Open AccessActivation in the Hypothalamic–Pituitary–Adrenocortical Axis and Sympathetic Nervous System in Women with Carpal Tunnel Syndrome
Author(s) -
Fernándezde-lasPeñas César,
DíazRodríguez Lourdes,
SalomMoreno Jaime,
GalianoCastillo Noelia,
ValverdeHerreros Lis,
MartínezMartín Javier,
Pareja Juan A.
Publication year - 2014
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/pme.12453
Subject(s) - medicine , saliva , endocrinology , amylase , immune system , sympathetic nervous system , carpal tunnel syndrome , hypothalamic–pituitary–adrenal axis , hormone , immunology , surgery , blood pressure , biology , biochemistry , enzyme
Objective The aim of this study is to investigate the differences in salivary cortisol (hypothalamic–pituitary–adrenocortical [ HPA ] axis), α‐amylase activity (sympathetic nervous system [ SNS ]), and immunoglobulin A ( IgA ; immune system) concentrations between women with carpal tunnel syndrome ( CTS ) and healthy women. Design A cross‐sectional study. Setting Activation of HPA , SNS , and immune system in CTS has not been clearly determined. Patients One hundred two women (age: 45 ± 7 years) with electrodiagnostic and clinical diagnosis of CTS and 102 matched healthy women. Outcome Measures The intensity of the pain was assessed with a Numerical Pain Rating Scale (0–10), and disability was determined with B oston C arpal T unnel Q uestionnaire. Salivary cortisol concentration, α‐amylase activity, salivary flow rate, and IgA concentration were collected from nonstimulated saliva. Results Women with CTS exhibited lower salivary flow rate ( P < 0.001) and higher α‐amylase activity ( P < 0.01) than controls. No significant differences for cortisol and IgA concentrations ( P > 0.2) were found between groups as a total. Women with severe CTS exhibited lower salivary flow rate ( P < 0.001), higher α‐amylase activity ( P = 0.002), and higher cortisol concentration ( P = 0.03) than healthy women and than those with minimal/moderate CTS ( P < 0.05). Within women with CTS , significant positive associations between α‐amylase activity and the intensity of pain were found: the highest the level of pain, the higher the α‐amylase activity, i.e., higher SNS activation. Conclusions These results suggest that women with severe CTS exhibit changes in activation in the HPA axis and SNS but not in the humoral immune system. Activation of the SNS was associated with the intensity of pain. Future studies are needed to elucidate the direction of this relationship.