Spectral Clustering Reveals Different Profiles of Central Sensitization in Women with Carpal Tunnel Syndrome
Abstract
:1. Introduction
2. Methods
2.1. Participants
2.2. Self-Reported Outcomes
2.3. Quantitative Sensory Testing
2.4. Motor Output
2.5. Data Preprocessing
2.6. Clustering Algorithms
2.7. Spectral Clustering
Algorithm 1: Normalized Spectral Clustering using pairwise Gaussian similarity |
Input: Standardized data points , Number of clusters , Gaussian variance Output: Label of the cluster to which each point has been assigned.
|
2.8. Statistical Analysis of the Clusters
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
- Thiese, M.S.; Gerr, F.; Hegmann, K.T.; Harris-Adamson, C.; Dale, A.M.; Evanoff, B.A.; Eisen, E.A.; Kapellusch, J.; Garg, A.; Burt, S.; et al. Effects of Varying Case Definition on Carpal Tunnel Syndrome Prevalence Estimates in a Pooled Cohort. Arch. Phys. Med. Rehabilit. 2014, 95, 2320–2326. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Pourmemari, M.H.; Heliövaara, M.; Viikari-Juntura, E.; Shiri, R. Carpal tunnel release: Lifetime prevalence, annual incidence, and risk factors. Muscle Nerve 2018, 58, 497–502. [Google Scholar] [CrossRef] [PubMed]
- Epstein, S.; Sparer, E.H.; Tran, B.N.; Ruan, Q.Z.; Dennerlein, J.T.; Singhal, D.; Lee, B.T. Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists: A Systematic Review and Meta-analysis. JAMA Surg. 2018, 153, e174947. [Google Scholar] [CrossRef] [PubMed]
- Dale, A.M.; Harris-Adamson, C.; Rempel, D.; Gerr, F.; Hegmann, K.; Silverstein, B.; Burt, S.; Garg, A.; Kapellusch, J.; Merlino, L.; et al. Prevalence and incidence of carpal tunnel syndrome in US working populations: Pooled analysis of six prospective studies. Scand. J. Work Environ. Health 2013, 39, 495–505. [Google Scholar] [CrossRef] [PubMed]
- Foley, M.; Silverstein, B. The long-term burden of work-related carpal tunnel syndrome relative to upper-extremity fractures and dermatitis in Washington State. Am. J. Ind. Med. 2015, 58, 1255–1269. [Google Scholar] [CrossRef]
- Genova, A.; Dix, O.; Saefan, A.; Thakur, M.; Hassan, A. Carpal Tunnel Syndrome: A Review of Literature. Cureus 2020, 12, e7333. [Google Scholar] [CrossRef] [Green Version]
- Fernández-De-Las-Peñas, C.; Plaza-Manzano, G. Carpal tunnel syndrome: Just a peripheral neuropathy? Pain Manag. 2018, 8, 209–216. [Google Scholar] [CrossRef]
- Fernández-de-las-Peñas, C.; De-la-Llave-Rincón, A.I.; Fernández-Carnero, J.; Cuadrado, M.L.; Arendt-Nielsen, L.; Pareja, J.A. Bilateral widespread mechanical pain sensitivity in carpal tunnel syndrome: Evidence of central processing in unilateral neuropathy. Brain 2009, 132, 1472–1479. [Google Scholar] [CrossRef] [Green Version]
- de-la-Llave-Rincón, A.I.; Fernández-de-las-Peñas, C.; Fernández-Carnero, J.; Padua, L.; Arendt-Nielsen, L.; Pareja, J.A. Bilateral hand/wrist head and cold hyperalgesia, but not hypoesthesia, in unilateral carpal tunnel syndrome. Exp Brain Res. 2009, 198, 455–463. [Google Scholar] [CrossRef]
- Zanette, G.; Cacciatori, C.; Tamburin, S. Central sensitization in carpal tunnel syndrome with extraterritorial spread of sensory symptoms. Pain 2010, 148, 227–236. [Google Scholar] [CrossRef]
- Fernández-De-Las-Peñas, C.; Pérez-De-Heredia-Torres, M.; Martínez-Piédrola, R.; De La Llave-Rincón, A.I.; Cleland, J.A. Bilateral deficits in fine motor control and pinch grip force in patients with unilateral carpal tunnel syndrome. Exp. Brain Res. 2009, 194, 29–37. [Google Scholar] [CrossRef] [PubMed]
- Fernández-De-Las-Peñas, C.; Fernández-Muñoz, J.J.; Navarro-Pardo, E.; da-Silva-Pocinho, R.; Quesada, S.A.; Pareja, J.A. Identification of Subgroups of Women with Carpal Tunnel Syndrome with Central Sensitization. Pain Med. 2016, 17, 1749–1756. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Wang, X.; Qian, B.; Davidson, I. On constrained spectral clustering and its applications. Data Min. Knowl. Discov. 2012, 28, 1–30. [Google Scholar] [CrossRef] [Green Version]
- Pellicer-Valero, O.J.; Martín-Guerrero, J.D.; Cigarán-Méndez, M.I.; Écija-Gallardo, C.; Fernández-De-Las-Peñas, C.; Navarro-Pardo, E. Mathematical Modeling for Neuropathic Pain: Bayesian Linear Regression and Self-Organizing Maps Applied to Carpal Tunnel Syndrome. Symmetry 2020, 12, 1581. [Google Scholar] [CrossRef]
- American Association of Electro-diagnostic Medicine, American Academy of Neurology; American Academy of Physical Medicine and Rehabilitation. Practice parameter: Electro-diagnostic studies in carpal tunnel syndrome. Neurology 2002, 58, 1589–1592. [Google Scholar]
- Jensen, M.P.; Turner, A.J.; Romano, J.M.; Fisher, L.D. Comparative reliability and validity of chronic pain intensity measures. Pain 1999, 83, 157–162. [Google Scholar] [CrossRef]
- Rosales, R.S.; Benseny, E.; Díez de la Lastra-Bosch, I. Evaluation of the Spanish version of the DASH and carpal tunnel syn-drome health-related quality of life instruments: Cross cultural adaptation process and reliability. J. Hand Surg. 2002, 27, 334–343. [Google Scholar] [CrossRef]
- Levine, D.W.; Simmons, B.; Koris, M.; Daltroy, L.; Hohl, G.; Fossel, A.; Katz, J. 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, 1585–1592. [Google Scholar] [CrossRef]
- de Carvalho Leite, J.C.; Jerosch-Herold, C.; Song, F. A systematic review of the psychometric properties of the Boston Carpal Tunnel Questionnaire. BMC Musculoskelet. Disord. 2006, 7, 78–79. [Google Scholar] [CrossRef] [Green Version]
- Beck, A.T.; Steer, R.A.; Brown, G.K. Beck Depression Inventory, 2nd ed.; The Psychological Corporation: San Antonio, TX, USA, 1996. [Google Scholar]
- Jones, D.H.; Kilgour, R.D.; Comtois, A.S. Test-Retest Reliability of Pressure Pain Threshold Measurements of the Upper Limb and Torso in Young Healthy Women. J. Pain 2007, 8, 650–656. [Google Scholar] [CrossRef]
- Moloney, N.; Hall, T.; O’Sullivan, T.C.; Doody, C.M. Reliability of thermal quantitative sensory testing of the hand in a cohort of young, healthy adults. Muscle Nerve 2011, 44, 547–552. [Google Scholar] [CrossRef]
- Schreuders, T.A.R.; Roebroeck, M.E.; Goumans, J.; Van Nieuwenhuijzen, J.F.; Stijnen, T.H.; Stam, H.J. Measurement Error in Grip and Pinch Force Measurements in Patients with Hand Injuries. Phys. Ther. 2003, 83, 806–815. [Google Scholar] [CrossRef] [Green Version]
- Von Luxburg, U. A tutorial on spectral clustering. Stat. Comput. 2007, 17, 395–416. [Google Scholar] [CrossRef]
- Shi, J.; Malik, J. Normalized cuts and image segmentation. IEEE Trans. Pattern Anal. Mach. Intell. 2000, 22, 888–905. [Google Scholar] [CrossRef] [Green Version]
- Pellicer-Valero, O.J.; Fernández-De-Las-Peñas, C.; Martín-Guerrero, J.D.; Navarro-Pardo, E.; Cigarán-Méndez, M.I.; Florencio, L.L. Patient Profiling Based on Spectral Clustering for an Enhanced Classification of Patients with Tension-Type Headache. Appl. Sci. 2020, 10, 9109. [Google Scholar] [CrossRef]
- Virtanen, P.; Gommers, R.; Oliphant, T.E.; Haberland, M.; Reddy, T.; Cournapeau, D.; Burovski, E.; Peterson, P.; Weckesser, W.; Bright, J.; et al. SciPy 1.0: Fundamental algorithms for scientific computing in Python. Nat. Methods 2020, 17, 261–272. [Google Scholar] [CrossRef] [Green Version]
- Skipper, S.; Perktold, J. Statsmodels: Econometric and statistical modeling with phyton. In Proceedings of the 9th Python in Science Conference, Austin, TX, USA, 28 June–3 July 2010. [Google Scholar]
- De la Llave-Rincón, A.I.; Fernández-de-las-Peñas, C.; Laguarta-Val, S.; Alonso-Blanco, C.; Martínez-Perez, A.; Arendt-Nielsen, L.; Pareja, J.A. Increased pain sensitivity is not associated with electrodiagnostic findings in women with carpal tunnel syn-drome. Clin. J. Pain 2011, 27, 747–754. [Google Scholar] [CrossRef]
- De Medinaceli, L.; Hurpeau, J.; Merle, M.; Begorre, H. Cold and post-traumatic pain: Modeling of the peripheral nerve message. Biosystems 1997, 43, 145–167. [Google Scholar] [CrossRef]
- Woolf, C.J. Central sensitization: Implications for the diagnosis and treatment of pain. Pain 2011, 152, S2–S15. [Google Scholar] [CrossRef]
- Nacir, B.; Genc, H.; Duyur Cakit, B.; Karagoz, A.; Erdem, H.R. Evaluation of Upper Extremity Nerve Conduction Velocities and the Relationship Between Fibromyalgia and Carpal Tunnel Syndrome. Arch. Med. Res. 2012, 43, 369–374. [Google Scholar] [CrossRef]
- O’Leary, H.; Smart, K.M.; Moloney, N.A.; Doody, C.M. Nervous System Sensitization as a Predictor of Outcome in the Treatment of Peripheral Musculoskeletal Conditions: A Systematic Review. Pain Pract. 2016, 17, 249–266. [Google Scholar] [CrossRef] [PubMed]
- Roh, Y.H.; Kim, S.; Gong, H.S.; Baek, G.H. Influence of centrally mediated symptoms on functional outcomes after carpal tunnel release. Sci. Rep. 2018, 8, 11134. [Google Scholar] [CrossRef] [PubMed]
- Fernández-De-Las-Peñas, C.; De-La-Llave-Rincón, A.I.; Cescon, C.; Barbero, M.; Arias-Buría, J.L.; Falla, D. Influence of Clinical, Psychological, and Psychophysical Variables on Long-term Treatment Outcomes in Carpal Tunnel Syndrome: Evidence From a Randomized Clinical Trial. Pain Pract. 2019, 19, 644–655. [Google Scholar] [CrossRef] [PubMed]
- Tamburin, S.; Cacciatori, C.; Marani, S.; Zanette, G. Pain and motor function in carpal tunnel syndrome: A clinical, neuro-physiological and psychophysical study. J. Neurol. 2008, 255, 1636–1643. [Google Scholar] [CrossRef]
- Yoshida, A.; Kurimoto, S.; Iwatsuki, K.; Saeki, M.; Nishizuka, T.; Nakano, T.; Yoneda, H.; Onishi, T.; Yamamoto, M.; Tatebe, M.; et al. Upper extremity disability is associated with pain intensity and grip strength in women with bilateral idiopathic carpal tunnel syndrome. NeuroRehabilitation 2019, 44, 199–205. [Google Scholar] [CrossRef]
- Fernández-de-Las Peñas, C.; Ortega-Santiago, R.; de la Llave-Rincón, A.I.; Martínez-Perez, A.; Díaz, H.F.-S.; Martínez-Martín, J.; Pareja, J.A.; Cuadrado-Pérez, M.L. Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome: A Randomized Parallel-Group Trial. J. Pain 2015, 16, 1087–1094. [Google Scholar] [CrossRef]
- Fernández-De-Las-Peñas, C.; Fernández-Muñoz, J.J.; 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, 2405–2411. [Google Scholar] [CrossRef] [Green Version]
Mean | SD | Min. | Max. | |
---|---|---|---|---|
Age (years) | 45.5 | 9.1 | 21.0 | 64.00 |
Years with Pain | 3.5 | 3.0 | 0.5 | 17.00 |
Right Side Affected * | 0.9 | 0.3 | 0.00 | 1.00 |
Left Side Affected * | 0.75 | 0.45 | 0.00 | 1.00 |
EMG Minimal affectation # | 0.3 | 0.45 | 0.00 | 1.00 |
EMG Severe affectation # | 0.4 | 0.5 | 0.00 | 1.00 |
Pain Intensity (NPRS, 0–10) | 5.8 | 2.1 | 0.00 | 10.00 |
Symptom Severity (BCTQ, 1–5) | 2.75 | 0.7 | 1.25 | 5.00 |
Function (BCTQ, 1–5) | 2.4 | 0.75 | 1.0 | 4.62 |
Depression (BDI-II, 0–21) | 4.6 | 2.9 | 0.0 | 15.0 |
CPT carpal tunnel (°C) | 19.4 | 6.7 | 5.00 | 30.2 |
CPT thenar eminence (°C) | 19.2 | 6.45 | 5.00 | 29.75 |
HPT carpal tunnel (°C) | 39.9 | 2.6 | 35.2 | 48.45 |
HPT thenar eminence (°C) | 40.1 | 2.85 | 32.1 | 48.2 |
PPT median nerve (kPa) | 192.55 | 50.7 | 57.65 | 365.5 |
PPT ulnar nerve (kPa) | 293.7 | 73.6 | 115.5 | 465.5 |
PPT radial nerve (kPa) | 225.25 | 61.9 | 109.5 | 433.5 |
PPT cervical spine (kPa) | 171.1 | 53.75 | 57.0 | 499.5 |
PPT carpal tunnel (kPa) | 346.05 | 95.4 | 130.5 | 731.0 |
PPT tibialis anterior (kPa) | 322.85 | 85.5 | 110.5 | 652.5 |
Thumb-index finger pinch tip (pounds) | 4.15 | 1.7 | 0.5 | 8.5 |
Thumb-little finger pinch tip (pounds) | 1.1 | 0.8 | 0.0 | 5.5 |
Thumb-middle finger pinch tip (pounds) | 4.0 | 1.9 | 0.0 | 9.5 |
Thumb-ring finger pinch tip (pounds) | 2.45 | 1.4 | 0.0 | 6.35 |
Cluster 0 (n = 37) | Cluster 1 (n = 68) | Cluster 2 (n = 103) | p-Value | |
---|---|---|---|---|
Age (years) | 46.19 ± 6.84 | 49.37 ± 8.81 | 42.71 ± 9.02 | <0.001 |
Years with Pain | 3.68 ± 2.79 | 4.43 ± 3.94 | 2.88 ± 2.01 | 0.0162 |
Pain Intensity (NPRS, 0–10) | 4.68 ± 2.46 | 6.54 ± 1.84 | 5.77 ± 1.91 | <0.001 |
Function (BCTQ, 1–5) | 1.84 ± 0.58 | 2.8 ± 0.74 | 2.39 ± 0.67 | <0.001 |
Symptom Severity (BCTQ, 1–5) | 2.2 ± 0.54 | 3.1 ± 0.69 | 2.69 ± 0.57 | <0.001 |
Depression (BDI-II, 0–21) | 2.92 ± 2.71 | 5.57 ± 3.36 | 4.52 ± 2.38 | <0.001 |
PPT median nerve (kPa) | 245.24 ± 41.99 | 162.85 ± 39.22 | 193.22 ± 44.62 | <0.001 |
PPT ulnar nerve (kPa) | 366.25 ± 57.53 | 259.3 ± 68.51 | 290.37 ± 63.45 | <0.001 |
PPT radial nerve (kPa) | 284.88 ± 57.71 | 191.8 ± 48.69 | 225.9 ± 54.9 | <0.001 |
PPT cervical spine (kPa) | 211.01 ± 40.47 | 145.44 ± 43.66 | 173.75 ± 54.85 | <0.001 |
PPT carpal tunnel (kPa) | 463.34 ± 83.18 | 291.31 ± 81.54 | 340.06 ± 68.16 | <0.001 |
PPT tibialis anterior (kPa) | 419.01 ± 76.96 | 273.34 ± 65.82 | 321.0 ± 70.06 | <0.001 |
HPT carpal tunnel (°C) | 42.25 ± 2.61 | 40.14 ± 2.65 | 38.91 ± 1.84 | <0.001 |
CPT carpal tunnel (°C) | 12.83 ± 6.01 | 17.34 ± 6.89 | 23.11 ± 3.89 | <0.001 |
HPT hand (°C) | 42.83 ± 2.45 | 40.76 ± 2.91 | 38.67 ± 1.91 | <0.001 |
CPT hand (°C) | 12.57 ± 5.71 | 17.37 ± 6.48 | 22.72 ± 3.85 | <0.001 |
Left Side Affected * | 0.76 ± 0.43 | 0.81 ± 0.4 | 0.69 ± 0.47 | 1 |
Right Side Affected * | 0.89 ± 0.31 | 0.91 ± 0.29 | 0.87 ± 0.33 | 1 |
Thumb-index finger pinch tip (pounds) | 4.84 ± 1.8 | 2.87 ± 1.29 | 4.72 ± 1.47 | <0.001 |
Thumb-middle finger pinch tip (pounds) | 4.72 ± 2.03 | 2.56 ± 1.27 | 4.75 ± 1.58 | <0.001 |
Thumb-ring finger pinch tip (pounds) | 2.99 ± 1.54 | 1.49 ± 0.96 | 2.84 ± 1.31 | <0.001 |
Thumb-little finger pinch tip (pounds) | 1.37 ± 0.81 | 0.72 ± 0.55 | 1.25 ± 0.86 | <0.001 |
Minimal EMG Findings # | 0.19 ± 0.4 | 0.44 ± 0.5 | 0.23 ± 0.42 | 0.0845 |
Severe EMG Findings # | 0.32 ± 0.47 | 0.28 ± 0.45 | 0.46 ± 0.5 | 0.4656 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Pellicer-Valero, O.J.; Martín-Guerrero, J.D.; Fernández-de-las-Peñas, C.; De-la-Llave-Rincón, A.I.; Rodríguez-Jiménez, J.; Navarro-Pardo, E.; Cigarán-Méndez, M.I. Spectral Clustering Reveals Different Profiles of Central Sensitization in Women with Carpal Tunnel Syndrome. Symmetry 2021, 13, 1042. https://doi.org/10.3390/sym13061042
Pellicer-Valero OJ, Martín-Guerrero JD, Fernández-de-las-Peñas C, De-la-Llave-Rincón AI, Rodríguez-Jiménez J, Navarro-Pardo E, Cigarán-Méndez MI. Spectral Clustering Reveals Different Profiles of Central Sensitization in Women with Carpal Tunnel Syndrome. Symmetry. 2021; 13(6):1042. https://doi.org/10.3390/sym13061042
Chicago/Turabian StylePellicer-Valero, Oscar J., José D. Martín-Guerrero, César Fernández-de-las-Peñas, Ana I. De-la-Llave-Rincón, Jorge Rodríguez-Jiménez, Esperanza Navarro-Pardo, and Margarita I. Cigarán-Méndez. 2021. "Spectral Clustering Reveals Different Profiles of Central Sensitization in Women with Carpal Tunnel Syndrome" Symmetry 13, no. 6: 1042. https://doi.org/10.3390/sym13061042
APA StylePellicer-Valero, O. J., Martín-Guerrero, J. D., Fernández-de-las-Peñas, C., De-la-Llave-Rincón, A. I., Rodríguez-Jiménez, J., Navarro-Pardo, E., & Cigarán-Méndez, M. I. (2021). Spectral Clustering Reveals Different Profiles of Central Sensitization in Women with Carpal Tunnel Syndrome. Symmetry, 13(6), 1042. https://doi.org/10.3390/sym13061042