PAIN+ CPN

Wu IX, Lam VC, Ho RS, et al. Acupuncture and related interventions for carpal tunnel syndrome: systematic review. Clin Rehabil. 2019 Sep 26:269215519877511. doi: 10.1177/0269215519877511. (Systematic review)
Abstract

OBJECTIVE: To synthesize evidence on the effectiveness of acupuncture and related therapies for primary carpal tunnel syndrome (CTS) by conducting a systematic review of randomized controlled trials (RCTs).

DATA SOURCES: Nine databases were searched for potential RCTs from their inception till July 2019.

REVIEW METHODS: RCTs which reported at least one of the three outcomes were included: symptom severity, functional status and pain. Included RCTs were appraised using the Cochrane Risk of Bias Tool.

RESULTS: A total of 10 RCTs (728 participants) were included. Majority were at high risk of bias for blinding of participants, personnel and outcome assessors. When compared to conventional medications, manual acupuncture showed significant superior effect in reducing symptom than ibuprofen (mean difference (MD) on Symptom Severity Scale (SSS)) = -5.80, 95% confidence interval (CI): -7.95 to -3.65) and prednisolone (MD = -6.50, 95% CI: -10.1, -2.86). Electroacupuncture plus splinting was more effective in reducing symptom severity than splinting alone (SSS score: MD = -0.20, 95% CI: -0.36 to -0.03). Manual acupuncture showed significantly superior effect than ibuprofen in improving functional status (Functional Status Scale (FSS): MD = -1.84, 95% CI: -2.66 to -1.02). The combination of electroacupuncture and splinting showed more improvement in functional status compared to splinting alone (FSS: MD = -6.22, 95%CI: -10.7 to -1.71). Triple treatment of acupuncture, magnetic spectrum heat lamp and splinting showed stronger pain relief than splinting alone.

CONCLUSION: For both symptom relief and function improvement, manual acupuncture is superior to ibuprofen while electroacupuncture plus splinting outperforms splinting alone. Limited evidence showed electroacupuncture's potential role in pain reduction.

Ratings
Discipline Area Score
Physician 5 / 7
Comments from MORE raters

Physician rater

This review is composed of very small unblinded studies, so the conclusions are suspect.

Physician rater

Data are generally from biased studies but suggest that acupuncture may be helpful for CTS. Access to this may not be readily available.

Physician rater

Unfortunately, the study is 10-years-old and with poor validity.

Physician rater

Interesting but not practice-changing.

Physician rater

I am a primary care and sports medicine physician who frequently sees patients with carpel tunnel like symptoms. This study suggests that acupuncture may be of benefit. Given the methods and limitations of this review, one cannot conclude that acupuncture should be first-line treatment, but acupuncture should be considered for patients who are being referred for expensive and invasive treatments.

Physician rater

Acupuncture has an uncertain role in the management of patients with carpal tunnel syndrome. It is not better than traditional therapy in pain management. It may have a role in symptom management and functional status, although current studies are conflicting and have serious bias issues that make their results of uncertain validity.

Physician rater

As a Chinese medicine practitioner, the positive results of acupuncture for CTS are not surprising because I routinely see this in my practice. The SR results are very valuable in my communication with patients, general practitioners, and other health practitioners. To make it more relevant to acupuncturists, it would be helpful to compare the effects of different forms of acupuncture and of different combinations of points. The number of trials is perhaps too small to conduct such comparisons.
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