Fernández-de-las-Peñas César, de la Llave-Rincón Ana Isabel, Fernández-Carnero Josué, Cuadrado María Luz, Arendt-Nielsen Lars, Pareja Juan A
Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Avenida de Atenas s/n, Alcorcón, Madrid, Spain.
Brain. 2009 Jun;132(Pt 6):1472-9. doi: 10.1093/brain/awp050. Epub 2009 Mar 31.
The aim of this study was to investigate whether bilateral widespread pressure hypersensitivity exists in patients with unilateral carpal tunnel syndrome. A total of 20 females with carpal tunnel syndrome (aged 22-60 years), and 20 healthy matched females (aged 21-60 years old) were recruited. Pressure pain thresholds were assessed bilaterally over median, ulnar, and radial nerve trunks, the C5-C6 zygapophyseal joint, the carpal tunnel and the tibialis anterior muscle in a blinded design. The results showed that pressure pain threshold levels were significantly decreased bilaterally over the median, ulnar, and radial nerve trunks, the carpal tunnel, the C5-C6 zygapophyseal joint, and the tibialis anterior muscle in patients with unilateral carpal tunnel syndrome as compared to healthy controls (all, P < 0.001). Pressure pain threshold was negatively correlated to both hand pain intensity and duration of symptoms (all, P < 0.001). Our findings revealed bilateral widespread pressure hypersensitivity in subjects with carpal tunnel syndrome, which suggest that widespread central sensitization is involved in patients with unilateral carpal tunnel syndrome. The generalized decrease in pressure pain thresholds associated with pain intensity and duration of symptoms supports a role of the peripheral drive to initiate and maintain central sensitization. Nevertheless, both central and peripheral sensitization mechanisms are probably involved at the same time in carpal tunnel syndrome.
本研究的目的是调查单侧腕管综合征患者是否存在双侧广泛的压力超敏反应。共招募了20名患有腕管综合征的女性（年龄22 - 60岁）和20名匹配的健康女性（年龄21 - 60岁）。采用盲法设计，双侧评估正中神经、尺神经和桡神经干、C5 - C6关节突关节、腕管和胫前肌的压痛阈值。结果显示，与健康对照组相比，单侧腕管综合征患者双侧正中神经、尺神经和桡神经干、腕管、C5 - C6关节突关节和胫前肌的压痛阈值水平显著降低（均P < 0.001）。压痛阈值与手部疼痛强度和症状持续时间均呈负相关（均P < 0.001）。我们的研究结果揭示了腕管综合征患者存在双侧广泛的压力超敏反应，这表明广泛的中枢敏化参与了单侧腕管综合征患者的发病过程。与疼痛强度和症状持续时间相关的压痛阈值普遍降低支持外周驱动在启动和维持中枢敏化中的作用。然而，中枢和外周敏化机制可能在腕管综合征中同时起作用。
