Predictors of Pain Intensity and Disability After Minor Hand Surgery

doi:10.1016/j.jhsa.2010.02.001

The Journal of Hand Surgery

Volume 35, Issue 6, June 2010, Pages 956-960

https://doi.org/10.1016/j.jhsa.2010.02.001 Get rights and content

Purpose

To test the null hypothesis that there is no relationship between coping mechanisms and depression measured before surgery, and pain intensity and disability after surgery, as assessed at the time of suture removal.

Methods

A total of 120 patients (39 electing surgery for carpal tunnel syndrome, 65 for trigger finger, and 16 for a benign tumor) completed questionnaires measuring depression, pain self-efficacy (confidence that one can perform various activities despite pain), pain anxiety (fear and anxiety in response to pain sensations), and pain catastrophizing (maladaptive cognitive activities such as pain-related rumination, magnification, and helplessness) before surgery. Before the surgery and at the time of suture removal (10 to 14 days after surgery) participants completed the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) and a numerical pain intensity rating scale.

Results

At the time of suture removal, there was a significant correlation between pain intensity and depression (r = 0.45, p<.001), pain catastrophizing (r = 0.41, p<.001), pain anxiety (r = 0.32, p<.01), and self-efficacy (r = −0.29, p<.01). Disability correlated with self-efficacy (r = −0.34; p<.001) and depression (r = 0.49; p<.001), but not with pain anxiety and catastrophizing (p>.05). In multivariate analyses, depression was the sole predictor of both disability and pain intensity and accounted for 26% of the variance in DASH scores and 25% of the variance in pain intensity, after removing the influence of preoperative DASH and diagnosis, which accounted for 14% variance.

Conclusions

Psychosocial factors, especially depression, explain a notable proportion of the variation in pain intensity and disability after minor hand surgery.

Type of study/level of evidence

Prognostic I.

Section snippets

Materials and Methods

All adult, English-speaking patients who requested surgery for electrodiagnostically confirmed idiopathic median nerve dysfunction at the carpal tunnel, TF, or a benign hand tumor were invited to enroll under a protocol approved by our Human Research Committee. Patients requesting revision of prior surgery for the identical problem were excluded. The study was described in detail and the 3 treating surgeons and study staff obtained informed consent. No eligible patient declined enrollment. We

Preoperative assessment

There were no significant differences in pain catastrophizing (mean, 20.5; SD, 8.3), pain anxiety (mean, 17.9; SD, 19.3), pain self-efficacy (mean, 48.9; SD, 13.4), depressive symptoms (mean, 2.9; SD, 3.2), or pain (mean, 4.3; SD, 2.8) among categorical demographics variables, or the 3 diagnostic groups (p<.05). However, there was a significant difference in presurgery disability (mean, 50.4; SD, 18.3) among patients in the 3 groups (p=.003). Post hoc analyses using the Bonferroni correction

Discussion

Our findings are consistent with prior work and show that depressive symptoms are a key variable in reports of disability and pain intensity after surgery.6, 24, 25, 26 This suggests the possibility that some of the disproportionate pain and disability after otherwise uncomplicated and objectively successful surgery may be a function of untreated depressive symptoms. Future studies should replicate this finding by carefully assessing and controlling for other factors related to unsuccessful

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History of mood and anxiety disorders affects return to work and return to sports after rotator cuff repair
2024, Revue de Chirurgie Orthopedique et Traumatologique
Après réparation de la coiffe des rotateurs (RCR), la reprise du travail et du sport est influencée par différents facteurs psychosociaux, parmi lesquels le rôle des antécédents anxiodépressifs (AAD) est débattu. L’objectif principal de cette étude était d’étudier l’influence des AAD sur la reprise du travail et du sport après RCR. L’hypothèse de travail était que les délais de reprise du travail et du sport seraient allongés et les taux de reprises diminués en cas d’AAD.
Il s’agit d’une étude rétrospective monocentrique incluant des patients opérés d’une RCR arthroscopique (rupture distale du supraspinatus). Les patients ayant une activité professionnelle et ceux qui pratiquaient un sport en préopératoire ont été inclus respectivement dans un groupe « travail » et un groupe « sport ». Les critères d’évaluations principaux étaient les délais postopératoires de reprise du travail et du sport. Les critères d’évaluation secondaires étaient : les taux de reprise du travail et du sport à 3, 6, et 12 mois, le taux de retour au même niveau sportif, le changement ou l’arrêt du travail ou du sport. L’analyse de l’effet des antécédents anxiodépressifs sur ces différents critères d’évaluation a été réalisée avec des méthodes de statistiques bayésiennes, en analyses multivariées.
Le groupe « travail » comptait 158 patients (dont 16,5 % de patients avec des AAD) et le groupe « sport », 118 (dont 17,8 % de patients avec des AAD). En présence d’AAD, la reprise du travail se faisait en moyenne 21 ± 11 semaines et la reprise du sport 17 ± 8,2 semaines plus tard qu’en l’absence d’AAD. On retrouvait une probabilité de 98 % que la reprise du travail et du sport soit retardée d’au moins 4 semaines chez les patients avec AAD. Le risque que les patients avec des AAD arrêtent complètement le sport était 2,8 fois plus important (OR = 2,8 [1 ; 7,8]).
Nous retrouvons une influence négative des AAD sur les modalités de reprise du travail et du sport.
III ; étude rétrospective cas-témoins.
After rotator cuff repair (RCR), return to work and return to sports is affected by various psychosocial factors. The role of one of these factors — mood and anxiety disorders (MAD) — is still not clear. The primary objective of this study was to determine the influence of prior MAD on the return to work and return to sports after RCR. Our hypothesis was that patients with a history of MAD would take longer to return to work and to sports after RCR, and the rate of return would be lower, than for patients without MAD.
This was a retrospective single-center study of patients who underwent arthroscopic RCR (distal supraspinatus tear). Patients who were employed and those who participated in sports before the surgery were included in the “working” and “sports” groups, respectively. The primary outcomes were the time to return to work and return to sports after surgery. The secondary outcomes were the ratio of patients returning to work and to sports at 3, 6, and 12 months; rate of return to same level of sports; need to change or stop working or sports. The effects of prior MAD on these various outcomes were determined using Bayesian multivariate analysis.
The “working” group consisted of 158 patients (of which 16.5% had MAD) and the “sports” group consisted of 118 patients (of which 17.8% had MAD). In those with a history of MAD, return to work was 21 ± 11 weeks later and the return to sports was 17 ± 8 weeks later than in those without MAD. There was a 98% probability that return to work or return to sports was delayed by at least 4 weeks in patients with history of MAD. The likelihood that patients with prior MAD who undergo RCR will completely abandon their sport was 2.8 times higher (OR = 2.8 [1; 7.8]).
We found a negative influence of prior MAD on the return to work and return to sports after RCR.
III; retrospective case-control study.
History of mood and anxiety disorders affects return to work and return to sports after rotator cuff repair
2024, Orthopaedics and Traumatology: Surgery and Research
After rotator cuff repair (RCR), return to work and return to sports is affected by various psychosocial factors. The role of one of these factors – mood and anxiety disorders (MAD) – is still not clear. The primary objective of this study was to determine the influence of prior MAD on the return to work and return to sports after RCR. Our hypothesis was that patients with a history of MAD would take longer to return to work and to sports after RCR, and the rate of return would be lower, than for patients without MAD.
This was a retrospective single-center study of patients who underwent arthroscopic RCR (distal supraspinatus tear). Patients who were employed and those who participated in sports before the surgery were included in the “working” and “sports” groups, respectively. The primary outcomes were the time to return to work and return to sports after surgery. The secondary outcomes were the ratio of patients returning to work and to sports at 3, 6 and 12 months; rate of return to same level of sports; need to change or stop working or sports. The effects of prior MAD on these various outcomes were determined using Bayesian multivariate analysis.
The “working” group consisted of 158 patients (of which 16.5% had MAD) and the “sports” group consisted of 118 patients (of which 17.8% had MAD). In those with a history of MAD, return to work was 21 ± 11 weeks later and the return to sports was 17 ± 8 weeks later than in those without MAD. There was a 98% probability that return to work or return to sports was delayed by at least 4 weeks in patients with history of MAD. The likelihood that patients with prior MAD who undergo RCR will completely abandon their sport was 2.8 times higher (OR = 2.8 [1; 7.8]).
We found a negative influence of prior MAD on the return to work and return to sports after RCR.
III; retrospective case-control study.
The Influence of Mental Health Diagnoses on Patient Experiences and Outcomes in Patients Undergoing WALANT Hand Surgery
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The purpose of this study was to gauge whether patients with preexisting mental health conditions have desirable outcomes when undergoing wide-awake local anesthesia with no tourniquet (WALANT) hand surgery.
A retrospective review of 133 patients who underwent WALANT surgery by 2 senior authors from August 2019 to October 2020 was performed. Patients were administered a 10-question postoperative survey detailing perioperative pain, experience, and satisfaction concerning their procedure. Analysis was performed for patient responses to the questionnaire, demographics, comorbidities, and patient-reported outcomes using the Single Assessment Numeric Evaluation (SANE).
There were 61 patients identified as having a preexisting psychiatric diagnosis compared to 70 patients without who underwent WALANT surgery. Comparing psychiatric diagnosis and nonpsychiatric diagnosis cohorts, there was no significant difference in preoperative anxiety (3.75 vs 3.30), pain during procedure (0.67 vs 0.56), or pain after surgery (4.89 vs 4.26). There was a significantly higher pain score with preoperative injection in the psychiatric diagnosis cohort (4.07 vs 2.93). When asked if they would have a WALANT procedure again, 95.1% of patients in the psychiatric diagnosis cohort and 98.6% of patients in the nonpsychiatric diagnosis group said they would. There was no significant difference in average preoperative SANE scores (59.67 [no psych diagnosis] vs 61.70 [psych diagnosis]) or postoperative SANE scores (82.82 [no psych diagnosis] vs 81.06 [psych diagnosis]) between the two cohorts.
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Shoulder arthroplasty outcomes in patients with major depressive disorder or generalized anxiety disorder
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Anxiety and depression are among the most common mental health disorders in the United States and have been linked to increased health-care utilization and poorer clinical outcomes. However, data on the relationship between anxiety and depression and outcomes after shoulder arthroplasty (SA) are both limited and conflicting.
This retrospective cohort study examined the influence of a preoperative diagnosis of anxiety and/or major depressive disorder (MDD) on outcomes following shoulder arthroplasty, such as range of motion, pain, perioperative and postoperative complications, and readmission rates. A retrospective chart review of our health system’s electronic medical record was performed for dates of service January 2014–December 2019. Patients who underwent primary total shoulder arthroplasty or reverse total shoulder arthroplasty were considered for inclusion. These patients were then divided into two groups based on the presence or absence of an anxiety disorder and/or MDD in their past medical history.
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A pre-existing mood and anxiety disorder (MAD) is often present in patients with rotator cuff pathology, but its presumed negative effect on the outcomes has not been demonstrated.
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The study population consisted of 219 patients (mean age 54.5 ± 6.6 years) who underwent arthroscopic repair for a distal supraspinatus tendon tear, with 17% (38/219) presenting an history of MAD (depression, unspecified mood disorder, anxiety, and bipolar disorder). Using univariate and multivariate analyses, the joint range of motion, Constant score, analgesic consumption, occurrence of complications during the first postoperative year and tendon healing at 1 year (MRI or CT arthrography) were compared between the two groups (with or without MAD).
The Constant score was lower preoperatively in patients with history of MAD (−4 points, p = .04) but there were no significant differences between the two groups at the various postoperative follow-up time points (p > .05). No significant difference was found between the two groups of patients in their analgesic consumption at the various postoperative time points (p > .05), tendon healing at 1 year (p = .17) or the occurrence of postoperative complications (p = .59).
Pre-existing MAD had no effect on the clinical outcomes after arthroscopic RCR at 1 year and no effect on tendon healing, analgesic consumption or the occurrence of complications in our study population.
III; retrospective case-control study.
History of mood and anxiety disorders does not affect the outcomes of arthroscopic rotator cuff repair
2023, Revue de Chirurgie Orthopedique et Traumatologique
La présence d’antécédents anxiodépressifs (AAD) est fréquente avec les pathologies de la coiffe des rotateurs, mais leur influence négative suspectée sur les résultats n’est que peu documentée.
L’objectif principal de cette étude était d’évaluer l’influence des AAD sur les résultats cliniques à 1 an après réparation arthroscopique de la coiffe des rotateurs (RCR). Les objectifs secondaires étaient d’évaluer l’influence de ces antécédents sur la cicatrisation tendineuse, la consommation d’antalgiques et la survenue de complications.
Deux cent dix-neuf patients, d’âge moyen 54,5 ± 6,6 ans, opérés d’une réparation arthroscopique d’une rupture distale du supraspinatus, ont été inclus, dont 17,4 % (38/219) présentaient des AAD (dépression, trouble de l’humeur non spécifique, anxiété et trouble bipolaire) et 82,6 % (181/219) n’en présentaient pas. Les 2 groupes constitués en fonction de la présence ou non d’AAD ont été comparés (analyses uni et multivariées) pour les critères suivants : amplitudes articulaires, score de Constant, consommation d’antalgiques, survenue d’une complication – durant la première année postopératoire – et cicatrisation tendineuse (IRM ou arthroscanner) à 1 an.
On retrouvait un score de Constant moins élevé en préopératoire chez les patients avec AAD (–4 points, p = 0,04) mais aucune différence significative n’a été retrouvée entre les deux groupes aux différentes consultations postopératoires (p > 0,05). Aucune différence significative n’a été mise en évidence entre les deux groupes de patients concernant la consommation d’antalgiques aux différentes consultations postopératoires (p > 0,05), la cicatrisation tendineuse à 1 an (p = 0,17) ou la survenue d’une complication postopératoire (p = 0,59).
La présence d’AAD n’avait pas d’influence sur les résultats cliniques postopératoires après RCR à 1 an et aucune influence sur la cicatrisation tendineuse, la consommation d’antalgiques ou la survenue d’une complication dans notre série.
III ; étude rétrospective cas-témoins.

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: D.R. received unrestricted research grants from Acumed and Tornier. D.R. received royalties from Hand Innovations and is a consultant for Wright Medical, Acumed, and Tornier.

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Scientific articlePredictors of Pain Intensity and Disability After Minor Hand Surgery

Purpose

Methods

Results

Conclusions

Type of study/level of evidence

Section snippets

Materials and Methods

Preoperative assessment

Discussion

Pain

Spine J

Pain

Pain

J Pain

Lancet

Behav Res Ther

Long-term results of percutaneous and open surgery for trigger fingers and thumbs

Int Surg

Predictors of return to work following carpal tunnel release

Am J Ind Med

Determinants of work absence following carpal tunnel syndrome

Am J Ind Med

Health-related quality of life following operative treatment of unstable ankle fractures: a prospective observational study

J Orthop Trauma

Predictors of surgical outcome and their assessment

Eur Spine J

Psychosocial factors and surgical outcomes: an evidence-based literature review

J Am Acad Orthop Surg

Emotional health predicts pain and functioning after fusion: a prospective multicenter study

Spine

Assessment of pain beliefs and pain coping

Cognitive distortions and psychological distress in chronic low back pain

J Consult Clin Psychol

A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain

Spine

Does coping mediate disability in chronic low back patients presenting for physiotherapy?

J Bone Joint Surg

Scientific article
Predictors of Pain Intensity and Disability After Minor Hand Surgery