Pilot Study: Evaluating Pillar Pain Outcomes Following Carpal Tunnel Release Surgery With Fractional CO2 Laser Therapy.

Abstract

Background: Carpal tunnel syndrome is the most common peripheral entrapment neuropathy of the upper limb, and pillar pain is a frequent, often debilitating complication following carpal tunnel release (CTR). Traditional treatment modalities, including corticosteroid injections, deep tissue massage, and medications, may fail to adequately relieve symptoms. Fractional carbon dioxide (CO₂) laser therapy has shown promise in scar management and analgesia, but its use for pillar pain remains understudied. This pilot study evaluated the efficacy of fractional CO₂ laser therapy in reducing pillar pain after CTR.

Methods: A retrospective chart review was performed at a tertiary referral center between 2021 and 2024. Patients who developed pillar pain after CTR and subsequently underwent fractional CO₂ laser treatment were included. Demographic, clinical, and treatment data were collected, including comorbidities, incision type, laser treatment parameters, and medication use. Outcomes included visual analog scale pain scores and SCAR-Q survey results assessing scar appearance, symptoms, and psychosocial impact. Pre- and posttreatment pain scores were compared using paired t tests with significance set at P < 0.05.

Results: A total of 30 procedures in 23 patients were identified. The mean prelaser visual analog scale pain score of 5.23 significantly decreased to 1.87 after treatment (mean decrease 3.37, P < 0.00001). SCAR-Q (Appearance, Symptom, and Psychosocial Impact) scores demonstrated positive outcomes in appearance (73.5), symptoms (85.0), and psychosocial impact (85.0). Most patients (91%) reported improvement in pain, and no adverse outcomes were observed. Patients with higher body mass index reported higher residual pain levels, although still improved compared with baseline.

Conclusions: Fractional CO₂ laser therapy significantly reduced pillar pain and improved patient satisfaction following CTR, with no reported complications. This pilot study suggests that fractional CO₂ laser may serve as a safe, effective alternative for refractory pillar pain. Larger, prospective studies are warranted to validate these findings and determine broader applicability.