Influence of Clinical, Psychological, and Psychophysical Variables on Long‐term Treatment Outcomes in Carpal Tunnel Syndrome: Evidence From a Randomized Clinical Trial

Abstract

Objective To assess the influence of clinical, psychological, and psychophysical variables on long‐term clinical outcomes after the application of either physical therapy or surgery in women presenting with carpal tunnel syndrome (CTS). Methods A secondary analysis of a randomized trial investigating the efficacy of manual therapy including desensitization maneuvers of the central nervous system against surgery in 120 women with CTS was performed. Clinical outcomes including pain intensity, function, or symptom severity were assessed at 6 and 12 months post‐intervention. Participants completed at baseline several clinical (pain intensity, function, and symptom severity), psychological (depression), and psychophysical (pressure pain thresholds and pain extent) variables, which were included as predictors. Multiple regression analyses were conducted to assess the relationship between baseline variables and clinical outcomes at 6 and 12 months post‐intervention. Results The regression models indicated that higher scores of each clinical outcome (ie, intensity of pain or symptom severity) at baseline predicted better outcomes at 6 and 12 months post‐intervention (from 15% to 65% of variance) in both groups. Lower pressure pain thresholds over the carpal tunnel at baseline predicted poorer clinical outcomes at 6 and 12 months post‐intervention (from 5% to 20% of variance) in the physical therapy group, whereas higher depressive symptoms at baseline contributed to poorer outcomes at 6 and 12 months post‐intervention (from 5% to 15% of the variance) within the surgery group. Conclusion This study found that baseline localized pressure pain sensitivity and depression were predictive of long‐term clinical outcomes in women with CTS following physical therapy or surgery, respectively.

Influence of Clinical, Physical, Psychological, and Psychophysical Variables on Treatment Outcomes in Somatic Tinnitus Associated With Temporomandibular Pain: Evidence From a Randomized Clinical Trial

“…These results were expected since it seems easier to elicit greater changes in an outcome with higher baseline scores because subjects with less pain and disability had less room to exhibit improvements. Current results agree with those of studies investigating prognostic factors in other conditions (eg, in subjects with carpal tunnel syndrome 30 or whiplash‐associated disorder 31 ), in which higher pain or disability scores at baseline are also associated with greater change in the same clinical outcome after receiving physical therapy. Our results are also consistent with the fact that greater tinnitus intensity is not associated with poorer prognosis in patients with TMD‐related tinnitus 12 suggesting that those experiencing more severe symptoms can respond better to treatment.…”

Spectral Clustering Reveals Different Profiles of Central Sensitization in Women with Carpal Tunnel Syndrome

“…Centrally-mediated symptoms have been associated with poorer outcomes after carpal tunnel surgery, supporting this hypothesis [34]. However, peripheral sensitization has been also found to be associated with poorer clinical outcomes after conservative treatment [35]. Clusters identified in the current study could explain discrepancies in previous findings, since dominant nociceptive pain (cluster 1) may response better to peripheral treatments, whereas dominant neuropathic pain (cluster 2) may need different approaches, such as pharmacological approaches.…”

Clinical Significance and Diagnostic Value of Pain Extent Extracted from Pain Drawings: A Scoping Review

“…After removing duplicates and those not related to the topic, 13 studies remained for full-text analysis. From the thirteen studies that were examined, two were excluded, the first one because it included asymptomatic individuals [ 11 ], and the second one because it was a randomized controlled clinical trial [ 19 ]. A total of eleven cross-sectional cohort studies [ 10 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ] were included in the final literature data mapping ( Figure 3 ).…”