Fernández-de-Las-Peñas C, Cleland J, Palacios-Ceña M, Fuensalida-Novo S, Alonso-Blanco C, Pareja J A, Alburquerque-Sendín F
Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain.
Department of Physical Therapy, Franklin Pierce University, Manchester, USA.
Eur J Pain. 2017 Aug;21(7):1266-1276. doi: 10.1002/ejp.1026. Epub 2017 Mar 14.
People with carpal tunnel syndrome (CTS) exhibit widespread pressure pain and thermal pain hypersensitivity as a manifestation of central sensitization. The aim of our study was to compare the effectiveness of manual therapy versus surgery for improving pain and nociceptive gain processing in people with CTS.
The trial was conducted at a local regional Hospital in Madrid, Spain from August 2014 to February 2015. In this randomized parallel-group, blinded, clinical trial, 100 women with CTS were randomly allocated to either manual therapy (n = 50), who received three sessions (once/week) of manual therapies including desensitization manoeuvres of the central nervous system, or surgical intervention (n = 50) group. Outcomes including pressure pain thresholds (PPT), thermal pain thresholds (HPT or CPT), and pain intensity which were assessed at baseline, and 3, 6, 9 and 12 months after the intervention by an assessor unaware of group assignment. Analysis was by intention to treat with mixed ANCOVAs adjusted for baseline scores.
At 12 months, 95 women completed the follow-up. Patients receiving manual therapy exhibited higher increases in PPT over the carpal tunnel at 3, 6 and 9 months (all, p < 0.01) and higher decrease of pain intensity at 3 month follow-up (p < 0.001) than those receiving surgery. No significant differences were observed between groups for the remaining outcomes.
Manual therapy and surgery have similar effects on decreasing widespread pressure pain sensitivity and pain intensity in women with CTS. Neither manual therapy nor surgery resulted in changes in thermal pain sensitivity.
The current study found that manual therapy and surgery exhibited similar effects on decreasing widespread pressure pain sensitivity and pain intensity in women with carpal tunnel syndrome at medium- and long-term follow-ups investigating changes in nociceptive gain processing after treatment in carpal tunnel syndrome.
腕管综合征（CTS）患者表现出广泛的压痛和热痛超敏反应，这是中枢敏化的一种表现。我们研究的目的是比较手法治疗与手术治疗对改善CTS患者疼痛和伤害性感受增益处理的效果。
该试验于2014年8月至2015年2月在西班牙马德里的一家地方区域医院进行。在这项随机平行组、双盲临床试验中，100名CTS女性被随机分配到手法治疗组（n = 50），接受为期三周（每周一次）的手法治疗，包括中枢神经系统脱敏操作，或手术干预组（n = 50）。通过不知道分组情况的评估者在基线时以及干预后3、6、9和12个月评估包括压力痛阈（PPT）、热痛阈（HPT或CPT）和疼痛强度等结果。采用意向性分析，通过混合协方差分析对基线分数进行调整。
12个月时，95名女性完成了随访。在3、6和9个月时，接受手法治疗的患者腕管处的PPT升高幅度更大（均p < 0.01），在3个月随访时疼痛强度下降幅度更大（p < 0.001），高于接受手术治疗的患者。在其余结果方面，两组之间未观察到显著差异。
手法治疗和手术治疗对降低CTS女性广泛的压痛敏感性和疼痛强度具有相似的效果。手法治疗和手术治疗均未导致热痛敏感性的改变。
本研究发现，在对腕管综合征治疗后伤害性感受增益处理变化的中长期随访中，手法治疗和手术治疗在降低腕管综合征女性广泛的压痛敏感性和疼痛强度方面表现出相似的效果。
