Predicting Nociplastic Pain in Carpal Tunnel Syndrome Through Quantitative Sensory Testing

Inclusion Criteria: * Adults ages 18-60 * Clinical diagnosis of CTS based on presence of parasthesias and/or pain in median nerve distribution, positive Phalen's test and/or Tinel's sign, and nocturnal symptoms * Electrodiagnostic evidence of median neuropathy at the wrist: 1. Prolonged median motor distal latency \>4.2 ms 2. Prolonged median sensory latency \>3.4 ms * Symptom duration between 6 months and 2 years (to exclude very early or very late stages) * Pain severity of ≥5 on 0-10 numerical rating scale * No evidence of thenar muscle atrophy on physical exam * No prior surgery or fracture of the affected wrist * No evidence of comorbid diabetes mellitus, cervical radiculopathy, polyneuropathy, or other neuromuscular disorders Exclusion Criteria: * Diabetes mellitus, as a common cause of polyneuropathy, which can confound QST measures. * Cervical radiculopathy or other upper limb neuropathies, which can cause overlapping sensory symptoms and signs. * History of wrist fracture or surgery, which may cause structural abnormalities affecting nerve function. * Pregnancy, due to physiological changes that can affect nerve function. * Patients with severe thenar muscle atrophy, indicating long-standing severe median neuropathy. * Patients unable to provide informed consent or comply with study procedures.