Facilitatory and inhibitory pain mechanisms are altered in patients with carpal tunnel syndrome
Preliminary evidence from studies using quantitative sensory testing suggests the presence of central mechanisms in patients with carpal tunnel syndrome (CTS) as apparent by widespread hyperalgesia. Hallmarks of central mechanisms after nerve injuries include nociceptive facilitation and reduced end...
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| description | Preliminary evidence from studies using quantitative sensory testing suggests the presence of central mechanisms in patients with carpal tunnel syndrome (CTS) as apparent by widespread hyperalgesia. Hallmarks of central mechanisms after nerve injuries include nociceptive facilitation and reduced endogenous pain inhibition. Methods to study nociceptive facilitation in CTS so far have been limited to quantitative sensory testing and the integrity of endogenous inhibition remains unexamined. The aim of this study was therefore to investigate changes in facilitatory and inhibitory processing in patients with CTS by studying hypersensitivity following experimentally induced pain (facilitatory mechanisms) and the efficacy of conditioned pain modulation (CPM, inhibitory mechanisms). Twenty-five patients with mild to moderate CTS and 25 age and sex matched control participants without CTS were recruited. Increased pain facilitation was evaluated via injection of hypertonic saline into the upper trapezius. Altered pain inhibition through CPM was investigated through cold water immersion of the foot as the conditioning stimulus and pressure pain threshold over the thenar and hypothenar eminence bilaterally as the test stimulus. The results demonstrated that patients with CTS showed a greater duration (p = 0.047), intensity (p = 0.044) and area (p = 0.012) of pain in response to experimentally induced pain in the upper trapezius and impaired CPM compared to the control participants (p = 0.006). Although typically considered to be driven by peripheral mechanisms, these findings indicate that CTS demonstrates characteristics of altered central processing with increased pain facilitation and reduced endogenous pain inhibition. |
| doi_str_mv | 10.1371/journal.pone.0183252 |
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Hallmarks of central mechanisms after nerve injuries include nociceptive facilitation and reduced endogenous pain inhibition. Methods to study nociceptive facilitation in CTS so far have been limited to quantitative sensory testing and the integrity of endogenous inhibition remains unexamined. The aim of this study was therefore to investigate changes in facilitatory and inhibitory processing in patients with CTS by studying hypersensitivity following experimentally induced pain (facilitatory mechanisms) and the efficacy of conditioned pain modulation (CPM, inhibitory mechanisms). Twenty-five patients with mild to moderate CTS and 25 age and sex matched control participants without CTS were recruited. Increased pain facilitation was evaluated via injection of hypertonic saline into the upper trapezius. Altered pain inhibition through CPM was investigated through cold water immersion of the foot as the conditioning stimulus and pressure pain threshold over the thenar and hypothenar eminence bilaterally as the test stimulus. The results demonstrated that patients with CTS showed a greater duration (p = 0.047), intensity (p = 0.044) and area (p = 0.012) of pain in response to experimentally induced pain in the upper trapezius and impaired CPM compared to the control participants (p = 0.006). Although typically considered to be driven by peripheral mechanisms, these findings indicate that CTS demonstrates characteristics of altered central processing with increased pain facilitation and reduced endogenous pain inhibition.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0183252</identifier><identifier>PMID: 28854251</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Arthritis ; Biology and Life Sciences ; Care and treatment ; Carpal tunnel syndrome ; Carpal Tunnel Syndrome - physiopathology ; Case-Control Studies ; Chronic Pain - physiopathology ; Cold pressing ; Cold water ; Comparative analysis ; Conditioning ; Conditioning (Psychology) ; Development and progression ; Feet ; Female ; Hand - innervation ; Hand - physiopathology ; Humans ; Hyperalgesia ; Hyperalgesia - physiopathology ; Hypersensitivity ; Immersion ; Inhibition ; Injections, Intramuscular ; Injury prevention ; Male ; Manipulative therapy ; Medicine and Health Sciences ; Middle Aged ; Muscle, Skeletal - innervation ; Muscle, Skeletal - physiopathology ; Nociception ; Nociceptive Pain - physiopathology ; Overuse injuries ; Pain ; Pain Measurement ; Pain perception ; Pain Threshold ; Patients ; Physical Sciences ; Physical Stimulation ; Pressure ; Saline Solution, Hypertonic - administration & dosage ; Saline solutions ; Sensory testing ; Studies ; Water immersion</subject><ispartof>PloS one, 2017-08, Vol.12 (8), p.e0183252-e0183252</ispartof><rights>COPYRIGHT 2017 Public Library of Science</rights><rights>2017 Soon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2017 Soon et al 2017 Soon et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-a6e32dba45a8063f804c52855b0cc7a722ff28f5855b5cfcce8322e13fc8c3da3</citedby><cites>FETCH-LOGICAL-c692t-a6e32dba45a8063f804c52855b0cc7a722ff28f5855b5cfcce8322e13fc8c3da3</cites><orcidid>0000-0002-8840-1372</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5576684/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5576684/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2095,2914,23846,27903,27904,53769,53771,79346,79347</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28854251$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Tremblay, François</contributor><creatorcontrib>Soon, Benjamin</creatorcontrib><creatorcontrib>Vicenzino, Bill</creatorcontrib><creatorcontrib>Schmid, Annina B</creatorcontrib><creatorcontrib>Coppieters, Michel W</creatorcontrib><title>Facilitatory and inhibitory pain mechanisms are altered in patients with carpal tunnel syndrome</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Preliminary evidence from studies using quantitative sensory testing suggests the presence of central mechanisms in patients with carpal tunnel syndrome (CTS) as apparent by widespread hyperalgesia. Hallmarks of central mechanisms after nerve injuries include nociceptive facilitation and reduced endogenous pain inhibition. Methods to study nociceptive facilitation in CTS so far have been limited to quantitative sensory testing and the integrity of endogenous inhibition remains unexamined. The aim of this study was therefore to investigate changes in facilitatory and inhibitory processing in patients with CTS by studying hypersensitivity following experimentally induced pain (facilitatory mechanisms) and the efficacy of conditioned pain modulation (CPM, inhibitory mechanisms). Twenty-five patients with mild to moderate CTS and 25 age and sex matched control participants without CTS were recruited. Increased pain facilitation was evaluated via injection of hypertonic saline into the upper trapezius. Altered pain inhibition through CPM was investigated through cold water immersion of the foot as the conditioning stimulus and pressure pain threshold over the thenar and hypothenar eminence bilaterally as the test stimulus. The results demonstrated that patients with CTS showed a greater duration (p = 0.047), intensity (p = 0.044) and area (p = 0.012) of pain in response to experimentally induced pain in the upper trapezius and impaired CPM compared to the control participants (p = 0.006). Although typically considered to be driven by peripheral mechanisms, these findings indicate that CTS demonstrates characteristics of altered central processing with increased pain facilitation and reduced endogenous pain inhibition.</description><subject>Adult</subject><subject>Arthritis</subject><subject>Biology and Life Sciences</subject><subject>Care and treatment</subject><subject>Carpal tunnel syndrome</subject><subject>Carpal Tunnel Syndrome - physiopathology</subject><subject>Case-Control Studies</subject><subject>Chronic Pain - physiopathology</subject><subject>Cold pressing</subject><subject>Cold water</subject><subject>Comparative analysis</subject><subject>Conditioning</subject><subject>Conditioning (Psychology)</subject><subject>Development and progression</subject><subject>Feet</subject><subject>Female</subject><subject>Hand - innervation</subject><subject>Hand - physiopathology</subject><subject>Humans</subject><subject>Hyperalgesia</subject><subject>Hyperalgesia - physiopathology</subject><subject>Hypersensitivity</subject><subject>Immersion</subject><subject>Inhibition</subject><subject>Injections, Intramuscular</subject><subject>Injury prevention</subject><subject>Male</subject><subject>Manipulative therapy</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Muscle, Skeletal - innervation</subject><subject>Muscle, Skeletal - physiopathology</subject><subject>Nociception</subject><subject>Nociceptive Pain - physiopathology</subject><subject>Overuse injuries</subject><subject>Pain</subject><subject>Pain Measurement</subject><subject>Pain perception</subject><subject>Pain Threshold</subject><subject>Patients</subject><subject>Physical Sciences</subject><subject>Physical Stimulation</subject><subject>Pressure</subject><subject>Saline Solution, Hypertonic - administration & dosage</subject><subject>Saline solutions</subject><subject>Sensory testing</subject><subject>Studies</subject><subject>Water immersion</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk9-LEzEQxxdRvLP6H4guCKIPrZtf2_RFOA5PCwcH_noN02zSTckmvSSr9r83bfeOrtyD7EM2k898MzOZKYqXqJohMkcfNr4PDuxs652aVYgTzPCj4hwtCJ7WuCKPT_7PimcxbqqKEV7XT4szzDmjmKHzQlyBNNYkSD7sSnBNaVxrVuaw3YJxZadkC87ELpYQVAk2qaD2WD5ORrkUy98mtaWEsAVbpt45Zcu4c03wnXpePNFgo3oxrJPix9Wn75dfptc3n5eXF9dTWS9wmkKtCG5WQBnwqiaaV1QyzBlbVVLOYY6x1phrtrcwqaVUOV-sENGSS9IAmRSvj7pb66MYahNFrgBZsHmdM58UyyPReNiIbTAdhJ3wYMTB4MNaQEhGWiUqUtUM5SAQ1VRSzWs2R0w20FCGQOms9XG4rV91qpG5CgHsSHR84kwr1v6XYDmWmtMs8G4QCP62VzGJzkSprAWnfH-Im2JOar6P-80_6MPZDdQacgLGaZ_vlXtRccEqTCmvMc7U7AEqf43qjMyNpE22jxzejxwyk9SftIY-RrH89vX_2ZufY_btCduq3FVt9LZPxrs4BukRlMHHGJS-LzKqxH4O7qoh9nMghjnIbq9OH-je6a7xyV-Y0gOX</recordid><startdate>20170830</startdate><enddate>20170830</enddate><creator>Soon, Benjamin</creator><creator>Vicenzino, Bill</creator><creator>Schmid, Annina B</creator><creator>Coppieters, Michel W</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-8840-1372</orcidid></search><sort><creationdate>20170830</creationdate><title>Facilitatory and inhibitory pain mechanisms are altered in patients with carpal tunnel syndrome</title><author>Soon, Benjamin ; Vicenzino, Bill ; Schmid, Annina B ; Coppieters, Michel W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-a6e32dba45a8063f804c52855b0cc7a722ff28f5855b5cfcce8322e13fc8c3da3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Arthritis</topic><topic>Biology and Life Sciences</topic><topic>Care and treatment</topic><topic>Carpal tunnel syndrome</topic><topic>Carpal Tunnel Syndrome - physiopathology</topic><topic>Case-Control Studies</topic><topic>Chronic Pain - physiopathology</topic><topic>Cold pressing</topic><topic>Cold water</topic><topic>Comparative analysis</topic><topic>Conditioning</topic><topic>Conditioning (Psychology)</topic><topic>Development and progression</topic><topic>Feet</topic><topic>Female</topic><topic>Hand - innervation</topic><topic>Hand - physiopathology</topic><topic>Humans</topic><topic>Hyperalgesia</topic><topic>Hyperalgesia - physiopathology</topic><topic>Hypersensitivity</topic><topic>Immersion</topic><topic>Inhibition</topic><topic>Injections, Intramuscular</topic><topic>Injury prevention</topic><topic>Male</topic><topic>Manipulative therapy</topic><topic>Medicine and Health Sciences</topic><topic>Middle Aged</topic><topic>Muscle, Skeletal - innervation</topic><topic>Muscle, Skeletal - physiopathology</topic><topic>Nociception</topic><topic>Nociceptive Pain - physiopathology</topic><topic>Overuse injuries</topic><topic>Pain</topic><topic>Pain Measurement</topic><topic>Pain perception</topic><topic>Pain Threshold</topic><topic>Patients</topic><topic>Physical Sciences</topic><topic>Physical Stimulation</topic><topic>Pressure</topic><topic>Saline Solution, Hypertonic - administration & dosage</topic><topic>Saline solutions</topic><topic>Sensory testing</topic><topic>Studies</topic><topic>Water immersion</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Soon, Benjamin</creatorcontrib><creatorcontrib>Vicenzino, Bill</creatorcontrib><creatorcontrib>Schmid, Annina B</creatorcontrib><creatorcontrib>Coppieters, Michel W</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection (ProQuest)</collection><collection>Natural Science Collection (ProQuest)</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Soon, Benjamin</au><au>Vicenzino, Bill</au><au>Schmid, Annina B</au><au>Coppieters, Michel W</au><au>Tremblay, François</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Facilitatory and inhibitory pain mechanisms are altered in patients with carpal tunnel syndrome</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2017-08-30</date><risdate>2017</risdate><volume>12</volume><issue>8</issue><spage>e0183252</spage><epage>e0183252</epage><pages>e0183252-e0183252</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Preliminary evidence from studies using quantitative sensory testing suggests the presence of central mechanisms in patients with carpal tunnel syndrome (CTS) as apparent by widespread hyperalgesia. Hallmarks of central mechanisms after nerve injuries include nociceptive facilitation and reduced endogenous pain inhibition. Methods to study nociceptive facilitation in CTS so far have been limited to quantitative sensory testing and the integrity of endogenous inhibition remains unexamined. The aim of this study was therefore to investigate changes in facilitatory and inhibitory processing in patients with CTS by studying hypersensitivity following experimentally induced pain (facilitatory mechanisms) and the efficacy of conditioned pain modulation (CPM, inhibitory mechanisms). Twenty-five patients with mild to moderate CTS and 25 age and sex matched control participants without CTS were recruited. Increased pain facilitation was evaluated via injection of hypertonic saline into the upper trapezius. Altered pain inhibition through CPM was investigated through cold water immersion of the foot as the conditioning stimulus and pressure pain threshold over the thenar and hypothenar eminence bilaterally as the test stimulus. The results demonstrated that patients with CTS showed a greater duration (p = 0.047), intensity (p = 0.044) and area (p = 0.012) of pain in response to experimentally induced pain in the upper trapezius and impaired CPM compared to the control participants (p = 0.006). Although typically considered to be driven by peripheral mechanisms, these findings indicate that CTS demonstrates characteristics of altered central processing with increased pain facilitation and reduced endogenous pain inhibition.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>28854251</pmid><doi>10.1371/journal.pone.0183252</doi><tpages>e0183252</tpages><orcidid>https://orcid.org/0000-0002-8840-1372</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Arthritis Biology and Life Sciences Care and treatment Carpal tunnel syndrome Carpal Tunnel Syndrome - physiopathology Case-Control Studies Chronic Pain - physiopathology Cold pressing Cold water Comparative analysis Conditioning Conditioning (Psychology) Development and progression Feet Female Hand - innervation Hand - physiopathology Humans Hyperalgesia Hyperalgesia - physiopathology Hypersensitivity Immersion Inhibition Injections, Intramuscular Injury prevention Male Manipulative therapy Medicine and Health Sciences Middle Aged Muscle, Skeletal - innervation Muscle, Skeletal - physiopathology Nociception Nociceptive Pain - physiopathology Overuse injuries Pain Pain Measurement Pain perception Pain Threshold Patients Physical Sciences Physical Stimulation Pressure Saline Solution, Hypertonic - administration & dosage Saline solutions Sensory testing Studies Water immersion |
| title | Facilitatory and inhibitory pain mechanisms are altered in patients with carpal tunnel syndrome |
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