• Bernard X W Liew, Ana I de-la-Llave-Rincón, José L Arias-Buría, Ricardo Ortega-Santiago, and César Fernández-de-Las-Peñas.
• School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK.
• Pain Med. 2021 Nov 26; 22 (11): 2708-2717.

ObjectiveCurrent evidence suggests that carpal tunnel syndrome (CTS) involves widespread pressure pain sensitivity as a manifestion of central sensitization. This study aimed to quantify mechanisms driving widespread pressure pain hyperalgesia in CTS by using network analysis.DesignCross-sectional.SettingUrban hospital.SubjectsWomen with CTS (n=120) who participated in a previous randomized clinical trial.MethodsPain intensity, related function, symptom severity, depressive levels, and pressure pain threshold (PPTs) over the median, radial, and ulnar nerves, as well as the cervical spine, the carpal tunnel, and the tibialis anterior, were collected. Network analysis was used to quantify the adjusted correlations between the modeled variables and to determine the centrality indices of each variable (i.e., the degree of connection with other symptoms in the network).ResultsThe estimated network showed several local associations between clinical variables and the psychophysical outcomes separately. The edges with the strongest weights were those between the PPT over the median nerve and the PPT over the radial nerve (P=0.34), between function and depressive levels (P=0.30), and between the PPT over the carpal tunnel and the PPT over the tibialis anterior (P=0.29 ). The most central variables were PPT over the tibialis anterior (the highest Strength centrality) and PPT over the carpal tunnel (the highest Closeness and Betweenness centrality).ConclusionsThis is the first study to apply network analysis to understand the multivariate mechanisms of individuals with CTS. Our findings support a model in which clinical symptoms, depression, and widespread pressure pain sensitivity are connected, albeit within separate clusters. The clinical implications of the present findings, such as the development of treatments targeting these mechanisms, are also discussed.© The Author(s) 2021. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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