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

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.