{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T21:23:14Z","timestamp":1782422594106,"version":"3.54.5"},"reference-count":49,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2020,6,15]],"date-time":"2020-06-15T00:00:00Z","timestamp":1592179200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns4:p>Carpal tunnel syndrome is the most common nerve compression disorder of the upper extremity, and it is traditionally considered a peripheral neuropathy associated with a localized compression of the median nerve just at the level of the carpal tunnel. Surgery and physiotherapy are treatment approaches commonly used for this condition; however, conflicting clinical outcomes suggest that carpal tunnel syndrome may be more complex. There is evidence supporting the role of peripheral nociception from the median nerve in carpal tunnel syndrome; however, emerging evidence also suggests a potential role of central sensitization. The presence of spreading pain symptoms (e.g. proximal pain), widespread sensory changes, or bilateral motor control impairments in people presenting with strictly unilateral sensory symptoms supports the presence of spinal cord changes. Interestingly, bilateral sensory and motor changes are not directly associated with electrodiagnostic findings. Other studies have also reported that patients presenting with carpal tunnel syndrome exhibit neuroplastic brainstem change supporting central sensitization. Current data would support the presence of a central sensitization process, mediated by the peripheral drive originating in the compression of the median nerve, in people with carpal tunnel syndrome. The presence of altered nociceptive gain processing should be considered in the treatment of carpal tunnel syndrome by integrating therapeutic approaches aiming to modulate long-lasting nociceptive barrage into the central nervous system (peripheral drive) and strategies aiming to activate endogenous pain networks (central drive).<\/ns4:p>","DOI":"10.12688\/f1000research.22570.1","type":"journal-article","created":{"date-parts":[[2020,6,15]],"date-time":"2020-06-15T11:30:06Z","timestamp":1592220606000},"page":"605","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":23,"title":["Understanding central sensitization for advances in management of carpal tunnel syndrome"],"prefix":"10.12688","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3772-9690","authenticated-orcid":false,"given":"C\u00e9sar","family":"Fern\u00e1ndez-de-las-pe\u00f1as","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 L","family":"Arias-Bur\u00eda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Ortega-Santiago","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana I","family":"De-la-Llave-Rinc\u00f3n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2020,6,15]]},"reference":[{"key":"ref-1","first-page":"36-9","article-title":"Carpal tunnel syndrome in general practice (1987 and 2001): Incidence and the role of occupational and non-occupational factors.","volume":"57","author":"F Bongers","year":"2007","journal-title":"Br J Gen Pract."},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"2320-6","DOI":"10.1016\/j.apmr.2014.08.004","article-title":"Effects of varying case definition on carpal tunnel syndrome prevalence estimates in a pooled cohort.","volume":"95","author":"M Thiese","year":"2014","journal-title":"Arch Phys Med Rehabil."},{"key":"ref-3","doi-asserted-by":"publisher","first-page":"155-72","DOI":"10.1002\/ajim.20430","article-title":"The economic burden of carpal tunnel syndrome: Long-term earnings of CTS claimants in Washington State.","volume":"50","author":"M Foley","year":"2007","journal-title":"Am J Ind Med."},{"key":"ref-4","doi-asserted-by":"publisher","first-page":"209-16","DOI":"10.2217\/pmt-2017-0063","article-title":"Carpal tunnel syndrome: Just a peripheral neuropathy?","volume":"8","author":"C Fern\u00e1ndez-de-las-Pe\u00f1as","year":"2018","journal-title":"Pain Manag."},{"key":"ref-5","doi-asserted-by":"publisher","first-page":"275-83","DOI":"10.1016\/j.clinph.2004.08.013","article-title":"What symptoms are truly caused by median nerve compression in carpal tunnel syndrome?","volume":"116","author":"D Nora","year":"2005","journal-title":"Clin Neurophysiol."},{"key":"ref-6","doi-asserted-by":"publisher","first-page":"264-70","DOI":"10.1016\/j.pain.2006.01.034","article-title":"Extra-median spread of sensory symptoms in carpal tunnel syndrome suggests the presence of pain-related mechanisms.","volume":"122","author":"G Zanette","year":"2006","journal-title":"Pain."},{"key":"ref-7","doi-asserted-by":"publisher","first-page":"91-7","DOI":"10.1111\/j.1529-8027.2007.00127.x","article-title":"Proximal pain in patients with carpal tunnel syndrome: A clinical-neurophysiological study.","volume":"12","author":"G Zanette","year":"2007","journal-title":"J Peripher Nerv 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Kinesiol."},{"key":"ref-11","doi-asserted-by":"publisher","first-page":"186-93","DOI":"10.1179\/106698111X13129729551903","article-title":"Basic aspects of musculoskeletal pain: From acute to chronic pain.","volume":"19","author":"L Arendt-Nielsen","year":"2013","journal-title":"J Man Manip Ther."},{"key":"ref-12","doi-asserted-by":"publisher","first-page":"S2-15","DOI":"10.1016\/j.pain.2010.09.030","article-title":"Central sensitization: Implications for the diagnosis and treatment of pain.","volume":"152","author":"C Woolf","year":"2011","journal-title":"Pain."},{"key":"ref-13","doi-asserted-by":"publisher","first-page":"19-27","DOI":"10.1097\/j.pain.0000000000001384","article-title":"Chronic Pain as a Symptom or a Disease: The IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11).","volume":"160","author":"R Treede","year":"2019","journal-title":"Pain."},{"key":"ref-14","doi-asserted-by":"publisher","first-page":"175-94","DOI":"10.1016\/0304-3959(92)90259-e","article-title":"Painful neuropathy: Altered central processing maintained dynamically by peripheral input.","volume":"51","author":"R Gracely","year":"1992","journal-title":"Pain."},{"key":"ref-15","doi-asserted-by":"publisher","first-page":"105-9","DOI":"10.1016\/j.pain.2009.05.023","article-title":"Differential involvement of A-delta and A-beta fibres in neuropathic pain related to carpal tunnel syndrome.","volume":"145","author":"A Truini","year":"2009","journal-title":"Pain."},{"key":"ref-16","doi-asserted-by":"publisher","first-page":"58-62","DOI":"10.2519\/jospt.2018.0603","article-title":"Entrapment Neuropathies: Challenging Common Beliefs With Novel Evidence.","volume":"48","author":"A Schmid","year":"2018","journal-title":"J Orthop Sports Phys 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Zanette","year":"2010","journal-title":"Pain."},{"key":"ref-20","doi-asserted-by":"publisher","first-page":"747-54","DOI":"10.1097\/AJP.0b013e31821c29d3","article-title":"Increased Pain Sensitivity Is Not Associated With Electrodiagnostic Findings in Women With Carpal Tunnel Syndrome.","volume":"27","author":"A de La Llave-Rinc\u00f3n","year":"201","journal-title":"Clin J Pain."},{"key":"ref-21","doi-asserted-by":"publisher","first-page":"1899-906","DOI":"10.1080\/03007995.2018.1451313","article-title":"Sensory profiles are comparable in patients with distal and proximal entrapment neuropathies, while the pain experience differs.","volume":"34","author":"B Tampin","year":"2018","journal-title":"Curr Med Res Opin."},{"key":"ref-22","doi-asserted-by":"publisher","first-page":"217-28","DOI":"10.1016\/j.ejpain.2011.06.003","article-title":"Can widespread hypersensitivity in carpal tunnel syndrome be substantiated if neck and arm pain are absent?","volume":"16","author":"A 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Napadow","year":"2006","journal-title":"Neuroimage."},{"key":"ref-26","doi-asserted-by":"publisher","first-page":"3062-73","DOI":"10.1093\/brain\/aws233","article-title":"Spatio-temporal mapping cortical neuroplasticity in carpal tunnel syndrome.","volume":"135","author":"R Dhond","year":"2012","journal-title":"Brain."},{"key":"ref-27","doi-asserted-by":"publisher","first-page":"e0183252","DOI":"10.1371\/journal.pone.0183252","article-title":"Facilitatory and inhibitory pain mechanisms are altered in patients with carpal tunnel syndrome.","volume":"12","author":"B Soon","year":"2017","journal-title":"PLoS ONE."},{"key":"ref-28","doi-asserted-by":"publisher","first-page":"66-72","DOI":"10.1080\/16501960310010179","article-title":"Cortical reorganisation and chronic pain: Implications for rehabilitation.","volume":"35","author":"H Flor","year":"2003","journal-title":"J Rehabil Med."},{"key":"ref-29","doi-asserted-by":"publisher","first-page":"29-37","DOI":"10.1007\/s00221-008-1666-4","article-title":"Bilateral deficits in fine motor control and pinch grip force in patients with unilateral carpal tunnel syndrome.","volume":"194","author":"C Fern\u00e1ndez-de-las-Pe\u00f1as","year":"2009","journal-title":"Exp Brain Res."},{"key":"ref-30","doi-asserted-by":"publisher","first-page":"443-51","DOI":"10.1097\/PHM.0b013e31821a7170","article-title":"Bilateral deficits in fine motor control and pinch grip force are not associated with electrodiagnostic findings in women with carpal tunnel syndrome.","volume":"90","author":"A de La Llave-Rinc\u00f3n","year":"2011","journal-title":"Am J Phys Med Rehabil."},{"key":"ref-31","article-title":"Management of Carpal Tunnel Syndrome Evidence-Based Clinical Practice Guideline"},{"key":"ref-32","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1186\/s12891-020-03306-1","article-title":"Open versus endoscopic carpal tunnel release: A systematic review and meta-analysis of randomized controlled trials.","volume":"21","author":"Y Li","year":"2020","journal-title":"BMC Musculoskelet Disord."},{"key":"ref-33","doi-asserted-by":"publisher","first-page":"1530-9","DOI":"10.1016\/j.jhsa.2013.04.024","article-title":"Revision carpal tunnel surgery: A 10-year review of intraoperative findings and outcomes.","volume":"38","author":"L Zieske","year":"2013","journal-title":"J Hand Surg Am."},{"key":"ref-34","doi-asserted-by":"publisher","first-page":"242-6","DOI":"10.1007\/s11552-012-9429-x","article-title":"Long-term outcomes of carpal tunnel release: A critical review of the literature.","volume":"7","author":"D Louie","year":"2012","journal-title":"Hand (N Y)."},{"key":"ref-35","doi-asserted-by":"publisher","first-page":"2253-63","DOI":"10.1016\/j.apmr.2014.06.022","article-title":"Carpal tunnel syndrome: Hand surgeons, hand therapists, and physical medicine and rehabilitation physicians agree on a 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Approaches in Patients with Carpal Tunnel Syndrome.","volume":"12","author":"A Zaralieva","year":"2020","journal-title":"Cureus."},{"key":"ref-39","doi-asserted-by":"publisher","first-page":"24-35","DOI":"10.1016\/j.physio.2019.06.005","article-title":"Low-level laser therapy for carpal tunnel syndrome: Systematic review and network meta-analysis.","volume":"106","author":"W Cheung","year":"2020","journal-title":"Physiotherapy."},{"key":"ref-40","doi-asserted-by":"publisher","first-page":"CD009601","DOI":"10.1002\/14651858.CD009601.pub2","article-title":"Therapeutic ultrasound for carpal tunnel syndrome.","volume":"2013","author":"M Page","year":"2013","journal-title":"Cochrane Database Syst Rev."},{"key":"ref-41","doi-asserted-by":"publisher","first-page":"CD010003","DOI":"10.1002\/14651858.CD010003","article-title":"Splinting for carpal tunnel syndrome.","author":"M Page","year":"2012","journal-title":"Cochrane Database Syst 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Boudier-Rev\u00e9ret","year":"2017","journal-title":"Musculoskeletal Sci Pract."},{"key":"ref-45","doi-asserted-by":"publisher","first-page":"1609-1622.e10","DOI":"10.1016\/j.apmr.2018.03.003","article-title":"Effectiveness of Oral Pain Medication and Corticosteroid Injections for Carpal Tunnel Syndrome: A Systematic Review.","volume":"99","author":"B Huisstede","year":"2018","journal-title":"Arch Phys Med Rehabil."},{"key":"ref-46","doi-asserted-by":"publisher","first-page":"1087-94","DOI":"10.1016\/j.jpain.2015.07.012","article-title":"Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome: A Randomized Parallel-Group Trial.","volume":"16","author":"C Fern\u00e1ndez-de-las Pe\u00f1as","year":"2015","journal-title":"J Pain."},{"key":"ref-47","doi-asserted-by":"publisher","first-page":"55-63","DOI":"10.2519\/jospt.2019.8483","article-title":"Cost-Effectiveness Evaluation of Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome: Evidence From a Randomized Clinical Trial.","volume":"49","author":"C Fern\u00e1ndez-de-las-Pe\u00f1as","year":"2019","journal-title":"J Orthop Sports Phys Ther."},{"key":"ref-48","doi-asserted-by":"publisher","first-page":"249-66","DOI":"10.1111\/papr.12484","article-title":"Nervous System Sensitization as a Predictor of Outcome in the Treatment of Peripheral Musculoskeletal Conditions: A Systematic Review.","volume":"17","author":"H O'Leary","year":"2017","journal-title":"Pain Pract."},{"key":"ref-49","doi-asserted-by":"publisher","first-page":"644-55","DOI":"10.1111\/papr.12788","article-title":"Influence of Clinical, Psychological, and Psychophysical Variables on Long-term Treatment Outcomes in Carpal Tunnel Syndrome: Evidence From a Randomized Clinical Trial.","volume":"19","author":"C Fern\u00e1ndez-de-las-Pe\u00f1as","year":"2019","journal-title":"Pain 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