Summary

History of psychiatric disorder was predictive of worse postoperative pain and activity outcomes after fasciotomy for CECS but not pain frequency or return to sports.

Abstract

Background

Chronic exertional compartment syndrome (CECS) is a neuromuscular disorder that causes exertional limb pain and is most commonly diagnosed among athletes such as runners and joggers. CECS of the leg may be surgically treated with fasciotomy but pain relief and outcomes for return to sport may vary considerably. Psychiatric conditions may influence pain perception and thus affect patient-reported outcomes following fasciotomy. This study aimed to determine whether psychiatric diagnoses and medication use were associated with post-fasciotomy outcomes among CECS patients.

Methods

We conducted a retrospective analysis of patients who underwent primary fasciotomy for CECS at a single academic medical center from 2010-2020. Psychiatric history was abstracted from electronic health records and included disease diagnosis and associated medications. Postoperative outcomes were assessed using an email survey and included pain frequency, pain severity, Tegner Activity Scale score, and return to sport. Associations between psychiatric history and outcomes were identified using multivariable linear or logistic regression with subjects without psychiatric disorders as controls. P-values less than 0.05 were considered significant.

Results

81 subjects (legs) were included in the study cohort. The cohort was 54% male with average age at time of surgery of 30 years (range 14 - 64) and average follow-up time of 52 months (range 4 - 126). 24 subjects (30%) had at least one psychiatric diagnosis at the time of surgery. Regression analysis found positive psychiatric history to be an independent predictor of worse outcomes versus controls for postoperative pain severity and postoperative Tegner scores (p < 0.05). Furthermore, subjects with a psychiatric disorder but not on medication were associated with worse pain severity (p < 0.001) and Tegner scores (p < 0.01) versus controls whereas subjects with a psychiatric disorder and on medication were associated with better pain severity during daily activity and sports (p < 0.05) versus controls.

Conclusion

History of psychiatric disorder was predictive of worse postoperative pain and activity outcomes after fasciotomy for CECS but not pain frequency or return to sports. Furthermore, use of psychiatric medication was associated with improvement in pain severity in some domains. These findings suggest that psychiatric disorders may modulate pain pathways leading to more severe self-reported postoperative pain, while psychiatric medications may potentially provide an analgesic effect in these patients.