Clinical Orthopaedics and Related Research®

, Volume 468, Issue 12, pp 3328–3332 | Cite as

Determinants of Pain in Patients with Carpal Tunnel Syndrome

  • Fiesky Nunez
  • Ana-Maria Vranceanu
  • David RingEmail author
Clinical Research



Carpal tunnel syndrome causes numbness, weakness, and atrophy. Pain without numbness is not characteristic of this disease.


We tested the hypothesis that among patients with carpal tunnel syndrome confirmed by electrophysiologic testing, pain catastrophizing and/or depression would be good predictors of pain intensity at the time of diagnosis, whereas nerve conduction velocity would not.

Patients and Methods

Fifty-four patients completed a measure of tendency to misinterpret pain, a measure of depressive symptoms, anxiety about pain, self-efficacy in response to pain, and a five-point Likert measure of pain intensity. One-tailed Spearman correlation was performed to find a correlation between pain and continuous variables. One-way ANOVA was performed to assess differences between categorical variables. For each group, all variables with significant correlations with pain intensity were included in a multiple linear regression analysis.


Sex, age, and electrophysiologic measures did not correlate with pain intensity. All measures of illness behavior correlated with pain intensity and were entered in a multiple linear regression model; only misinterpretation of nociception and depression were significantly associated and accounted for 39% of the variation in pain intensity.


Illness behavior (specifically depression and misinterpretation of nociception) predicts pain intensity in patients with carpal tunnel syndrome.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.


Pain Intensity Carpal Tunnel Syndrome Carpal Tunnel Electrophysiologic Testing Illness Behavior 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Ed 4. Arlington, VA: American Psychiatric Association; 2000.Google Scholar
  2. 2.
    Asghari A, Julaeiha S, Godarsi M. Disability and depression in patients with chronic pain: pain or pain-related beliefs? Arch Iran Med. 2008;11:263–269.PubMedGoogle Scholar
  3. 3.
    Bair MJ, Wu J, Damush TM, Sutherland JM, Kroenke K. Association of depression and anxiety alone and in combination with chronic musculoskeletal pain in primary care patients. Psychosom Med. 2008;70:890–897.CrossRefPubMedGoogle Scholar
  4. 4.
    Carpal Tunnel Syndrome: Myths, Facts, Diagnosis, and Treatment: an interview with Aaron Daluiski, MD. Summary by Mike Elvin. Available at: Accessed May 6, 2010.
  5. 5.
    Graham B. The value added by electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. J Bone Joint Surg Am. 2008;90:2587–2593.CrossRefPubMedGoogle Scholar
  6. 6.
    Graham B, Regehr G, Naglie G, Wright JG. Development and validation of diagnostic criteria for carpal tunnel syndrome. J Hand Surg Am. 2006;31:919–924.PubMedGoogle Scholar
  7. 7.
    Kroenke K, Spitzer RL, Williams JB. The PHQ-9 validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–613.CrossRefPubMedGoogle Scholar
  8. 8.
    Lee EJ, Wu MY, Lee GK, Cheing G, Chan F. Catastrophizing as a cognitive vulnerability factor related to depression in workers’ compensation patients with chronic musculoskeletal pain. J Clin Psychol Med Settings. 2008;15:182–192.CrossRefPubMedGoogle Scholar
  9. 9.
    McCracken LM, Dhingra L. A short version of the Pain Anxiety Symptoms Scale (PASS-20): preliminary development and validity. Pain Res Manag. 2002;7:45–50.PubMedGoogle Scholar
  10. 10.
    McCracken LM, Zayfert C, Gross RT. The Pain Anxiety Symptoms Scale: development and validation of a scale to measure fear of pain. Pain. 1992;50:67–73.CrossRefPubMedGoogle Scholar
  11. 11.
    Mitchell T, O’Sullivan PB, Smith A, Burnett AF, Straker L, Thornton J, Rudd CJ. Biopsychosocial factors are associated with low back pain in female nursing students: a cross-sectional study. Int J Nurs Stud. 2009;46:678–688.CrossRefPubMedGoogle Scholar
  12. 12.
    Nicholas MK. The pain self-efficacy questionnaire: taking pain into account. Eur J Pain. 2007;11:153–163.CrossRefPubMedGoogle Scholar
  13. 13.
    Osman A, Barrios FX, Gutierrez PM, Kopper BA, Merrifield T, Grittmann L. The Pain Catastrophizing Scale: further psychometric evaluation with adult samples. J Behav Med. 2000;23:351–365.CrossRefPubMedGoogle Scholar
  14. 14.
    Potter RG, Jones JM. The evolution of chronic pain among patients with musculoskeletal problems: a pilot study in primary care. Br J Gen Pract. 1992;42:462–464.PubMedGoogle Scholar
  15. 15.
    Scangas G, Lozano-Calderon S, Ring D. Disparity between popular (Internet) and scientific illness concepts of carpal tunnel syndrome causation. J Hand Surg Am. 2008;33:1076–1080.CrossRefPubMedGoogle Scholar
  16. 16.
    Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999;282:1737–1744.CrossRefPubMedGoogle Scholar
  17. 17.
    Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: development and validation. Psychol Assess. 1995;7:524–532.CrossRefGoogle Scholar
  18. 18.
    Vaccarino AL, Sills TL, Evans KR, Kalali AH. Multiple pain complaints in patients with major depressive disorder. Psychosom Med. 2009;71:159–162.CrossRefPubMedGoogle Scholar
  19. 19.
    Vranceanu AM, Jupiter JB, Mudgal CS, Ring D. Predictors of pain intensity and disability after minor hand surgery. J Hand Surg Am. 2010;35:956–960.CrossRefPubMedGoogle Scholar
  20. 20.
    Wright PE. Carpal tunnel, ulnar tunnel and stenosing tenosynovitis. In: Canale ST, Beaty JH, eds. Campbell’s Operative Orthopaedics. Vol 2. Philadelphia, PA: Mosby Elsevier; 2008:4285–4309.Google Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  1. 1.Massachusetts General Hospital/Harvard Medical SchoolBostonUSA

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