Acupuncture in Patients with Carpal Tunnel Syndrome – A RCT.
Chun-Pai Yang, MD,*w z Ching-Liang Hsieh, MD, PhD,w y Nai-Hwei Wang, MD,Jz Tsai-Chung Li, PhD,z# Kai-Lin Hwang, MSc, ** Shin-Chieh Yu, MD,* and Ming-Hong Chang, MD w w zz – Clinical Journal of Pain, May 2009 (4) 327 – 333
Overview of Trail
RCT to test efficacy of acupuncture compared with steroid treatment for patients with mild to moderate carpal tunnel syndrome (CTS).
METHODS:
A total of 77 consecutive and prospective CTS patients confirmed by NCS were enrolled in the study. Those who had fixed sensory complaint over the median nerve and thenar muscle atrophy were excluded. The CTS patients were randomly divided into 2 treatment arms: (1) 2 weeks of prednisolone 20 mg daily followed by 2 weeks of prednisolone 10 mg daily (n = 39), and (2) acupuncture administered in 8 sessions over 4 weeks (n = 38). A validated standard questionnaire as a subjective measurement was used to rate the 5 major symptoms (pain, numbness, paresthesia, weakness/clumsiness, and nocturnal awakening) on a scale from 0 (no symptoms) to 10 (very severe). The total score in each of the 5 categories was termed the global symptom score (GSS). Patients completed standard questionnaires at baseline and 2 and 4 weeks later. The changes in GSS were analyzed to evaluate the statistical significance. NCS were performed at baseline and repeated at the end of the study to assess improvement. All main analyses used intent-to-treat.
RESULTS:
A total of 77 patients who fulfilled the criteria for mild-to-moderate CTS were recruited in the study. There were 38 in the acupuncture group and 39 in the steroid group. The evaluation of GSS showed that there was a high percentage of improvement in both groups at weeks 2 and 4 (P < 0.01), though statistical significance was not demonstrated between the 2 groups (P = 0.15). Of the 5 main symptoms scores (pain, numbness, paresthesia, weakness/clumsiness, nocturnal awakening), only 1, nocturnal awakening, showed a significant decrease in acupuncture compared with the steroid group at week 4 (P = 0.03). Patients with acupuncture treatment had a significant decrease in distal motor latency compared with the steroid group at week 4 (P = 0.012). Acupuncture was well tolerated with minimal adverse effects.
CONCLUSIONS:
Short-term acupuncture treatment is as effective as short-term low-dose prednisolone for mild-to-moderate CTS. For those who do have an intolerance or contraindication for oral steroid or for those who do not opt for early surgery, acupuncture treatment provides an alternative choice.
More detail about treatment
The patients who received acupuncture were treated with only two points:
PC-7 (Da Liing), PC-6 (Neiguan)
The needles were applied at standard depths for theses points. Thrusting and twirling stimulation was used after insertion and then the needles were left in for 30- minutes. This treatment was repeated twice a week for four weeks.
More Details about how results
For full details of other measurements see paper. Here’s a few I thought were interesting
Decrease in sleep disturbances / insomnia was measured. this is is fairly common in patients with CTS who are worken up by the pain and numbness sensations in the hand or they have trouble getting comfortable in bed to then relax into sleep. The acupuncture treatment had significantly better improvements in sleep disturbances compared with steroid treatment in week 4.
DML – Distal motor latancy – internal between stimulus and compound action muscle potential (CMAP).
Acupuncture had significantly better improvement in DML compared with steroid group
CMAP – the action potential of group of muscle fibres stimulated by a motor nerve
Steriod group had significantly better CMAP of the APB muscle (Abductor Pollicis Brevis – The muscle that abducts the thumb)
Side effects and drop outs
Some expected side effects during acupuncture treatment including pain , paresthesia. 5% of patients reported these symptoms during treatment.
18% of patients on steroids reported side effects and 4 dropped out due to intolerance of severe epigastralgia.
Comments
A good study but short and as the authors conclude we need more studies into long term treatment benefits of acupuncture for CTS . This would help determine whether acupuncture is required for long term symptom relief or after a longer period of time the acupuncture could be discontinued when CTS become asymptomatic. Perhaps after intensive treatment the patient requires less frequent treatments over a long period of time.