Effectiveness of physiotherapy plus acupuncture compared with physiotherapy alone on pain, disability and grip strength in people with carpal tunnel syndrome: A randomized clinical trial

The effectiveness of single-dose blinded platelet-rich plasma (PRP) vs. corticosteroid injection in mild-to-moderate carpal tunnel syndrome: A prospective, randomized, double blind study

BACKGROUND

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and patients suffer from nocturnal paresthesia, numbness, and weakness. The many different methods used in the treatment of CTS include physical therapy modalities, oral medication, exercises, or injections. However, no single method has been shown to be superior to others. The aim of this study was to evaluate the effectiveness in the relief of CTS symptoms of single-dose platelet-rich plasma injection (PRP) vs. corticosteorid (CS) injection.

MATERIAL AND METHODS

The study included 78 wrists of 59 female patients with mild to moderate CTS, who were randomly assigned to one of the two groups for a single dose PRP or CS injection. All the injections were administered by the same physician. Evaluations at the end of one and six months were performed by a different physician who was blinded to the groups. The patient evaluations were made using the Boston carpal tunnel questionnaire (BTCQ), grip strength, provocation tests and electrophysiological parameters.

RESULTS

No significant differences were determined between the groups in terms of BTCQ, grip strengths and provocation tests. All the electrophysiological parameters improved in the CS group, and all except amplitudes in the PRP group. Mid-long term (1st-6th month follow-up) improvements in velocities were observed only in the PRP group.

CONCLUSION

Platelet-rich plasma injection did not seem to be superior to CS injection.

CLINICAL TRIAL REGISTRATION

clinicaltrials. gov (NCT04000932).

Comparing the effects of computerized versus manual methods of identifying point-specific acupuncture as an adjunct to physiotherapy in the management of knee osteoarthritis: A randomized controlled trial protocol

BACKGROUND

Knee osteoarthritis (KOA) is a prevalent condition causing significant pain and functional impairment. Acupuncture has shown promise as an adjunctive therapy, but conventional manual selection of acupoints lacks standardization. The Acugraph system provides a computerized method for identifying acupoints, potentially enhancing treatment precision.

OBJECTIVE

This study aims to compare the effects of computerized Acugraph-guided acupuncture versus manually selected acupuncture as adjuncts to physiotherapy in managing KOA.

METHODS

A randomized, double-blind controlled trial will be conducted with 50 participants diagnosed with mild to moderate KOA. Participants will be randomly assigned to one of two groups: Group 1 Comp-AcuPhysio (n = 25), receiving Acugraph-guided acupuncture with physiotherapy, or Group 2 Man-AcuPhysio (n = 25), receiving manually selected acupuncture with physiotherapy. Both groups will undergo 12 weekly treatment sessions, each lasting 60 minutes. Outcome measures, including the Knee Injury and Osteoarthritis Outcome Score, active knee flexion range, Timed Up and Go test, Visual Analog Scale for pain, Short Form-36 health survey, and Personal Integrated Energetics score, will be assessed at baseline and immediately post-intervention. An intention-to-treat analysis will be applied. Changes from baseline to 12 weeks will be analyzed using repeated measures analysis of variance for both within-group and between-group comparisons.

RESULTS

This study will provide a definitive assessment of the effectiveness of computerized Acugraph-guided acupuncture compared to manually selected acupuncture as supplementary treatments alongside KOA physiotherapeutic rehabilitation.

CONCLUSION

This trial will offer insights into how incorporating technology-driven approaches, such as Acugraph, with physiotherapy can enhance the customization and effectiveness of KOA management, leading to improved clinical outcomes. These results could advocate for the integration of technological tools in acupuncture to boost treatment precision and efficacy for KOA.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ACTRN12624000646549p).

How Does Nerve Mechanical Interface Treatment Impact Pre-Surgical Carpal Tunnel Syndrome Patients? A Randomized Controlled Trial

BACKGROUND

Carpal tunnel syndrome (CTS) presents a high burden on the healthcare system. However, no alternative treatments are provided during the waiting period. In addition, the incidence of severe patients with comorbidities is underestimated. The aim of this study was to determine whether nerve mechanical interface treatment improves the symptoms, function, and quality of life in pre-surgical CTS patients.

METHODS

A randomized controlled trial and intention-to-treat analysis were carried out. Forty-two patients with an electrodiagnosis of carpal tunnel syndrome, included on the surgery waiting list of a public healthcare system, were analyzed. The intervention group (n = 20) received a 45 min session/per week of instrument-assisted manual therapy (diacutaneous fibrolysis) for 3 weeks. The Boston Carpal Tunnel Questionnaire (BCTQ) was the primary outcome. The symptoms, mechanical threshold, grip strength, mechanosensitivity of the median nerve, quality of life, and patient satisfaction were included as secondary outcomes. The control group (n = 22) remained on the waiting list.

RESULTS

The intervention seems to be beneficial for the BCTQ score (function and symptoms scale), pain, and mechanosensitivity after treatment, at the 3 and 6 months follow-up (p < 0.05). Kinesiophobia was improved at 6 months (p = 0.043; η2 = 0.10) and the mechanical threshold at the 3-month follow-up (p = 0.048; η2 = 0.10). No differences were identified for grip strength. At 6 months, the intervention group patients were satisfied (100%), as opposed to the controls, who felt that they had experienced a worsening of their condition (50.1%).

CONCLUSIONS

Nerve mechanical interface treatment improved the symptoms, function, and quality of life in pre-surgical CTS patients. One hundred percent of the treated patients, characterized as moderate and severe CTS with associated comorbidities, were satisfied.

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.

The role of N6-methyladenosine modification in rodent models of neuropathic pain: from the mechanism to therapeutic potential

Neuropathic pain (NP) is a common chronic pain condition resulted from lesions or diseases of somatosensory nervous system, but the pathogenesis remains unclear. A growing body of evidence supports the relationship between pathogenesis and N6-methyladenosine (m6A) modifications of RNA. However, studies on the role of m6A modifications in NP are still at an early stage. Elucidating different etiologies is important for understanding the specific pathogenesis of NP. This article provides a comprehensive review on the role of m6A methylation modifications including methyltransferases ("writers"), demethylases ("erasers"), and m6A binding proteins ("readers") in NP models. Further analysis of the pathogenic mechanism relationship between m6A and NP provided novel theoretical and practical significance for clinical treatment of NP.