Acupuncture and related interventions for the treatment of symptoms associated with carpal tunnel syndrome

Abstract

Background Carpal tunnel syndrome (CTS) is a compressive neuropathic disorder at the level of the wrist. Acupuncture and other methods that stimulate acupuncture points, such as electroacupuncture, auricular acupuncture, laser acupuncture, moxibustion, and acupressure, are used in treating CTS. Acupuncture has been recommended as a potentially useful treatment for CTS, but its effectiveness remains uncertain. We used Cochrane methodology to assess the evidence from randomised and quasi-randomised trials of acupuncture for symptoms in people with CTS. Objectives To assess the benefits and harms of acupuncture and acupuncture-related interventions compared to sham or active treatments for the management of pain and other symptoms of CTS in adults. Search methods On 13 November 2017, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, AMED, CINAHL Plus, DARE, HTA, and NHS EED. In addition, we searched six Korean medical databases, and three Chinese medical databases from inception to 30 April 2018. We also searched clinical trials registries for ongoing trials. Selection criteria We included randomised and quasi-randomised trials examining the effects of acupuncture and related interventions on the symptoms of CTS in adults. Eligible studies specified diagnostic criteria for CTS. We included outcomes measured at least three weeks after randomisation. The included studies compared acupuncture and related interventions to placebo/sham treatments, or to active interventions, such as steroid nerve blocks, oral steroid, splints, non-steroidal anti-inflammatory drugs (NSAIDs), surgery and physical therapy. Data collection and analysis The review authors followed standard Cochrane methods. Main results We included 12 studies with 869 participants. Ten studies reported the primary outcome of overall clinical improvement at short-term follow-up (3 months or less) after randomisation. Most studies could not be combined in a meta-analysis due to heterogeneity, and all had an unclear or high overall risk of bias. Seven studies provided information on adverse events. Non-serious adverse events included skin bruising with electroacupuncture and local pain after needle insertion. No serious adverse events were reported. One study (N = 41) comparing acupuncture to sham/placebo reported change on the Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale (SSS) at three months after treatment (mean difference (MD) −0.23, 95% confidence interval (CI) −0.79 to 0.33) and the BCTQ Functional Status Scale (FSS) (MD −0.03, 95% CI −0.69 to 0.63), with no clear difference between interventions; the evidence was of low certainty. The only dropout was due to painful acupuncture. Another study of acupuncture versus placebo/sham acupuncture (N = 111) provided no usable data. Two studies assessed laser acupuncture versus sham laser acupuncture. One study (N = 60), which was at low risk of bias, provided low-certainty evidence of a better Global Symptom Scale (GSS) score with active treatment...

Acupuncture for the Relief of Chronic Pain: A Synthesis of Systematic Reviews

“…The earliest systematic reviews were published in 1989 by ter Riet [19][20][21]. There were 20 Cochrane SRs (including updates), with the earliest published in 2000 by Tulder et al [22] and the most recent published in 2018 by Choi et al [23]. Findings are presented according to the most frequent evaluations of acupuncture for different types of pain and described chronologically to provide a sense of the evolution of evidence over time.…”

Carpal Tunnel Syndrome Secondary to Ganglion Cyst, with Denervation of Abductor Pollicis Brevis

“…Oral and injected steroids have long-term treatment effects [10]. There is limited evidence of short-term clinical improvements with acupuncture, and adverse events are possible [11]. Manual therapy, nerve gliding exercises, and electrophysiological modalities improve nerve conduction and pain reduction and improve functional status [12].…”

Understanding Traditional Chinese Medicine Therapeutics: An Overview of the Basics and Clinical Applications

“…Carpal tunnel syndrome is a painful and disabling condition affecting the hands when the median nerve, which runs from the forearm into the hand, becomes compressed or inflamed at the wrist. If, one the one hand, the literature exploring the effects of acupuncture in the treatment of symptoms associated with carpal tunnel syndrome point to beneficial effects similar to, or sometimes better than, conventional treatment [ 115 , 116 ], on the other hand, some authors point to little or no effect compared to controls [ 117 , 118 ]. More studies are needed to clarify the ambiguities.…”