Combined Physical and Psychological Intervention in Carpal Tunnel Syndrome Patients With Nociplastic Pain

Inclusion Criteria: * Adults aged 25-65 years with unilateral or bilateral carpal tunnel syndrome confirmed by compatible clinical findings and electrodiagnostic evidence of median neuropathy at the wrist. * CTS-related symptoms present for ≥3 months. * Mild-to-moderate CTS suitable for nonsurgical management. * Coexisting mixed neuropathic-nociplastic pain features according to a CTS-adapted IASP-aligned clinical algorithm. Exclusion Criteria: * Previous carpal tunnel release surgery on the study side. * Severe CTS with marked thenar weakness/atrophy, severe axonal loss, or other findings requiring prompt surgical evaluation. * Cervical radiculopathy or cervical myelopathy judged to better explain the upper-extremity symptoms. * Proximal median neuropathy or other clinically important peripheral entrapment neuropathy. * Generalized polyneuropathy. * Major shoulder, elbow, wrist, or hand disorder considered the dominant cause of symptoms or disability. * Recent corticosteroid injection or other invasive CTS treatment within a prespecified washout period. * Concurrent structured CTS rehabilitation outside the study protocol. * Previous participation in a structured psychological pain-management program during the recent prespecified period. * Medical, cognitive, or communication limitations preventing safe participation or valid completion of study procedures.