title: The Relationship Between Catastrophic Thinking and Hand Diagram Areas.
abstract: OBJECTIVE
  To evaluate the relationship between the total area marked on pain and numbness diagrams and psychosocial factors (depression, pain catastrophic thinking, and health anxiety).
  
  
  METHODS
  A total of 155 patients marked painful and numb areas on separate hand diagrams. Patients also completed demographic, condition-related, and psychosocial (Pain Catastrophizing Scale, Patient-Reported Outcomes Measurement Information System Depression Computer Adaptive Test, and Short Health Anxiety Inventory) questionnaires. Bivariate and multivariable analyses were used to determine factors associated with total area marked on the pain and numbness diagrams.
  
  
  RESULTS
  The total area marked on the pain diagram correlated with catastrophic thinking, symptoms of depression, and health anxiety. In multivariable analysis, catastrophic thinking was the sole predictor of marked pain area, accounting for 10% of variance in the hand pain diagram. The total area marked on the numbness diagram correlated with the interval between onset and visit, diagnosis, catastrophic thinking, and symptoms of depression. In multivariable analysis, the interval between onset and visit, a diagnosis of carpal tunnel syndrome, and catastrophic thinking were independently associated with total area marked on the hand numbness diagram.
  
  
  CONCLUSIONS
  Catastrophic thinking was independently associated with larger pain and numbness areas on a hand diagram. This suggests that larger symptom markings on hand diagrams may indicate less effective coping strategies. Hand diagrams might be used as a basis for discussion of coping strategies and illness behavior in patients with upper extremity conditions.
  
  
  METHODS
  Diagnostic III.
authors.affiliation: Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Moradi
authors.affiliation: Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Jos J
authors.initials: JJ
authors.lastname: Mellema
authors.affiliation: Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Kamilcan
authors.initials: K
authors.lastname: Oflazoglu
authors.affiliation: Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Aleksandr
authors.initials: A
authors.lastname: Isakov
authors.affiliation: Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: dring@partners.org.
authors.forename: David
authors.initials: D
authors.lastname: Ring
authors.affiliation: Department of Behavioral Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Vranceanu
mesh_terms: D000223:Adaptation, Psychological; D001007:Anxiety / Q000523:psychology; D002349:Carpal Tunnel Syndrome / Q000523:psychology*; D058443:Catastrophization / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology; D005260:Female; D006225:Hand; D006801:Humans; D006987:Hypesthesia / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D011795:Surveys and Questionnaires
keywords: Hand diagram; catastrophic thinking; pain and numbness; psychosocial; symptoms