:immunology / Q000503:physiopathology*; D007118:Immunoassay; D007070:Immunoglobulin A / Q000032:analysis / Q000378:metabolism; D008875:Middle Aged; D010146:Pain / Q000276:immunology / Q000503:physiopathology*; D010913:Pituitary-Adrenal System / Q000276:immunology / Q000503:physiopathology*; D012463:Saliva / Q000737:chemistry / Q000378:metabolism; D013564:Sympathetic Nervous System / Q000276:immunology / Q000503:physiopathology*; D000516:alpha-Amylases / Q000032:analysis / Q000378:metabolism
chemical_list: D007070:Immunoglobulin A; D000516:alpha-Amylases; D006854:Hydrocortisone
keywords: Carpal Tunnel Syndrome; Cortisol; Immunoglobulin A; Pain; α-Amylase