TITLE:
Effects of the Treatment of Carpal Tunnel Syndrome with Surgery and Injections on the Hospital Anxiety and Depression Scale (HADS)
AUTHORS:
Domingo Ly-Pen, José Luis Andreu, Gema de Blas, Isabel Millán, Alberto Sánchez-Olaso
KEYWORDS:
Carpal Tunnel Syndrome, Anxiety, Depression, Local Corticosteroid Injections, Surgery, Hospital Anxiety and Depression Scales (HADS)
JOURNAL NAME:
Open Journal of Psychiatry,
Vol.13 No.1,
December
12,
2022
ABSTRACT: Background: The prevalence of carpal tunnel syndrome (CTS) and of anxiety and
depression in primary care practice are high. Different studies had shown an
increased prevalence of anxiety and depression in CTS patients. Nevertheless, few papers had been published studying the
anxiety and depression scales in the treatment of CTS, either with
corticosteroid injections (I) or with surgical decompression (S). Objective: To assess whether clinical improvement observed after the treatment of CTS
either with I or with S correlates with an improvement
in the punctuations of the Hospital Anxiety and Depression scales
(HADS), at 3, 6 and 12-month follow-up. Methods: Randomized and
open-label clinical trial, comparing I and S. Patients with symptoms suggestive
of CTS (nocturnal paraesthesias) of at least 3 months duration and
neurophysiological confirmation were included. Patients with clinically
apparent motor impairment were excluded. The
subjective evaluation of symptoms was carried out using the
visual-analogue scale of pain (VAS-p). Clinical reviews were performed 3, 6 and
12 months after treatment. Each patient completed the HADS questionnaire and a
VAS-p at 0, 3, 6, and 12 months. Statistical
significance was established using the Student’s t test and the Mann-Whitney
U test when necessary. A linear regression analysis was used to know the effect of the treatment adjusted for the initial score of both
scales. Results: 65 patients were included (30 in group I and 35 in
group S). There was no statistical difference between both groups in terms of
age, gender distribution, disease duration, VAS-p, neurophysiological testing
severity of CTS or the 8 subscales of HADS.
Both groups improved significantly in relation to the baseline VAS-p
values, in the reviews at 3, 6 and 12 months, with no significant differences
between I and S. At 6 months, the reduction in the anxiety scale was around 3
points for both treatments (S = 3.6 and I = 3.2), without reaching significant
differences. At 12 months, it was somewhat higher for those treated with I, but
always around 3 points and without significant differences. The Depression
scale score was slightly reduced at 6 months, and in a similar way for both
groups (I = 1 and S = 1.19; p = 0.8). After 12 months, group I doubled the
previous reduction, with group S experiencing a very slight change (I = 1.96
and S = 1.03; p = 0.3). When analysing the effect of group S on group I, the
result was a reduction of 0.25 points for Anxiety (p = 0.7) and of 0.02 points
for Depression (p = 0.9). Conclusions: Treatment of CTS with I or S results in a similar and discrete
improvement in Anxiety scores on the HADS scale at 6 and 12 months. For
both types of treatment, the Depression scores barely changed at 6 months,
being somewhat higher in group I after 12-month follow-up. The independent
effect of the S on both scales is small and not significant.