What Can Family Physicians Offer Patients With Carpal Tunnel Syndrome Other Than Surgery? A Systematic Review of Nonsurgical Management

I have published two papers utilizing laser acupuncture (and microamps TENS) to treat mild-moderate Carpal Tunnel Syndrome, which were not included in the Goodyear-Smith & Arroll, 2004, review of nonsurgical management of CTS:

Naeser MA, Hahn K-A K, Lieberman BE, Branco KF. Carpal Tunnel Syndrome Pain Treated with Low-Level Laser and Microamps TENS, A Controlled Study. Archives of Physical Medicine and Rehabilitation, 2002;83:978-988.

Branco K, Naeser MA. Carpal tunnel syndrome: Clinical Outcome After Low-Level Laser Acupuncture, Microamps Transcutaneous Electrical Nerve Stimulation, and Other Alternative Therapies - An Open Protocol Study. J Alternative and Complementary Med 1999; 5(1):5-26.

The success rate (as defined by at least a 50% reduction in pain following the full series of real laser acupuncture and microamps TENS treatments) was 88%; a placebo response was observed in 27% of the patients (as defined by at least a 50% reduction in pain following the full series of sham laser acupuncture and microamps TENS treatments) (Naeser et al., 2002). All patients had been diagnosed with CTS using nerve conduction studies: mild CTS (sensory involvement) or moderate CTS (sensory and motor involvement, with motor latencies above 4.3 ms).

In the open-protocol, acupuncture office study, the success rate was 92% (Branco & Naeser, 1999).

Patients with severe CTS (abnormal EMG) are not appropriate candidates for this conservative, nonsurgical treatment. However, in these patients with severe CTS, if pain persists following surgical release of the transverse carpal ligament, laser acupuncture with microamps TENS is appropriate (Branco & Naeser, 1999).

Website which describes the Naeser et al., (2002) study, and shows a supplemental home treatment program, including photographs of the program:

http://gancao.net/ht/cts.shtml

For more general information on low-level laser acupuncture:

http://gancao.net/ht/laser.shtml

Patients with mild-moderate CTS who wish to be treated with this alternative treatment may contact the Am. Assoc. of Oriental Medicine, for referral to a Licensed Acupuncturist who has been trained in laser acupuncture (1-888-500-7999).

It is suggested that this method be used early into the course of CTS, preferably within the first 6 to 12 months of symptom onset, although it may be effective in cases with CTS history of several years. A treatment course of three treatments per week (every other day) for 5 weeks (15 treatments) is recommended.

The abstract for the controlled study (Naeser et al., 2002) is copied below.

Objective: To investigate whether real or sham, low-level laser therapy (LLLT) plus microamps TENS applied to acupuncture points significantly reduces pain in carpal tunnel syndrome (CTS).

Design: Randomized, double-blind, placebo control, crossover trial. Patients and staff administering outcome measures, blinded.

Setting: Outpatient, V.A. hospital, university-affiliated.

Patients: Eleven mild-moderate CTS cases (nerve conduction study, clinical exam) who failed standard medical or surgical treatment for 3-30 months.

Intervention: Patients received real and sham treatment series (each for 3-4 weeks), order randomized. Real treatments used red-beam laser (continuous wave, 15 mW, 632.8 nm) on shallow acupuncture points on affected hand; infrared laser (pulsed, 9.4W, 904 nm) on deeper points on UE and cervical paraspinal areas; and microamps TENS on affected wrist. Devices were painless, non-invasive and produced no sensation whether real or sham. Hand treated behind hanging black curtain without patient knowing if devices were turned on (real) or off (sham).

Main Outcome Measures: Melzack pain score, sensory and motor latencies, Phalen and Tinel signs.

Results: Significant decreases in Melzack pain score, median nerve sensory latency, Phalen sign and Tinel sign, Post-real treatment series but not Post-sham. Patients able to perform prior work (computer typist, handyman) and stable for 1-3 years.

Conclusions: This new, conservative treatment was effective to treat CTS pain in this study, larger studies are recommended.

Competing interests:   None declared