Exactly where carpal tunnel pain hurts the most varies from person to person. That's because everybody experiences symptoms of carpal tunnel syndrome a little differently. 

In general, pain is usually the major symptom, followed by numbness and tingling (pins & needles). The pain can be on any finger except the little (pinky) finger. It can also include the entire palm of the hand and even the wrist. Sometimes pain shoots from the fingers, through the hand and up the arm.

Carpal tunnel syndrome (sometimes just called "carpal tunnel") is a progressive and painful neurological condition. And it's very common, affecting at least five million Americans. 

The condition occurs as a result of straining or stressing your hand and fingers. When you perform repetitive, rapid and forceful hand movements for a long time (called repetitive stress), wrist flexor tendons tend to react badly. (The flexor tendons are the structures responsible for curling your fingers.) 

Over time and a lot of stress, the tendons become inflamed and start to show signs of swelling. That’s when problems really go downhill.

The tendons swell inside the wrist joint in a tight space called the “carpal tunnel”. It's a narrow, crowded passageway through which your hand's tendons and the median nerve pass.

Unfortunately, the swelling pushes on the median nerve which is nearby. With enough time, the swelling slowly crushes the nerve. The crushed nerve is what produces all of the sensations of carpal tunnel syndrome - especially pain. You feel the pain in the fingers, hand or wrist. Along with pain, other carpal tunnel symptoms include:

• numbness
• tingling
• pins-and-needles
• burning
• weakness
• feelings of finger puffiness
• itching
• electric shock sensations

Usually, the place where carpal tunnel pain hurts the most is the palm of the hand, the thumb, and first (pointer) finger. It's common for the fingertips or the thumb's base to hurt more (see diagram below).

Carpal tunnel pain can be constant or intermittent. The pain is unusual in that it hurts even when you're not using your hand. In fact, most often the pain is worse when you're resting or even trying to sleep. This distinguishes carpal tunnel syndrome from wrist tendonitis pain.

People with moderate to severe carpal tunnel tend to wake up in the middle of the night. The severe pain makes them want to rub the pain out. With numbness, they feel the need to shake out their numb hand.

As describe above, the place where carpal tunnel pain hurts the most is easy to define. But describing the actual type of pain patients feel is more difficult.

The types of pain reported have a wide range. They can be anywhere from annoying or bothersome to crushing or punishing. The specific qualities of pain sensations usually described are:

• burning 
• throbbing
• pounding
• sharp
• dull
• deep
• grinding
• aching
• shooting

Note that you can have only one or all of these pain sensations at the same time. Usually having more than one type of pain sensation is relative to the stage of carpal tunnel syndrome. More advanced stages produce additional types of pain sensations.

The mild stage is where carpal tunnel pain is either annoying or just bothersome. It may not even wake you at night. Actually, by the time most people realize there's a problem, the condition is already well-developed.

The moderate stage is more advanced. It's where carpal tunnel pain keeps you awake at night and during the day. Usually this pain or numbness ranges from severe to excruciating. Hand weakness and loss of grip strength are obvious.

Without treatment, it's during the severe stage where carpal tunnel pain is described as "crushing, cruel or punishing". And the pain is present almost all the time - non-stop and 24/7. Essentially, there is no rest from the intense pain or numbness.



End stage carpal tunnel syndrome is the terminal phase. Ironically, pain diminishes because the pain fibers in the median nerve have died. Numbness and tingling can persist. But your hand is essentially useless, losing most of its gripping abilities. Most notably, the thenar muscle (at the base of the thumb) degenerates and flattens out because most of it has degenerated.

For most people, it doesn't matter where carpal tunnel pain is as long as they can treat it. But it may surprise you that treating the pain symptoms is only slightly helpful. But treating the cause of the pain (swollen tendons) is far more effective and lasting. In other words:

If you treat only the pain it will come back. But if you treat the cause of the pain it will eliminate symptoms forever. 

Therefore, where carpal tunnel pain is your main symptom, there are 2 approaches to treating it:

• temporary pain treatments which just treat pain for the time being
• permanent pain treatments which treat & eliminate the source of the pain

I highly recommend you use the permanent pain treatments for obvious reasons. I list the temporary ones below because you've probably tried them - with no long-term effects.

Pain pills 

Drugs in the form of "pain pills" (analgesics) are probably the most common way to help patients where carpal tunnel pain is the primary symptom. Specifically, over-the-counter non-steroidal anti-inflammatory drugs or NSAIDs are most popular. These include Advil, Motrin, Tylenol, Aleve, Naproxen and Aspirin. While these drugs do offer some relief from the pain, it's only temporary -- usually lasting a few hours. Moreover, according to the FDA, it's dangerous to take these drugs daily for more than a few weeks due to the elevated risks of liver or kidney damage, heart attack, and stroke.

Topical ointments

The most common topical ointment for carpal tunnel is Biofreeze. Patients say they apply it where carpal tunnel pain is most intense, like the thumb or forefinger. And it undoubtedly can help ease the pain. But like pain medicines, the relief is only temporary because it doesn't address the cause of the pain.

Ice baths

Most patients have told me they use ice baths for their hand pain. Others say ice-followed by warm water (called "contrast baths") works well also. Again, this may relieve pain for a few minutes after you pull your hand out of the bath. Then the temporary relief wears off and you're back at the starting line again.

Yoga

Study after study shows that yoga can improve symptoms of carpal tunnel syndrome. Its effects are likely due to stretching the area where carpal tunnel pain is most concentrated. While yoga is considered a temporary pain reliever, isolated carpal tunnel stretches (see below) are more permanent treatments.

Ultrasound

Therapeutic ultrasound is beneficial for carpal tunnel pain relief. Ultrasound therapy warms the carpal tunnel area. The warmth encourages the healing process and also reduces pain levels. Applying ultrasound over a several week period can reduce painful symptoms. But after the course of therapy ceases, pain usually returns.

Acupuncture

Several good studies have shown that acupuncture can reduce carpal tunnel symptoms significantly. Nobody is certain how acupuncture works as a pain reliever, but the effects are strong - if only temporary. The effects last 1-3 days after the acupuncture treatment. Again, this is a temporary treatment because the acupuncture therapy doesn't address the root cause of the disorder.

The most successful remedy I’ve ever experienced with patients is the “B.R.E.M.” combination. That stands for Brace, Rest, Exercise, Massage. 

These 4 combined treatments actually target the source of carpal tunnel syndrome: tendon swelling. The effects are usually complete and permanent. 

The B.R.E.M. components must be used together and for a period of about 4 weeks to see lasting results.

Bracing at night

Start bracing your hand while you sleep. Even though your thumb or finger is where carpal tunnel hurts the most, the pain actually comes from deep inside your wrist joint. Make sure you have an certified carpal tunnel night brace and not just a generic wrist brace from the drug store. (Those generic braces can do more harm than good.) Also, never wear a wrist brace during the day if you have carpal tunnel syndrome. Doing so makes your hand subconsciously fight the brace in addition to doing its regular work. That makes the problem in your wrist much worse.

Rest

Rest is the best treatment for any injury, especially for a repetitive stress injury. So rest your hands as often as you can when you work. Never maintain a constant grip on a hand tool like a saw or hair brush. Also, never perform continued grip-and-release activities with your hands without resting and stretching them in between.

Exercises

Stretching exercises for your fingers and hands are crucial. Specific carpal tunnel stretching exercises limber up your fingers and therefore your flexor tendons. This is perhaps the best way to avoid ever having hand pain to begin with.

Massage

Massage is by far the most powerful carpal tunnel fighter. Specifically, you must use the myofascial release massage technique for maximum benefit. To do this, a therapist digs their thumbs into your forearm, just below your wrist crease. Then they make circular, counter-rotating motions for a few minutes. This action breaks up adhesions and restrictions that cause tendon inflammation and swelling. It also encourages fluid drainage and promotes blood flow. The downside is you cannot perform myofascial release massage on yourself.

You'll note that I didn't mention carpal tunnel release surgery as a permanent pain treatment. That's because it isn't. Surgery doesn't eliminate the cause of the problem, which is tendon swelling. 

Surgery merely un-swells the area temporarily. And that's why pain relief is temporary. In fact, where carpal tunnel pain was the main symptom, about 50% of post-surgical patients saw pain return by 2 years after their hand operation. 

Why? Because surgery doesn't eliminate the source of the pain.

The place where carpal tunnel pain hurts the most is different for everybody. However, most often patients feel more pain in the thumb and first finger. The pain can range from mild to crushing. It can also remain in one area or shoot up your arm. Treating the pain is only temporary. But treating the cause of the pain will bring lasting relief.