Among Patients Seeking Care for Carpal Tunnel Syndrome, Variation in Symptom Intensity Is Associated More With Variation in Mindsets Than Variation in Compressive Median Neuropathy Severity.

Abstract

Specialists recognize discordance between levels of discomfort and incapability and pathophysiology severity among people presenting for care of compressive median neuropathy at the carpal tunnel, but there is limited evidence regarding factors associated with this discordance. Using statistical techniques to identify subgroups of mental health factors and pathophysiology factors among people presenting for care of compressive median neuropathy at the carpal tunnel can help determine their relative association with levels of discomfort and incapability. We therefore asked: (1) Can we identify statistical groupings of mental health and pathophysiological factors among people with compressive median neuropathy at the carpal tunnel? and (2) Is there a difference in pain intensity and magnitude of capability among the identified statical groupings? We performed a secondary analysis of 150 patients using a <i>k</i>-means clustering algorithm to identify statistical subgroups based on symptoms of distress, levels of fear of painful movement, and categorized pathophysiology severity (mild, moderate, or severe) on electrodiagnostic testing by the physician performing the test. We compared the relative levels of pain intensity and magnitude of incapability between the identified statistical groupings. There were 4 distinct statistical groupings defined by varying levels of fear of painful movement and feelings of distress (anxiety or depression) regarding sensations with minimal variation in mean neuropathy severity. Groupings with greater distress and fear of painful movement had greater mean pain intensity and magnitude of incapability. The evidence that discordance between symptom intensity and compressive median neuropathy severity is accounted for by less healthy mindsets directs clinicians to use relatively notable levels of pain intensity and incapability as a signal to prioritize timely and accurate diagnosis of less healthy mindsets (misconceptions and distress) as a safeguard for comprehensive care.