The association of sensory phenotype and concomitant mood, sleep and functional impairment with the outcome of carpal tunnel surgery

Abstract Background Up to 25% of people who have had carpal tunnel release surgery (CTR) fail to report improvement; however, evidence for prognostic indicators in this surgical cohort is limited. To identify candidate prognostic factors, this study investigated the association of quantitative senso...

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Autores principales:	Donna L. Kennedy, Deborah Ridout, Ladislava Lysakova, Jan Vollert, Caroline M. Alexander, Andrew S. C. Rice
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Anxiety Carpal tunnel surgery Catastrophizing Insomnia Neuropathic pain Phenotype Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/20bdd1913d404c9297a4564526e3d569
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spelling	oai:doaj.org-article:20bdd1913d404c9297a4564526e3d5692021-11-21T12:27:46ZThe association of sensory phenotype and concomitant mood, sleep and functional impairment with the outcome of carpal tunnel surgery10.1186/s12891-021-04832-21471-2474https://doaj.org/article/20bdd1913d404c9297a4564526e3d5692021-11-01T00:00:00Zhttps://doi.org/10.1186/s12891-021-04832-2https://doaj.org/toc/1471-2474Abstract Background Up to 25% of people who have had carpal tunnel release surgery (CTR) fail to report improvement; however, evidence for prognostic indicators in this surgical cohort is limited. To identify candidate prognostic factors, this study investigated the association of quantitative sensory testing (QST) derived sensory phenotype and attendant impairment with patient-reported surgical outcome. Methods With ethical approval and informed consent, this prospective observational longitudinal study recruited patients from two London hospitals. Multimodal phenotyping measures including quantitative sensory testing (QST), pain parameters, insomnia, pain-related worry, mood and function, were evaluated prior to; and at 3- and 6-months post-surgery. Pain in median nerve distribution with electrophysiologically confirmed conduction delay and DN4 score ≥ 4 was defined as neuropathic. Primary outcome was patient-rated change at 6 months, dichotomised as poor outcome; “worse” or “no change” and good outcome; “slightly better”, “much better” or “completely cured”. Results Seventy-six patients participated. Prior to surgery, substantial heterogeneity in established categories of somatosensory function was observed with 21% of participants categorised as having a healthy sensory phenotype; 29% with thermal hyperalgesia; 32% mechanical hyperalgesia and 18% sensory loss. Seventy six percent of participants were classified as having neuropathic pain, 33% with high levels of pain related worry and 64% with clinical insomnia. Observed differences in pain, sleep impairment, psychological factors and function, between sensory phenotypic groups, was not significant. At 3- and 6-months post-surgery there was significant improvement in all phenotyping measures with a moderate to large effect size. Thermal and mechanical measures of somatosensation improved (p < 0.001), as did functional ability (p < 0.001). Symptom severity diminished (p < 0.001), as did pain-related worry (p < 0.001), anxiety (p = 0.02) and insomnia (p < 0.001). Patient-rated surgical outcome was good in 92% of the cohort, poor in 8%. Baseline sensory phenotype category was not associated with surgical outcome however pain-related worry, anxiety and functional interference were significantly associated with outcome (p ≤ 0.05). Conclusion In patients undergoing carpal tunnel surgery, pain-related worry, anxiety and pain functional interference are candidate prognostic outcome factors and require further elucidation.Donna L. KennedyDeborah RidoutLadislava LysakovaJan VollertCaroline M. AlexanderAndrew S. C. RiceBMCarticleAnxietyCarpal tunnel surgeryCatastrophizingInsomniaNeuropathic painPhenotypeDiseases of the musculoskeletal systemRC925-935ENBMC Musculoskeletal Disorders, Vol 22, Iss 1, Pp 1-19 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Anxiety Carpal tunnel surgery Catastrophizing Insomnia Neuropathic pain Phenotype Diseases of the musculoskeletal system RC925-935
spellingShingle	Anxiety Carpal tunnel surgery Catastrophizing Insomnia Neuropathic pain Phenotype Diseases of the musculoskeletal system RC925-935 Donna L. Kennedy Deborah Ridout Ladislava Lysakova Jan Vollert Caroline M. Alexander Andrew S. C. Rice The association of sensory phenotype and concomitant mood, sleep and functional impairment with the outcome of carpal tunnel surgery
description	Abstract Background Up to 25% of people who have had carpal tunnel release surgery (CTR) fail to report improvement; however, evidence for prognostic indicators in this surgical cohort is limited. To identify candidate prognostic factors, this study investigated the association of quantitative sensory testing (QST) derived sensory phenotype and attendant impairment with patient-reported surgical outcome. Methods With ethical approval and informed consent, this prospective observational longitudinal study recruited patients from two London hospitals. Multimodal phenotyping measures including quantitative sensory testing (QST), pain parameters, insomnia, pain-related worry, mood and function, were evaluated prior to; and at 3- and 6-months post-surgery. Pain in median nerve distribution with electrophysiologically confirmed conduction delay and DN4 score ≥ 4 was defined as neuropathic. Primary outcome was patient-rated change at 6 months, dichotomised as poor outcome; “worse” or “no change” and good outcome; “slightly better”, “much better” or “completely cured”. Results Seventy-six patients participated. Prior to surgery, substantial heterogeneity in established categories of somatosensory function was observed with 21% of participants categorised as having a healthy sensory phenotype; 29% with thermal hyperalgesia; 32% mechanical hyperalgesia and 18% sensory loss. Seventy six percent of participants were classified as having neuropathic pain, 33% with high levels of pain related worry and 64% with clinical insomnia. Observed differences in pain, sleep impairment, psychological factors and function, between sensory phenotypic groups, was not significant. At 3- and 6-months post-surgery there was significant improvement in all phenotyping measures with a moderate to large effect size. Thermal and mechanical measures of somatosensation improved (p < 0.001), as did functional ability (p < 0.001). Symptom severity diminished (p < 0.001), as did pain-related worry (p < 0.001), anxiety (p = 0.02) and insomnia (p < 0.001). Patient-rated surgical outcome was good in 92% of the cohort, poor in 8%. Baseline sensory phenotype category was not associated with surgical outcome however pain-related worry, anxiety and functional interference were significantly associated with outcome (p ≤ 0.05). Conclusion In patients undergoing carpal tunnel surgery, pain-related worry, anxiety and pain functional interference are candidate prognostic outcome factors and require further elucidation.
format	article
author	Donna L. Kennedy Deborah Ridout Ladislava Lysakova Jan Vollert Caroline M. Alexander Andrew S. C. Rice
author_facet	Donna L. Kennedy Deborah Ridout Ladislava Lysakova Jan Vollert Caroline M. Alexander Andrew S. C. Rice
author_sort	Donna L. Kennedy
title	The association of sensory phenotype and concomitant mood, sleep and functional impairment with the outcome of carpal tunnel surgery
title_short	The association of sensory phenotype and concomitant mood, sleep and functional impairment with the outcome of carpal tunnel surgery
title_full	The association of sensory phenotype and concomitant mood, sleep and functional impairment with the outcome of carpal tunnel surgery
title_fullStr	The association of sensory phenotype and concomitant mood, sleep and functional impairment with the outcome of carpal tunnel surgery
title_full_unstemmed	The association of sensory phenotype and concomitant mood, sleep and functional impairment with the outcome of carpal tunnel surgery
title_sort	association of sensory phenotype and concomitant mood, sleep and functional impairment with the outcome of carpal tunnel surgery
publisher	BMC
publishDate	2021
url	https://doaj.org/article/20bdd1913d404c9297a4564526e3d569
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The association of sensory phenotype and concomitant mood, sleep and functional impairment with the outcome of carpal tunnel surgery

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