Psychological Factors in Neurogenic Thoracic Outlet Syndrome: Resilience and Post-Surgical Quality of Life



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Neurogenic thoracic outlet syndrome (nTOS) is a complex condition caused by compression of neurovascular structures in the thoracic outlet and is often associated with chronic pain and disability. Surgical management of nTOS remains problematic due to poorly understood factors contributing to treatment outcomes and difficulties in patient selection. This is the first study to prospectively explore psychosocial functioning in a sample of nTOS patients (N=37) undergoing first rib resection and scalenectomy surgery (FRRS). Additional aims were to examine the role of resilience in preoperative psychosocial functioning and post-surgical outcomes. Participants completed self-report questionnaires at baseline and one-month post surgery measuring resilience (CD-RISC 10), depression (PHQ-9), anxiety (GAD-7), somatic symptom burden (SSS-8), pain severity (BPI-sf), and quality of life (POP and BPI-sf). Patients experienced a high incidence of depression (43.2%) and anxiety (35.1%) prior to surgery. Baseline psychosocial functioning was more impaired in divorced patients and those who used opioids. Paired-samples t tests revealed significant decreases in depression, anxiety, somatic symptoms, and pain severity, and a significant increase in quality of life. Correlational analyses showed that resilience modulated psychosocial impairment suffered by nTOS patients prior to surgery, but was not linked to better outcomes after surgery. These results provide evidence that FRRS is an effective intervention that provides significant pain relief, reduced symptoms, and improved psychosocial functioning. Results also support the use of a biopsychosocial approach to treating nTOS. Future research should continue exploring the relationship between patient factors predictive of poor treatment outcomes and resilience.

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Quality of Life, Ribs, Thoracic Outlet Syndrome, Treatment Outcome


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