Article
Predictive factors for severe post-operative chronic pain after surgery for cubital tunnel syndrome
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Authors
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Erika Nyman
- Dept of Clin and Exp med, Linköping University, Division of Hand Surg and Plastic Surg, Linköping University, Linköping, Sweden
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Alice Giöstad
- Dept of Clin and Exp med, Linköping University, Division of Hand Surg and Plastic Surg, Linköping University, Linköping, Sweden
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Ronja Räntfors
- Dept of Clin and Exp med, Linköping University, Division of Hand Surg and Plastic Surg, Linköping University, Linköping, Sweden
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Torbjörn Nyman
- Dept of Clin and Exp med, Linköping University, Rehabilitation Medicine, Linköping University, Linköping, Sweden
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: There is a wide variation in outcome after surgery for cubital tunnel syndrome. Chronic pain is a well known and relatively common complication with severe consequences for the individual patient. In this study, we aimed to evaluate possible predictive factors for severe post-operative chronic pain after surgery for ulnar nerve entrapment at the elbow.
Methods: A retrospective observational study was performed on patients with ulnar nerve entrapment at the elbow operated at a referral centre 2011 - 2014, using data data from medical charts and a post surgical survey. In total 173 patients were included. A subgroup of 28 patients, postoperatively referred to a Pain Centre due to chronic neuropathic pain, was identified and further categorized with questionnaires for: 1) health status (EQ-5D), 2) life satisfaction (Li-Sat 11), 3) fear of movement related to pain (The Tampa Scale of Kinesiophobia), and 4) levels of anxiety and depression (Hospital Anxiety and Depression Scale). Logistic regression was used to evaluate predictive factors for referral to the Pain Centre regarding age, gender, BMI, smoking, civil status, interpreting requirements, comorbidity, and surgical method (simple decompression or subcutaneous ulnar nerve transposition). To compare the EQ-5D values with values for the national population, one sample t-test was done.
Results and Conclusions: Emerged postopertive neurogenic pain was seen in 8% of the whole population (n=173) and 2% developed CRPS (complex regional pain syndrome). Of the patients referred to a Pain Centre (n=28), 12/28 (43%) had previously been in contact with the Pain Centre and 20/28 (71%) suffered fom earlier pain problems. A significant association was found between referral and interpreting requirements, depression, other nerve compression lesions in the same arm, and surgery with ulnar nerve transposition instead of simple decompression. The mean value of EQ-5D was significantly lower than for the national population.
We conclude that earlier pain problems, interpreting requirements, depression and other nerve compression lesions are readily identifiable risk factors for developing postoperative severe chronic pain following surgery for cubital tunnel syndrome. Such patients have a low health-related wellbeing and need particular pre- and postoperative care. It should be carefully evaluated whether surgery should be performed or not. Simple decompression is the first choice of surgery.
