Electro acupuncture to alleviate cts symptoms

There is a little published work - not very good quality for electroacupuncture, a bit better but scanty for ordinary acupuncture. Overall I do not find it very convincing. We have a question about other treatments tried in our questionnaire. Relatively few people report having tried acupuncture and most of them say it did not help. JB

That is immensely helpful thank you, I am composing a research proposal for acupuncture and CTS currently. I am hugely impressed by your website and the level of knowledge on here.

You've presumably found the papers by Yang and the systematic review by Sim. Let me know if you get something off the ground and I'll keep an eye out for results in due course. JB

Yes I have seen both those papers thanks. Also the Branco study and a load of others - I am fortunate in being near the British Library in Boston Spa.
Out of interest I have been treating a patient in college clinic with CTS with success. She has had a shoulder problem as well and the treatment seems to have almost eradicated her symptoms of numbness and tingling at night. Her sister has also responded well to acupuncture and no longer has cts. I don't think either of them have had nerve tests though so it may be coincidental.
I have just looked at your papers on the BMJ website and they are so informative I wish I had found them earlier!

The link with diabetes has never been conclusively proven but circumstantial evidence suggests that there is one and it would make sense. Diabetes is known to impair the function of peripheral nerve generally and it is plausible that this could make the median nerves more susceptible to pressure in the carpal tunnel. The mechanism by which diabetes causes neuropathy is not fully understood and is probably a complex mixture of vascular and metabolic changes interacting with the particular genetic makeup of the patient (there do seem to be a few diabetic patients who never get peripheral nerve problems regardless of how long they live - so some people seem to be constitutionally resistant to this complication).

The evidence for a link with hypothyroidism comes mainly from a paper demonstrating resolution of CTS symptoms in a small group of patients treated with thyroxine. This seems fairly convincing but again the details of the mechanism by which thyroid function influences nerve function are rather obscure.

The most important thing to remember about anecdotal case reports in CTS (your two examples) is that a fairly substantial number of patients have a single episode of CTS which resolves spontaneously anyway and that many more have a relapsing remitting pattern of illness so that they tend to present for treatment at a time when symptoms have got worse and when they are in fact heading for the next remission and are going to improve anyway whether or not they are treated. When you add to that the placebo effect of any intervention it is not too hard to see why people become convinced that almost anything is good for CTS. It is a classic example of a condition where it is really hard to discern the effects of treatment without carefully blinded, randomised controlled trials. JB

So useful, thank you.

Have you seen the article by Kosrawi and Mogtaderi for acupuncture in treatment of carpal tunnel syndrome a randomized controlled trial study? J Res Med Sci 2012 January 17
I think it makes good use of blinding but I would appreciate your opinion (only if you have time). Also they reference you!

I hadn't seen this one yet but I've just read it now. It's not a bad attempt at a trial but there are some problems with it:

1) Although the paper is written in terms of patients treated and assessed there is no acknowledgement at all of the fact that patients have two hands. We are not told whether any of the subjects had bilateral symptoms nor whether one side or both were treated and analysed if there were bilateral symptoms. This is shoddy in a CTS paper.

2) The method of randomisation/treatment allocation is not described

3) The person administering the acupuncture/sham was clearly not blind to the treatment allocation - a potentially serious cause of bias and a hard one to avoid in an acupuncture trial. I suspect that the best you can do is to screen the treating physician off from the patient and try to prevent any interaction at any time between them and the patient other than the insertion of a needle, but the difficulty of doing this will be related to which acupuncture points you want to use

4) Although the patients were blindfolded for the acupuncture sessions the sham treatment regime included vitamin supplements whereas the true acupuncture treatment protocol seems not to have included these. This would make it perfectly obvious to the participants which treatment they received unless this is a mistake in the write up. I have never understood why investigators design these unnecessarily complex treatment regimes involving multiple simultaneous interventions for trials - it almost always renders the results uninterpretable.

5) No check seems to have been made as to the success of blinding by actually asking the patients whether they thought they had received the active or sham treatment. This is always a good idea where there are difficulties arranging blinding for a physical intervention.

6) There is mention in the discussion of the acupuncture group receiving more physician visits than the sham group. It is not obvious from the description why this should be so but if true it is quite possible that this may have introducd a significant bias.

7) The change in the NCS results is unimpressive. The difference in what I presume is short segment sensory NCV from 35.1 to 37.6 m/sec in the acupuncture group, though statistically significant (just) may just be a chance finding given that quite a few measurements were made and that others did not show any change.

Overall then I think one might count this as 'interesting but requires clarification from the authors' if considering this for a Cochrane review. JB

I had noticed some of these points - thank you for the feedback it really is invaluable. The particular feedback is about the NCS results is very important as its easy as a bystander to be impressed by this when in reality it is a small change.
I totally agree about the B6 - why add to the treatment something that is going to cloud the results!
Thank you again - I am now really enjoying my research!