Acupuncture for Carpal Tunnel Syndrome
Posted on 31st January 2017 by Alexander Lekakis
This blog is a critical appraisal of a randomized controlled trial of acupuncture in the treatment of carpal tunnel syndrome (KHOSRAWI et al. 2012).
Carpal tunnel syndrome (CTS) is a common condition, whereby pressure on the median nerve in your wrist causes numbness, tingling, pain and muscular dysfunction in the hand and fingers. This syndrome occurs more frequently in women and especially pregnant women (Bland 2007), but can occur regardless of age, ethnicity or occupation (Gerritsen et al. 2002). The diagnosis in most cases is straightforward, leading to an option of conservative treatment or surgery for more chronic cases. The most common treatment option is conservative management, which can include splinting, local steroid injection and ultrasound. However, some acupuncture-trained physiotherapists may offer acupuncture as a treatment modality, although its effectiveness remains uncertain.
What was the study?
The purpose of this study was to compare the short-term effects of two different treatment combinations for carpal tunnel syndrome: night splinting and acupuncture vs. night splinting, vitamin B1, B6 and sham acupuncture.
The intervention group received night splinting and 8 sessions of acupuncture treatment over the course of 4 weeks.
For this study, 72 patients (Male n= 24, Female n= 48) passed the inclusion criteria and were randomly assigned to one of the two groups. Although 72 patients were initially included in the study, 8 were excluded. This meant that at the end of the 4 weeks, 64 patients completed the intervention.
Outcomes were measured at four weeks’ post intervention. As outcome measures, the Global Symptom Score (GSS) was used, whereby patients can report on their experience of their symptoms. Objective measures were also assessed, including Distal Motor Latency, Nerve Conduction Velocity and Distal Sensory Latency. These measure how well relevant nerves and muscles are responding. These results after 4 weeks were then compared to the findings of the initial baseline reading.
What were the results?
Following the evaluation of the 64 patients that completed the 4-week intervention, there was a significant difference in the Global Symptom Score for the patients that had acupuncture (p<0.001) compared to those who had received sham acuptuncture.
Interestingly, when the results compared the differences of the electrophysiological parameters, only the Nerve Conduction Velocity showed significant difference between the two groups (p=0.02) which indicated an improvement for the acupuncture group. The Distal Motor and Distal Sensory Latency tests respectively did not show statistical significant difference following the intervention (p>0.05).
Thus the results suggest that acupuncture can indeed improve the overall subjective symptoms of carpal tunnel syndrome compared to more conventional interventions.
Strengths and weaknesses:
For the evaluation of this study, the CASP RCT critical appraisal tool will be followed as a guideline.
- The patients were successfully randomly allocated, with no significant demographic differences between the groups at the start of the trial (p>0.05). All patients were accounted for throughout the study.
- The number of patients used for this study (n=64) was low following the exclusion of 8 patients due to unsuitability. Due to the low number of patients and many of them being female, both in the acupuncture group (71.9%) and in the control, group (78.1%), this calls into question how valid the results are. It is unclear whether the lack of difference between the groups in two of the outcome measures was due to lack of statistical power. Furthermore, the small sample size prevents subgroup analysis to further consider the effects of acupuncture in mild and moderate CTS.
- Another possible weakness in the study is the lack of information given about who was the delivering acupuncture to the patients was and how experienced they are, as this could affect the results.
- Additionally, due to the nature of the intervention involving physical treatment, blinding the practitioners was not possible (although it was a strength that sham acupuncture was used, so at least the patients were blinded). Nonetheless, the interpretation of the results could be affected.
- Lastly, the study is limited in that it only considers the short-term effects of acupuncture for CTS.
The findings of this study suggest that acupuncture may be able to improve the symptoms of CTS in patients with mild to moderate symptoms. However, a Cochrane meta-analysis which reviewed twenty-one studies, all using various forms of conservative management of CTS, concluded that acupuncture did not produce significant benefit (O’Connor et al. 2003). This shows the informative value of combining data from multiple studies, and highlights the need for using larger sample sizes and studies with a longer follow-up period.
Ultimately, the use of acupuncture may come down to patient preference. But it is also worth considering that acupuncture may not be a cost-effective intervention, as it requires specialist training and a licence to practice. Acupuncture is also time consuming and is not offered widely by most NHS trusts.
BLAND, J. D. P., 2007. Carpal tunnel syndrome. [online]. August, vol. 335, no. 7615, [viewed 27 December 2016]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1949464/
GERRITSEN, A., KROM, de, STRUIJS, M., SCHOLTEN, R., VET, de and BOUTER, L., 2002. Conservative treatment options for carpal tunnel syndrome: A systematic review of randomised controlled trials. Journal of neurology. [online]. May, vol. 249, no. 3, pp. 272–80 [viewed 9 January 2017]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11993525
KHOSRAWI, S., MOGHTADERI, A. and HAGHIGHAT, S., 2012. Acupuncture in treatment of carpal tunnel syndrome: A randomized controlled trial study. [online]. January, vol. 17, no. 1, [viewed 2 January 2017]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3523426/
O’CONNOR, D., MARSHALL, S. and MASSY-WESTROPP, N., 2003. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. The Cochrane database of systematic reviews. [online]. January, [viewed 6 January 2017]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/12535461