Fernández-de-Las-Peñas César, Fernández-Muñoz Juan J, Navarro-Pardo Esperanza, da-Silva-Pocinho Ricardo F, Ambite-Quesada Silvia, Pareja Juan A
*Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain Grupo Excelencia Investigadora URJC-Banco Santander referencia Nº30VCPIGI03: Investigación traslacional en el proceso de salud - enfermedad (ITPSE), Universidad Rey Juan Carlos, Alcorcón, Spain
Department of Psychology, Universidad Rey Juan Carlos, Alcorcón, Spain.
Pain Med. 2016 Sep;17(9):1749-56. doi: 10.1093/pm/pnw054. Epub 2016 Apr 10.
Identification of subjects with different sensitization mechanisms can help to identify better therapeutic strategies for carpal tunnel syndrome (CTS). The aim of the current study was to identify subgroups of women with CTS with different levels of sensitization.
A total of 223 women with CTS were recruited. Self-reported variables included pain intensity, function, disability, and depression. Pressure pain thresholds (PPT) were assessed bilaterally over median, ulnar, and radial nerves, C5-C6 joint, carpal tunnel, and tibialis anterior to assess widespread pressure pain hyperalgesia. Heat (HPT) and cold (CPT) pain thresholds were also bilaterally assessed over the carpal tunnel and the thenar eminence to determine thermal pain hyperalgesia. Pinch grip force between the thumb and the remaining fingers was calculated to determine motor assessment. Subgroups were determined according to the status on a previous clinical prediction rule: PPT over the affected C5-C6 joint < 137 kPa, HPT on affected carpal tunnel <39.6ºC, and general health >66 points.
The ANOVA showed that women within group 1 (positive rule, n = 60) exhibited bilateral widespread pressure hyperalgesia (P < 0.001) and bilateral thermal thresholds (P < 0.001) than those within group 2 (negative rule, n = 162). Women in group 1 also exhibited higher depression than those in group 2 (P = 0.023). No differences in self-reported variables were observed.
This study showed that a clinical prediction rule originally developed for identifying women with CTS who are likely to respond favorably to manual physical therapy was able to identify women exhibiting higher widespread pressure hyper-sensitivity and thermal hyperalgesia. This subgroup of women with CTS exhibiting higher sensitization may need specific therapeutic programs.
识别具有不同致敏机制的受试者有助于确定更好的腕管综合征（CTS）治疗策略。本研究的目的是识别致敏水平不同的CTS女性亚组。
共招募了223名CTS女性。自我报告的变量包括疼痛强度、功能、残疾和抑郁。双侧评估正中神经、尺神经、桡神经、C5-C6关节、腕管和胫前肌的压力痛阈（PPT），以评估广泛的压力痛觉过敏。还双侧评估腕管和鱼际隆起处的热（HPT）和冷（CPT）痛阈，以确定热痛觉过敏。计算拇指与其余手指之间的捏力以进行运动评估。根据先前临床预测规则的状态确定亚组：患侧C5-C6关节处的PPT < 137 kPa，患侧腕管处的HPT < 39.6ºC，以及总体健康状况 > 66分。
方差分析显示，第1组（阳性规则，n = 60）的女性比第2组（阴性规则，n = 162）的女性表现出双侧广泛的压力痛觉过敏（P < 0.001）和双侧热阈（P < 0.001）。第1组的女性也比第2组的女性表现出更高的抑郁水平（P = 0.023）。自我报告的变量未观察到差异。
本研究表明，最初用于识别可能对手工物理治疗有良好反应的CTS女性的临床预测规则能够识别出表现出更高广泛压力超敏反应和热痛觉过敏的女性。这一具有更高致敏性的CTS女性亚组可能需要特定的治疗方案。
