More pain catastrophizing before carpal tunnel release led to lower patient satisfaction
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Patients with higher pain catastrophizing scores prior to carpal tunnel release experienced lower satisfaction at 12 months postoperatively, according to published results.
Researchers collected DASH scores, EuroQol-5D scores, pain catastrophizing scale scores and distal motor latency preoperatively and at 12 months postoperatively among 417 patients with carpal tunnel syndrome treated with either open or endoscopic carpal tunnel release. Researchers used Wilcoxon matched-pairs signed-rank test to test for differences in preoperative and postoperative DASH and EQ-5D scores, and examined risk factors for low postoperative patient-reported satisfaction with stepwise multiple logistic regression analysis.
Preoperatively to 12 months postoperatively, results showed a general improvement in DASH and EQ-5D scores among patients. Patients with higher preoperative pain catastrophizing scale scores, lower EQ-5D and higher DASH scores reported low satisfaction at 12 months postoperatively, according to results. Researchers found a statistically significant effect of preoperative pain catastrophizing scale scores on patient-reported satisfaction in the fully adjusted multiple regression analysis. However, researchers noted no statistically significant predictive effect of preoperative EQ-5D, DASH, distal motor latency, age or gender.
“Higher preoperative [pain catastrophizing scale] PCS seems to have a negative effect on postoperative patient-reported satisfaction after [carpal tunnel release],” the authors wrote. “Further studies on patient satisfaction should include additional information on patient smoking habits, alcohol consumption, BMI, diabetes and income to strengthen the explanatory power.”
Perspective
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David M. Kalainov, MD, MBA
Psychological factors of depression have been found by some authors to correlate with patient satisfaction after carpal tunnel release surgery. I commend Sebastian Breddam Mosegaard, MD, and colleagues on pursuing pain catastrophizing as another possible influence on patient satisfaction after this common procedure. The term “pain catastrophizing” refers to human expressions of rumination, magnification and helplessness in reference to pain.
A measurement tool, the so-called pain catastrophizing scale, was devised more 25 years ago. There are 13 questions in this survey with a maximum of four points allotted to each question for a total score of 0 to 52. A clinically relevant level of pain catastrophizing has been defined for a score of 30 points or greater.
Mosegaard and colleagues found a very small correlation between higher preoperative pain catastrophizing scale scores and lower patient satisfaction 1 year after carpal tunnel release surgery. However, as the authors implied, their findings should be interpreted carefully. The correlation was only significant for pain catastrophizing scale scores less than 30. Furthermore, other factors that can influence outcomes after carpal tunnel release surgery, such as diabetes, were not included in the analysis.
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