Local effects of acupuncture on the median and ulnar nerves in patients with carpal tunnel syndrome: a pilot mechanistic study protocol

A Data Mining Study for Analysis of Acupoint Selection and Combinations in Acupuncture Treatment of Carpal Tunnel Syndrome

Background

Carpal tunnel syndrome (CTS) is the most prevalent upper limb compressive neuropathy. A considerable number of clinical trials and meta-analyses have provided evidence supporting the effectiveness of acupuncture in treating CTS. Nevertheless, the ideal choice of acupoints remains ambiguous.

Objective

A data mining analysis was conducted with the objective of determining the most effective acupoint combinations and selection for CTS.

Methods

A search was conducted across seven Chinese and English electronic bibliographic databases spanning from their inception to March 2023. Selected were clinical trials that evaluated the efficacy of acupuncture therapy for CTS, with or without randomised controlled methods. Data extraction mainly included acupoint prescriptions. Information such as first author, study design and study setting were also extracted. The principal outcomes comprised the clinical manifestations linked to CTS. Statistical descriptions were generated using Excel 2019. The analysis of association rules was conducted using SPSS Modeler 18.0. Using SPSS Statistics 26.0, exploratory factor analysis and cluster analysis were conducted.

Results

142 trials (including 86 RCTs and 56 non RCTs) were identified, and 193 groups of effective prescriptions involving 68 acupoints were extracted. The most frequently used acupoints were Da-ling (PC7), Nei-guan (PC6), He-gu (LI4), Wai-guan (TE5), and Yang-xi (LI5). The most frequently used meridians were the pericardial meridian and the large intestine meridian. The majority of special acupoints used were Five-shu points and Yuan-source points, with acupoints on the upper limbs being the most frequently used. The core acupoint groups were analyzed and 11 groups of association rules, 8 factors, and 5 effective cluster groups were obtained.

Conclusion

The evidence-based acupoint selection and combinations of acupuncture therapy for carpal tunnel syndrome were provided by the findings of this study.

Efficacy and safety of electroacupuncture for carpal tunnel syndrome (CTS): A systematic review and meta-analysis of randomized controlled trials

Aim

We carried out a systematic review and meta-analysis to evaluate the safety and efficacy of electroacupuncture for patients with carpal tunnel syndrome.

Methods

We searched PubMed, Embase, Cochrane Library, Scopus, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Chongqing VIP Database (VIP), and Wan Fang Database up to May 2022 for relevant studies. Relevant studies were identified by using specific eligibility criteria and data were extracted.

Results

A total of 26 randomized controlled trials (RCTs) with 1,698 patients were included. Compared with routine treatment, electroacupuncture treatment had lower visual analog scale (VAS) score [mean difference = −0.79, 95% confidence interval (CI): −1.11 to −0.47, P < 0.00001], and the symptom severity scale and function status scale in electroacupuncture group were significantly lower than the control group (P = 0.0001 and P = 0.006). Moreover, the electrophysiological parameters in the electroacupuncture group were better than the control group. The electroacupuncture group had higher total effective rate than the control group (odds ratio = 4.94, 95% CI: 3.44–7.08, P < 0.00001).

Conclusion

Our meta-analysis indicated that electroacupuncture had lower VAS score, higher total effective rate, a lower the scores of symptoms and function and electroacupuncture had better electrophysiological parameters. However, these findings needed to be verified further by multicenter, double-blind, and large-sample RCTs.

Effect of Acupotomy Combined with Electroacupuncture Therapy on Finger Mobility and Pain Relief in Patients with Carpal Tunnel Syndrome

Objective. To explore the effect of acupotomy in combination with electroacupuncture therapy on the finger mobility and pain relief in patients who had carpal tunnel syndrome (CTS). Methods. The clinical data of 60 CTS patients in our hospital from November 2020 to November 2021 received retrospective analysis. With 30 cases in each group, they were randomly divided into the treatment group and the control group. The control group underwent hot compress, oral medication, and local injection during hospitalization, while the treatment group received acupotomy and electroacupuncture therapy on top of the above treatments, and the clinical effects, finger mobility, and pain relief were compared between both groups. Results. The clinical indexes in the treatment group after treatment were remarkably better than those in the control group ( $P<0.05$ ), with the remarkably higher number of cured cases in the treatment group ( $P<0.05$ ). After treatment, the treatment group had remarkably higher mean total active motion (TAM) and score of the 36-item short form (SF-36) health survey and a remarkably lower mean score of visual analog scale (VAS) than those in the control group ( $P<0.001$ ). Conclusion. The quality of life and finger mobility of CTS sufferers can be improved with acupotomy in conjunction with electroacupuncture therapy. In-depth research will help build better procedures for these patients because this approach lessens the discomfort and shortens the symptom duration in CTS sufferers.

Effectiveness of therapeutic ultrasound for the treatment of carpal tunnel syndrome (the USTINCTS trial): study protocol for a three-arm, prospective, multicentre, randomised controlled trial

INTRODUCTION

There has no consensus on optimal management of carpal tunnel syndrome (CTS), the most common compression neuropathy. Conservative therapy is generally accepted as first-line intervention. Therapeutic ultrasound has been widely reported to be treatment beneficial in nerve regeneration and conduction, and further accelerate compression recovery. The purpose of this study is to investigate the effectiveness of therapeutic ultrasound for CTS treatment.

METHODS AND ANALYSIS

This study protocol entails a three-arm, prospective, multicentre, randomised controlled trial. 162 eligible adult participants diagnosed with mild to moderate CTS by using criteria developed from a consensus survey by the UK Primary Care Rheumatology Society will be assigned to either (1) therapeutic ultrasound, (2) night splint or (3) therapeutic ultrasound +night splint (combined) group. Primary outcome will be difference in Symptom Severity Scale of Boston Carpal Tunnel Questionnaire (BCTQ-SSS) at 6-week between night splint and therapeutic ultrasound +night splint groups. Secondary outcomes include Functional Status Scale of BCTQ, sleep questionnaire for interrupted sleep, EuroQol-5D for general health, Hospital Anxiety and Depression Scale for mental status, Work Limitations Questionnaire-25 for functional limitations at work, Global Rating of Change for treatment success and recurrence rate, physical examination, electrophysiological and ultrasound parameters. Intention-to-treat analyses will be used.

ETHICS AND DISSEMINATION

Ethics committees of all clinical centres have approved this study. The leading centre is Shanghai Sixth People's Hospital, whose approval number is 2021-152. New versions with appropriate amendments will be submitted to the committee for further approval. Final results will be published in peer-reviewed journals and presented at local, national and international conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2100050701.

The Use of Quantitative Sensation Testing to Identify the Physiological Differences Between the Median and Ulnar Nerves

Introduction

Similarities in morphology, physiological function, and neurophysiological findings between median and ulnar nerves are not unequivocal. Our previous study confirmed differences in motor fiber parameters between these nerves in healthy persons. We made an attempt to assess and compare the physiological parameters of different sensation modalities (temperature, pain, and vibration) in median and ulnar nerves.

Methods

The study was performed in 31 healthy, right-handed volunteers: 17 women, 14 men, mean age 44.8 ± 15.5 years. Standard sensory conduction tests in the median and ulnar nerves were performed together with the estimation of vibratory, temperature, and warm- and cold-induced pain thresholds in the C7 and C8 dermatomes on the palm, using quantitative sensory testing.

Results

There were no statistically significant differences in the standard sensory conduction test in the median and ulnar nerves across the whole group: between right and left hands, and between women and men. We revealed differences in the temperature and pain thresholds between these nerves, mainly in low temperature perception. There were no differences in estimated thresholds between sides or in female and male groups. The vibratory limits did not differ significantly between nerves, and subgroups.

Conclusion

The study confirmed the differences in the physiological sensory perception between the median and ulnar nerves. The median nerve is more sensitive to temperature stimulation than the ulnar nerve, but simultaneously less sensitive to pain-inducing temperature stimuli. These findings should be considered during the examination of hand nerve pathology.

Acupuncture plus night splint for quality of life and disability in patients with carpal tunnel syndrome: a randomized controlled trial

Background

Carpal tunnel syndrome (CTS) is a common condition caused by pressure on a nerve in the wrist. This study aimed to evaluate the effects of acupuncture plus night splinting on quality of life, function and pain in patients with CTS.

Methods

This research is a prospective randomized, single-center trial. Acupuncture and night splinting was applied two times a week for five weeks, while the control group received night splinting only. Outcomes measured were Quality of life (Nottingham Health Profile, NHP), function (Boston Carpal Tunnel Questionnaire) and pain (visual analogue scale, VAS).

Results

At the end of the treatment, the acupuncture plus splinting group showed more reduction in the pain level than the splinting group (p = 0.007). The change in the pain subscale of the NHP was significantly reduced in the acupuncture plus night splinting group than the night splinting group (p = 0.001). The change in sleep and physical activity subscale of the NHP score failed to show significant differences between the two groups. The functional scores also failed to show the signficant differences between the two groups.

Conclusion

The effect of acupuncture plus night splinting may show significant reduction on pain but failed to show significant differences on the other outcomes compared to the night splinting group. Further studies with larger sample size may confirm the findings.

The Efficacy of Acupuncture in Chemotherapy-Induced Peripheral Neuropathy: Systematic Review and Meta-Analysis

Background: Chemotherapy-induced peripheral neuropathy (CIPN) has no cure, but acupuncture may provide relief through its known neuromodulation or neuroendocrine adjustment. This review aimed to assess the efficacy of acupuncture in treating CIPN. Method: A literature review following the PRISMA Statement was performed, searching 7 databases from inception through August 2019. All studies were clinical trials of the effect of acupuncture on CIPN. The methodological quality of these trials was assessed using Cochrane criteria; meta-analysis software (RevMan 5.2) was used to analyze the data. Data Sources: The databases searched were the following: MEDLINE (Ovid), Embase, Cochrane CENTRAL, Scopus, World Health Organization International Clinical Trials Registry Platform, CNKI (China National Knowledge Infrastructure), and Wanfang Med Online. Results: We examined 386 cancer patients from 6 randomized control trials, which had high quality, based on the modified Jadad scale. Meta-analysis showed that acupuncture led to significant improvements in pain scores (-1.21, 95% confidence interval [CI] = -1.61 to -0.82, P < .00001) and nervous system symptoms based on Functional Assessment of Cancer Therapy/Neurotoxicity questionnaire scores (-2.02, 95% CI = -2.21 to -1.84, P < .00001). No significant change was noted in nerve conduction velocity (1.58, 95% CI = -2.67 to 5.83, P = .47). Conclusion: Acupuncture can effectively relieve CIPN pain and functional limitation. The limited number of subjects warrants a larger scale study.