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Years ago, I had a work injury that left me partially paralyzed and in chronic pain. I've used a cane and wheelchair off and on ever since. The pressure on my wrists and hands has resulted in carpal tunnel syndrome on both sides. I have been taking prescription narcotics for all these years. I have a program and schedule of pain meds that works for me. If I have surgery for the carpal tunnel will I end up messing up my current (successful) pain control?

This is a very reasonable question and a concern raised by surgeons as well. The goal of carpal tunnel release surgery is to provide relief from painful (and other) symptoms. If doing the surgery will make things worse overall, then it's time to consider the risks versus the benefits. We have some information from a recent study at The Johns Hopkins University that might help you. They compared the results of surgical treatment between two groups of patients who had a carpal tunnel release. The two groups included one (chronic pain) group who had taken narcotic pain medications for pain in some other part of the body besides the hand/wrist. Chronic pain was defined by pain lasting more than three months. The second (control) group had carpal tunnel syndrome but without chronic pain and without taking pain medications. Everyone was evaluated before and after surgery for pain, hand/wrist function, and satisfaction with treatment. Follow-up occurred at regular intervals after surgery for a full year. Despite the surgeons' concern that chronic pain patients would not recover well after carpal tunnel surgery, there were no differences between the two groups at the end of the study. As this study showed, the benefit of pain relief and return of hand function outweighed the possible risks of further drug addiction. The surgeons did suggest some strategies for pain management among chronic pain patients having carpal tunnel surgery. These may be of interest and help to you in your present decision-making process. First, only the primary care physician (or pain specialist) should be in charge of prescribing and supervising your pain meds. The surgeon will give the necessary pain meds the day of the surgery and the day after surgery. But after that, any further medications must be under the care and coordination of your primary/pain physician. The overall plan should be discussed with all concerned including you, your surgeon, your primary care physician, and the pain specialist if one is involved.

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