Carpal tunnel syndrome pain treated with low-level laser and microamperes transcutaneous electric nerve stimulation: A controlled study.

OBJECTIVE To investigate whether real or sham low-level laser therapy (LLLT) plus microamperes transcutaneous electric nerve stimulation (TENS) applied to acupuncture points significantly reduces pain in carpal tunnel syndrome (CTS). DESIGN Randomized, double-blind, placebo-control, crossover trial. Patients and staff administered outcome measures blinded. SETTING Outpatient, university-affiliated Department of Veterans Affairs medical center. PARTICIPANTS Eleven mild to moderate CTS cases (nerve conduction study, clinical examination) who failed standard medical or surgical treatment for 3 to 30 months. INTERVENTION Patients received real and sham treatment series (each for 3-4wk), in a randomized order. Real treatments used red-beam laser (continuous wave, 15mW, 632.8nm) on shallow acupuncture points on the affected hand, infrared laser (pulsed, 9.4W, 904nm) on deeper points on upper extremity and cervical paraspinal areas, and microamps TENS on the affected wrist. Devices were painless, noninvasive, and produced no sensation whether they were real or sham. The hand was treated behind a hanging black curtain without the patient knowing if devices were on (real) or off (sham). MAIN OUTCOME MEASURES McGill Pain Questionnaire (MPQ) score, sensory and motor latencies, and Phalen and Tinel signs. RESULTS Significant decreases in MPQ score, median nerve sensory latency, and Phalen and Tinel signs after the real treatment series but not after the sham treatment series. Patients could perform their previous work (computer typist, handyman) and were stable for 1 to 3 years. CONCLUSIONS This new, conservative treatment was effective in treating CTS pain; larger studies are recommended.

[1]  J. Basford,et al.  Low‐energy laser therapy: Controversies and new research findings , 1989, Lasers in surgery and medicine.

[2]  A. Schindl,et al.  Low-Intensity Laser Irradiation Improves Skin Circulation in Patients With Diabetic Microangiopathy , 1998, Diabetes Care.

[3]  E. Mester,et al.  The biomedical effects of laser application , 1985, Lasers in surgery and medicine.

[4]  J. Balogun,et al.  The effects of acupuncture, electroneedling and transcutaneous electrical stimulation therapies on peripheral haemodynamic functioning. , 1998, Disability and rehabilitation.

[5]  G. A. Ferguson,et al.  Statistical analysis in psychology and education , 1960 .

[6]  W M Keyserling,et al.  Risk assessment in electronic assembly workers: carpal tunnel syndrome. , 1987, The Journal of hand surgery.

[7]  J. Matsumoto,et al.  Effects of 830 nm continuous wave laser diode irradiation on median nerve function in normal subjects , 1993, Lasers in surgery and medicine.

[8]  F. Soriano,et al.  GALLIUM ARSENIDE LASER TREATMENT OF CHRONIC LOW BACK PAIN: A PROSPECTIVE, RANDOMIZED AND DOUBLE BLIND STUDY , 1998 .

[9]  S. Passarella,et al.  He-Ne laser irradiation of isolated mitochondria. , 1989, Journal of photochemistry and photobiology. B, Biology.

[10]  H. Wolfe.  One approach to acumoxa therapy for pain due to tendinitis of the hand, wrist, and forearm , 1995 .

[11]  E. Lambert,et al.  Long-term results of operation for carpal tunnel syndrome. , 1966, Mayo Clinic proceedings.

[12]  Grant D. Huang,et al.  Clinical management of carpal tunnel syndrome: a 12-year review of outcomes. , 1999, American journal of industrial medicine.

[13]  D. Mason,et al.  Successful management of female office workers with "repetitive stress injury" or "carpal tunnel syndrome" by a new treatment modality--application of low level laser. , 1995, International journal of clinical pharmacology and therapeutics.

[14]  G Tam,et al.  Low power laser therapy and analgesic action. , 1999, Journal of clinical laser medicine & surgery.

[15]  Lars Hode,et al.  Low level laser therapy : clinical practice and scientific background : aguide for research scientists, doctors, dentists, veterinarians, and other interested parties within the medical field. , 1999 .

[16]  T. Yamamura,et al.  EFFICACY OF LOW REACTIVE-LEVEL LASER THERAPY FOR PAIN ATTENUATION OF POSTHERPETIC NEURALGIA , 1991 .

[17]  D. Walsh,et al.  Lack of effect of pulsed low‐intensity infrared (820 nm) laser irradiation on nerve conduction in the human superficial radial nerve , 2000, Lasers in surgery and medicine.

[18]  W. J. Hennessey,et al.  The Anatomy, Symptoms, and Signs of Carpal Tunnel Syndrome , 1997 .

[19]  L. Snyder-Mackler,et al.  Effect of helium-neon laser irradiation on peripheral sensory nerve latency. , 1988, Physical therapy.

[20]  Tiina I. Karu,et al.  Photobiological fundamentals of low-power laser therapy , 1987 .

[21]  Ralph D. Sawyer,et al.  Acupuncture : a comprehensive text , 1983, The Journal of Asian Studies.

[22]  R. E. Villalobos,et al.  Surgical Treatment of Carpal Tunnel Syndrome , 1997 .

[23]  C. Harris,et al.  The surgical treatment of the carpal-tunnel syndrome correlated with preoperative nerve-conduction studies. , 1979, The Journal of bone and joint surgery. American volume.

[24]  R. Gelberman,et al.  Carpal-tunnel syndrome. Results of a prospective trial of steroid injection and splinting. , 1980, The Journal of bone and joint surgery. American volume.

[25]  Raymond J. Lanzafame,et al.  Photomodulation of Oxidative Metabolism and Electron Chain Enzymes in Rat Liver Mitochondria , 1997, Photochemistry and photobiology.

[26]  Injury rates by industry 1970, BLS Report 406, Department of Labor, Bureau of Labor Statistics. , 1972, IMS, Industrial medicine and surgery.

[27]  J. C. Mulier,et al.  The effects of electric currents on ATP generation, protein synthesis, and membrane transport of rat skin. , 1982, Clinical orthopaedics and related research.

[28]  C. Ailioaie,et al.  BENEFICIAL EFFCTS OF LASER THERAPY IN THE EARLY STAGES OF RHEUMATOID ARTHRITIS ONSET , 1999 .

[29]  J. Walker,et al.  Relief from chronic pain by low power laser irradiation , 1983, Neuroscience Letters.

[30]  Royce C. Lewis,et al.  Treatment of carpal tunnel syndrome by members of the American Society for Surgery of the Hand: results of a questionnaire. , 1987, The Journal of hand surgery.

[31]  M. Naeser,et al.  Carpal tunnel syndrome: clinical outcome after low-level laser acupuncture, microamps transcutaneous electrical nerve stimulation, and other alternative therapies--an open protocol study. , 1999, Journal of alternative and complementary medicine.

[32]  C. Krarup,et al.  The carpal tunnel syndrome: diagnostic utility of the history and physical examination findings. , 1990, Annals of internal medicine.

[33]  G. Baxter,et al.  Therapeutic lasers : theory and practice , 1995 .

[34]  J. Kahn.  Principles and practice of electrotherapy , 1987 .

[35]  T. Ohshiro,et al.  A DOUBLE BLIND CROSSOVER TRIAL OF LOW LEVEL LASER THERAPY IN THE TREATMENT OF POSTHERPETIC NEURALGIA , 2004 .

[36]  D. Dawson,et al.  Entrapment neuropathies of the upper extremities. , 1993, The New England journal of medicine.

[37]  R. Melzack.  The McGill Pain Questionnaire: Major properties and scoring methods , 1975, PAIN.

[38]  GD Baxter,et al.  Effects of low intensity infrared laser irradiation upon conduction in the human median nerve in vivo , 1994, Experimental physiology.

[39]  Y. So,et al.  Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome , 1993, Muscle & nerve.

[40]  D. Walsh,et al.  Effect of low intensity laser (830 nm) irradiation on skin temperature and antidromic conduction latencies in the human median nerve: Relevance of radiant exposure , 1994, Lasers in surgery and medicine.

[41]  Raymond J. Lanzafame,et al.  Low Level Laser Therapy: Clinical Practice and Scientific Background , 1999 .

[42]  F. Chiou-Tan,et al.  Predicting acute denervation in carpal tunnel syndrome. , 1998, Archives of physical medicine and rehabilitation.

[43]  J. C. Stevens,et al.  AAEM minimonograph #26: The electrodiagnosis of carpal tunnel syndrome , 1997, Muscle & nerve.

[44]  P. Wall,et al.  Pain mechanisms: a new theory. , 1965, Science.

[45]  Kazuhiko Inoue,et al.  A DOUBLE-BLIND TRIAL OF LOW REACTIVE-LEVEL LASER THERAPY IN THE TREATMENT OF CHRONIC PAIN , 1998 .

[46]  M I Weintraub.  Noninvasive laser neurolysis in carpal tunnel syndrome , 1997, Muscle & nerve.