Bahadır DEMİR, Mazlum Serdar AKALTUN, Özlem ALTINDAĞ, Hacer KARAOGLAN, Abdurrahman ALTINDAĞ, Savaş GÜRSOY, Ali GÜR

Elektromyografisi normal karpal tünel sendromlu bireylerde anksiyete, sağlık anksiyetesi ve somatosensoryal amplifikasyon düzeyleri

Amaç: Bu çalışmada Karpal Tunel Sendromu (KTS) klinik tablosu ile başvuran ve Elektromyografi (EMG) sonucunda sinir iletimi normal tespit edilen hastalarda anksiyete, sağlık anksiyesi ve somatosensoryel amplifikasyon düzeylerinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Çalışmaya Fizik Tedavi ve Rehabilitasyon polikliniğine sırasıyla başvurmuş klinik bulgular ile KTS tanısı konulan hastalar alındı. EMG’de iletim kaybı bulgusu olmayan hastalara Sağlık Anksiyetesi Ölçeği-18 (HAI-18), Bedensel Belirtileri Abartma Ölçeği (BBAÖ), Beck Depresyon Ölçeği (BDÖ), Beck Anksiyete Ölçeği (BAÖ), Görsel Ağrı Skalası (VAS) ve Boston Karpal Tünel Sorgulama Anketi (BKTSA) uygulandı. Bulgular: Çalışmamız 56 hasta, 55 kontrol olmak üzere 111 vakadan oluştu. 42 erkek olmak üzere, 69 vaka kadın cinsiyetteydi. Hasta ve kontrol grubu arasında yaş, cinsiyet, beden kitle indeksi (BKİ) açısından anlamlı bir farklılık yoktu. Uygulanan ölçekler ile VAS, BKTSA semptom şiddeti ve BKTSA fonksiyonel durum arasında pozitif yönde anlamlı ilişki gözlendi. Sonuç: Çalışmamız ile bu hasta grubunun yüksek anksiyete, sağlık anksiyetesi ve somatosensoryal amplifikasyon özellikleri gösterdiği ve bu özelliklerin KTS klinik ölçeklerinin şiddeti ile ilişkili olduğu gösterilmiştir. Mevcut sonuçlarımızı doğrulamak için daha geniş örneklemlerde çalışmalara ihitiyaç vardır.

Anahtar Kelimeler:

karpal tünel sendromu, elektromyografi, anksiyete, depresyon, nöropatik ağrı

Anxiety, health anxiety and somatosensory amplification levels in individuals with carpal tunnel syndrome with normal electromyography

Purpose: The aim of this study was to investigate the levels of anxiety, health anxiety and somatosensory amplification in patients who presented with the clinical manifestation of Carpal Tunnel Syndrome (CTS) without electromyography findings. Materials and Methods: Patients who applied to the Physical Therapy and Rehabilitation outpatient clinic, respectively, and were diagnosed with CTS with clinical findings were included in the study. The patients who were determined to have no evidence of conduction loss in EMG were evaluated by using Short Health Anxiety Inventory (HAI-18), SomatoSensory Amplification Scale (SSAS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Visual Analog Scale (VAS) and Boston Carpal Tunnel Questionnaire (BCTQ). Results: A total of 111 participants were included in the study, of whom 56 were patients and 55 were healthy control subjects. There was no significant difference between the patient and control groups in terms of age, gender, and body mass index (BMI). A statistically significant relationship was observed between these scales and the VAS, BCTQ symptom-severity and BCTQ function status in the positive direction. Conclusion: In our study, it was shown that the patient group showed higher anxiety, health anxiety and somatosensory amplification characteristics, and these features were associated with the severity of the CTS clinical scales. Studies with large-scale samples are needed to be carried out to confirm the results of this study.

Keywords:

carpal tunnel syndrome, electromyography, anxiety, depression, neuropathic pain,

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1. Padua L, Coraci D, Erra C, Pazzaglia C, Paolasso I, Loreti C et al. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol. 2016;15:1273- 84.
2. Foley M, Silverstein B, Polissar N. The economic burden of carpal tunnel syndrome: Long‐term earnings of CTS claimants in Washington State. Am J Ind Med. 2007;50:155-72.
3. Werner RA, Andary M. Electrodiagnostic evaluation of carpal tunnel syndrome. Muscle Nerve. 2011;44:597-607.
4. Jablecki C, Andary M, Floeter M, Miller R, Quartly C, Vennix M et al. Practice parameter: electrodiagnostic studies in carpal tunnel syndrome: report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology. 2002;58:1589-92.
5. Keniş-Coşkun Ö, Karadağ-Saygı E, Özsoy T, Giray E, Mansız-Kaplan B, Kora K. Does electrodiagnostic evidence correlate with mood and function in patients with a pre- diagnosis of carpal tunnel syndrome? Turk J Phys Med Rehabil. 2017;63:335.
6. Pogorzelski R, Kułakowska A, Halicka D, Drozdowski W. Neurological and emotional profile of carpal tunnel syndrome patients. Przegl Lek. 2011;68:269-73.
7. Fernández-Muñoz JJ, Palacios-Ceña M, CigaránMéndez M, Ortega-Santiago R, de- la Llave-Rincón AI, Salom-Moreno J et al. Pain is associated to clinical, psychological, physical, and neurophysiological variables in women with carpal tunnel syndrome. Clin J Pain. 2016;32:122-9.
8. Fernandez-de-las-Penas C, Fernandez-Munoz JJ, Palacios-Ceña M, Navarro-Pardo E, Ambite-Quesada S, Salom-Moreno J. Direct and Indirect effects of function in associated variables such as depression and severity on pain intensity in women with carpal tunnel syndrome. Pain Med. 2015;16:2405-11.
9. Silverstein BA, Fine LJ, Armstrong TJ. Occupational factors and carpal tunnel syndrome. Am J Ind Med. 1987;11:343–58.
10. Jablecki CK, Andary MT, Floeter MK, Miller RG, Quartly CA, Vennix MJ et al. Practice parameter: Electrodiagnostic studies in carpal tunnel syndrome. Report of the American Association of Electrodiagnostic Medicine, American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Neurology. 2002;58:1589–92.
11. Barsky AJ, Wyshak G, Klerman GL. The somatosensory amplification scale and its relationship to hypochondriasis. J Psychiatr Res. 1990;24:323-34.
12. Güleç H, Sayar K, Güleç M. Bedensel Duyumları Abartma Ölçeği Türkçe formunun geçerlik ve güvenirliği. Dusunen Adam. 2007;20:16-24.
13. Salkovskis PM, Rimes KA, Warwick HMC. The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychol Med. 2002;32:843-53.
14. Aydemir Ö, Kirpinar I, Sati T, Uykur B, Cengisiz C. Sağlık Anksiyetesi Ölçeğinin Türkçe için güvenilirlik ve geçerlilik çalışması. Noro Psikiyatri Ars. 2013;50:325-31.
15. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561-71.
16. Hisli N. Beck depresyon envanterinin universite ogrencileri icin gecerliligi, güvenilirligi. Psikoloji Dergisi. 1989;7:3-13.
17. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56:893.
18. Ulusoy M, Sahin NH, Erkmen H. The Beck anxiety inventory: psychometric properties. J Cogn Psychother. 1998;12:163-72.
19. Matamalas A, Ramírez M, Mojal S, De Frutos AG, Molina A, Saló G et al. The visual analog scale and a five-item verbal rating scale are not interchangeable for back pain assessment in lumbar spine disorders. Spine (Phila Pa 1976). 2010;35:E1115-E9.
20. Levine DW SB, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, Katz JN. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993;75:1585-92.
21. Sezgin M, İncel NA, Sevim S, Camdeviren H, As İ, Erdogan C. Assessment of symptom severity and functional status in patients with carpal tunnel syndrome: reliability and validity of the Turkish version of the Boston Questionnaire. Disabil Rehabil. 2006;28:1281-6.
22. Jerosch-Herold C, Houghton J, Blake J, Shaikh A, Wilson EC, Shepstone L. Association of psychological distress, quality of life and costs with carpal tunnel syndrome severity: a cross-sectional analysis of the PALMS cohort. BMJ open. 2017;7:e017732.
23. Shin YH, Yoon JO, Kim YK, Kim JK. Psychological status is associated with symptom severity in patients with carpal tunnel syndrome. J Hand Surg Am. 2018;43:484.e1-e8
24. Hobby J, Venkatesh R, Motkur P. The effect of psychological disturbance on symptoms, self-reported disability and surgical outcome in carpal tunnel syndrome. J Bone Joint Surg Br. 2005;87:196-200.
25. Radat F, Margot‐Duclot A,Attal N. Psychiatric co‐ morbidities in patients with chronic peripheral neuropathic pain: A multicentre cohort study. Eur J Pain. 2013;17:1547-57.
26. Ring D, Kadzielski J, Malhotra L, Lee SGP, Jupiter JB. Psychological factors associated with idiopathic arm pain. J Bone Joint Surg Am. 2005;87:374-80.
27. Chan L, Turner JA, Comstock BA, Levenson LM, Hollingworth W, Heagerty PJ et al. The relationship between electrodiagnostic findings and patient symptoms and function in carpal tunnel syndrome. Arch Phys Med Rehabil. 2007;88:19-24.
28. De SD, Vranceanu AM, Ring DC. Contribution of kinesophobia and catastrophic thinking to upperextremity-specific disability. J Bone Joint Surg Am. 2013;95:76-81.
29. Lipowski ZJ. Somatization: the concept and its clinical application. Am J Psychiatry. 1988;145:1358-68.
30. Barsky AJ, Goodson JD, Lane RS, Cleary PD. The amplification of somatic symptoms. Psychosom Med. 1988;50:510-9.
31. Abramowitz JS, Olatunji BO, Deacon BJ. Health anxiety, hypochondriasis, and the anxiety disorders. Behav Ther. 2007;38:86-94.
32. Seto H, Nakao M. Relationships between catastrophic thought, bodily sensations and physical symptoms. Biopsychosoc Med. 2017;11:28.