Pillar pain incidence, duration, and psychological correlations in WALANT. A prospective study of 170 patients

Abstract

PurposeTo prospectively address our patients seeking carpal tunnel release (CTR) to evaluate the incidence, intensity, and duration of pillar pain (PP) and its correlation with catastrophic thinking, depression, and health anxiety.Methods: this is a prospective cohort study consisting of patients who underwent mini-open CTR under WALANT. Pillar pain was evaluated using the table test and was recorded as dichotomous variable and rated with a visual analogue scale (VAS). Patients with a positive result were evaluated on a monthly basis until the test yielded a negative result.To assess catastrophic thinking, health anxiety and depression levels, we employed the Pain Catastrophizing Scale (PCS) the Short Health Anxiety Inventory (SHAI), and the Beck scale respectively. ResultsThe study enrolled 170 patients who underwent CTR using WALANT technique. Among them, 84 patients (49 %) exhibited a positive table test. With exception of age and diabetes, both groups showed comparable demographic characteristics.The mean pain score for patients with a positive test was 3.5 ± 1.5, and the median duration of it was 3 months (interquartile range [IQR] 2–4). The median PCS score was 8 (IQR 2–14) in patients without PP, compared to 8 (IQR 4–11) in patients with PP. In the logistic regression model, the PCS variable had a crude odds ratio (OR) of 1 (95 % CI: 0.96–1.03) and an adjusted OR of 1 (95 % CI: 0.97–1.04). The SHAI score showed a crude OR of 0.97 (95 % CI: 0.93–1.01) and an adjusted OR of 0.97 (95 % CI: 0.92–1.01). The BECK score had a crude OR of 0.99 (95 % CI: 0.96–1.03) and an adjusted OR of 1.02 (95 % CI: 0.98–1.06). ConclusionPatients undergoing mini-open CTR have a risk of 49 % of experiencing PP, which typically registers a pain intensity of approximately 3 points and will last for a median of 3 months. The likelihood of experience it does not depend on catastrophic thinking, depression, and health anxiety. Type of study/level of evidencePrognostic II.