Enrollment in Treatment at a Specialized Pain Management Clinic at a Tertiary Referral Center after Surgery for Ulnar Nerve Compression: Patient Characteristics and Outcome

Abstract

To study patients who enroll in treatment at a specialized pain management clinic at a tertiary referral center following ulnar nerve decompression. Methods: Data from medical charts and postoperative questionnaires were collected for all patients after surgery for ulnar nerve compression at the elbow from 2011 to 2014 (n ¼ 173) at a tertiary referral center. Differences in characteristics between patients who enrolled in treatment at the pain management clinic (study group, n ¼ 26) and the rest of the patients (reference group, n ¼ 147) were analyzed. The study group was further evaluated using questionnaires from the Swedish Quality Registry for Pain Rehabilitation (SQRP) and regarding outcome of pain treatment. Results: The study group was characterized by prior pain conditions, earlier contact with a pain management clinic, and high degrees of kinesiophobia, depression/anxiety, low quality of life, and low life satisfaction. These patients had significantly higher postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) scores, were significantly younger, and had bilateral surgery significantly more often than the reference group. For patients with unilateral surgery, simple decompression was significantly more common in the reference group. The most common treatments at the clinic were antidepressants and anticonvulsants for neurogenic pain. In 5 of 26 patients, pain relief, or pain reduction was the documented reason for discharge. Conclusions: Pain is a relevant outcome measure for ulnar nerve decompression among complicated cases at a referral center. Severe postoperative pain is connected to higher disability, reduced life satisfaction, and overall low health status. This study maps out characteristics of patients who postoperatively enroll in treatment at a specialized pain management clinic following ulnar nerve decompression. Further studies are needed to define predictive factors for such pain.

Anterior transposition and positioning via helix sling method in cubital tunnel syndrome: An open-label, retrospective trial of maximum 5-year follow-up

“…It is appropriate to use anterior transposition technique in the ulnar nerve release to prevent postoperative nerve contraction or entrapment in CuTS with nerve instability [ 12 ]. There is no prominent improvement in decreasing nerve strain after simple release and decompression [ 13 ]. Among the different anterior transposition techniques, sling technique using the medial intermuscular septum was practiced before.…”

Overuse of the psychoactive analgesics’ opioids and gabapentinoid drugs in patients having surgery for nerve entrapment disorders

“…On the other hand, patients with previous overuse could be identified and properly treated for such nerve entrapment disorders. Interestingly, a group of patients, referred to a specialized pain management clinic following surgery for UNE, is characterized by prior pain conditions, earlier contact with a pain management clinic, and high degrees of kinesiophobia, depression/anxiety, low quality of life, and low life satisfaction 31 . Such patients have also significantly higher postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) scores, are significantly younger, and have more often bilateral surgery than a reference group 31 .…”

“…Interestingly, a group of patients, referred to a specialized pain management clinic following surgery for UNE, is characterized by prior pain conditions, earlier contact with a pain management clinic, and high degrees of kinesiophobia, depression/anxiety, low quality of life, and low life satisfaction 31 . Such patients have also significantly higher postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) scores, are significantly younger, and have more often bilateral surgery than a reference group 31 . Therefore, the treated surgeon must be particularly careful concerning the indication for surgery among patients with UNE, where also concomitant co-morbidities are described, including affection of the cervical spinal nerve roots.…”

The Unpredictable Ulnar Nerve—Ulnar Nerve Entrapment from Anatomical, Pathophysiological, and Biopsychosocial Aspects

“…Pain should also be related to the outcome of sensory function using a variety of assessment tools, such as the Semmes-Weinstein monofilament test, two-point discrimination, pick-up test, ten test, shape texture identification test (STI), manual tactile test, and thermal sensitivity test [70]. Chronic severe neuropathic pain, for example, associated with ulnar nerve entrapment, affects almost all aspects of daily life, including the impact on life satisfaction, overall health status, mood and emotions, struggle with self-image, changes in life roles, and sexual life [74,75]. Sleeping disturbances are well-known in patients with chronic neuropathic pain, including patients with neuroma, as well as in patients with ulnar nerve entrapment and carpal tunnel syndrome [76][77][78].…”