Predicting Nociplastic Pain in Carpal Tunnel Syndrome Through Quantitative Sensory Testing

Quantitative Sensory Testing to Predict Progression to Nociplastic Pain in Carpal Tunnel Syndrome: A Prospective Cohort Study

This study aims to investigate the predictive value of quantitative sensory testing (QST) in identifying patients with carpal tunnel syndrome (CTS) who are at risk of developing nociplastic pain.

The study will recruit 120 adults diagnosed with CTS and conduct baseline QST measures. The progression to nociplastic pain will be assessed over a one-year follow-up period to determine the predictive value of QST measures.

Inclusion Criteria:

• Adults ages 18-60

• Clinical diagnosis of CTS based on presence of parasthesias and/or pain in median nerve distribution, positive Phalen's test and/or Tinel's sign, and nocturnal symptoms

• Electrodiagnostic evidence of median neuropathy at the wrist:

  1. Prolonged median motor distal latency >4.2 ms
  2. Prolonged median sensory latency >3.4 ms

• Symptom duration between 6 months and 2 years (to exclude very early or very late stages)

• Pain severity of ≥5 on 0-10 numerical rating scale

• No evidence of thenar muscle atrophy on physical exam

• No prior surgery or fracture of the affected wrist

• No evidence of comorbid diabetes mellitus, cervical radiculopathy, polyneuropathy, or other neuromuscular disorders

Exclusion Criteria:

• Diabetes mellitus, as a common cause of polyneuropathy, which can confound QST measures.
• Cervical radiculopathy or other upper limb neuropathies, which can cause overlapping sensory symptoms and signs.
• History of wrist fracture or surgery, which may cause structural abnormalities affecting nerve function.
• Pregnancy, due to physiological changes that can affect nerve function.
• Patients with severe thenar muscle atrophy, indicating long-standing severe median neuropathy.
• Patients unable to provide informed consent or comply with study procedures.