Fibromyalgia is a centralized pain disorder associated with inferior postoperative outcomes across multiple surgical disciplines. Its impact on outcomes following carpal tunnel release (CTR) was yet to be studied. This study compared postoperative outcomes after CTR in patients with fibromyalgia and matched controls.

A retrospective matched cohort study was performed including adult patients who underwent open CTR between 2010 and 2024. Patients with fibromyalgia were matched 1:1 with controls without fibromyalgia based on age, sex, hand dominance, preoperative CTS-6 score, preoperative pain intensity, and follow-up duration. Outcomes included postoperative Numeric Pain Rating Scale (NPRS) scores, Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS) and Functional Status Scale (BCTQ-FSS), early postoperative pain, long-term pain (NPRS ≥ 5), pain improvement, and patient satisfaction.

Twenty-seven patients with fibromyalgia were matched to 27 controls. Baseline characteristics did not differ between the groups. Patients with fibromyalgia demonstrated higher postoperative pain (NPRS 3.6 vs 1.8; p = 0.02), worse symptom severity and function (BCTQ-SSS 2.2 vs 1.5; p = 0.004; BCTQ-FSS 2.8 vs 1.8; p = 0.002), and higher rates of both a painful early postoperative period (44.4% vs 7.4%; p = 0.002) and residual long-term pain (48% vs 15%; p = 0.008). Despite this, both groups experienced significant postoperative pain reduction (p < 0.001), with no significant difference in pain improvement rate and magnitude or patient satisfaction. The magnitude of within-group postoperative pain improvement in both cohorts exceeded the minimal clinically important difference.

Fibromyalgia is associated with higher postoperative pain and worse patient-reported outcomes after CTR but does not preclude clinically meaningful improvement. CTR remains effective in patients with fibromyalgia, although surgeons should counsel patients regarding a potentially more painful postoperative course and higher rates of residual symptoms.