Nonneurologic hand pain versus carpal tunnel syndrome: do psychological measures differentiate?

To determine whether psychological measures would differentiate a group of patients with physician-diagnosed nonneurologic hand pain from patients with carpal tunnel syndrome (CTS). Many patients, who also displayed symptoms of psychological distress, were referred to an electrodiagnostic clinic with a diagnosis of possible CTS; they subsequently had normal nerve conduction studies.

Sixty patients with hand pain were referred to either of two university clinics for electrophysiologic testing, were assigned to either the CTS or nonneurologic group, and were compared on a series of psychometric tests.

The Beck Depression Inventory and McGill Pain Questionnaire showed that the physician-assigned nonneurologic patients have a greater degree of depression, use more affective adjectives, and choose more words on the McGill Pain Questionnaire than the physician-assigned CTS group. The nonneurologic group also scored higher on indices of self-reported disability on the Pain Disability Inventory in five of seven categories. Although the CTS group perceived more control over their pain, no differences were observed in the types of coping strategies used on the Coping Strategy Questionnaire. Finally, the nonneurologic group had more Workers' Compensation Board claims.

Evidence of important psychological issues in some patients with hand pain suggests a need for greater awareness among treating physicians.