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

Current Treatments and Future Directions for Facial Paralysis

Facial palsy is a condition that affects the facial nerve, the seventh of the 12 cranial nerves. Its main function is to control the muscles of facial expression. This involves the ability to express emotion through controlling the position of the mouth, the eyebrow, nostrils, and eye closure. The facial nerve also plays a key role in maintaining the posture of the mouth and as such, people with facial paralysis often have problems with drooling, speech, and dental hygiene.Due to the devastating effects on the quality of life of individuals with facial palsy, there are a multitude of various treatment options for the paralyzed face. This article reviews current management strategies and points towards promising future directions for research in the field of facial reanimation.

Efficacy of Laser Acupuncture on Neurophysiological Parameters of Median Nerve and Hand Function in Postpartum Women: A Randomized Controlled Clinical Trial

Objective: This study was conducted to ascertain the efficacy of photo acupuncture (PA) on the neurophysiological parameters of the median nerve and hand function in postnatal women. Background: Carpal tunnel syndrome (CTS) has been documented in up to 62% of pregnant females. PA, a noninvasive treatment that utilizes photo therapy on acupoints, could aid in the management of CTS. Material and Methods: Thirty-six postpartum women diagnosed with CTS depending on their medical history, physical examination, and electrodiagnostic study were distributed into two equal-sized groups at random. The PA group (n = 18) received PA for 12 min on the following acupuncture points: PC4, PC6, PC7, PC8, HT2, HT3, HT7, LI10, LI11, LI4, LU9, and LU10. The treatment was given 3 times weekly for four weeks; in addition, night splints were worn. Women in the control group (n = 18) just wore night splints. Before and after the 12-session treatment, each woman was assessed using an electrodiagnostic test to measure the motor distal latency (MDL), sensory distal latency (SDL), motor conduction velocity (MCV), sensory conduction velocity (SCV), pinch dynamometer for assessing pinch strength, and the Brief Michigan Hand Questionnaire (BMHQ) for assessing hand function. Results: A statistically significant improvement was observed in both groups after therapy regarding SDL, SCV, MDL, MCV, pinch strength, and BMHQ (p < 0.05) in favor of the PA group. Conclusion: Adding PA to a night splint should be suggested as an effective conservative therapy for CTS in postpartum women.

Comparison of high intensity laser therapy and extracorporeal shock wave in treatment of lateral epicondylitis: a randomized controlled study

This study aims to evaluate and compare the short-term efficacies of high-intensity laser therapy (HILT) and ESWT(focused) on pain, sensitivity, handgrip strength and functions, in the treatment of lateral epicondylitis (LE). Fourty seven patients (age range, 18 to 65 years) with unilateral elbow pain were randomized into two groups. HILT group (n = 24) and ESWT group(n = 23). The HILT and ESWT were administered three times a week for three weeks, and each treatment was combined with exercises. All paticipant in both of two groups were evaluated with ultrasonography for common extansor tendon thickness. A visual analog scale (VAS), quick Disabilities of the Arm, Shoulder, and Hand (QDASH), hand grip strength test were used to evaluate the patients before, one and six weeks after treatment. There were significant improvement in VAS, hand grip strength, QuickDASH scores and CET thickness before and after treatment in both group(p < 0,05). But there were no significant differences between the groups pre-treatment, at the 1st week, and 6th week after treatment (p > 0.05). Only hand grip strength was smilar to the pretreatment outcomes in HILT group. Both treatment methods were found to be effective and safe in the short-term treatment of LE. Consequently, these non-invasive, effective and safe techniques can be successfully used in the treatment of common pathology of the elbow.

Expediting the reversal of inferior alveolar nerve block anesthesia in children with photobiomodulation therapy

In pediatric dentistry, complications arising from extended soft tissue anesthesia can negatively impact patient comfort and trust in dental care. This study evaluates the clinical efficacy of diode laser-based photobiomodulation therapy (PBMT) in expediting the resolution of anesthesia in children aged 6-9 receiving inferior alveolar nerve block (IANB) injections. In this split-mouth double-blind randomized clinical trial, 36 pediatric subjects aged 6-9, requiring pulpotomy procedures on both sides of the mandible, received IANBs (single cartridge of 2% lidocaine/1:100,000 epinephrine). PBMT and sham laser were alternately applied to each side of the mandible, in two separate sessions, with the envelope method determining treatment allocation and intervention side on the first treatment day. During the laser session, laser (808 nm, 250 mW, 23s continuous, 0.5 cm², 11.5 J/cm², direct contact) irradiated two points at the injection site, five intra-oral and five extra-oral points along the infra-alveolar nerve's pathway. Soft tissue anesthesia reversal was quantified through tactile assessment. Soft tissue trauma was also assessed by the researcher and reported by parents 24 h post-dental visit. All data were analyzed using IBM SPSS Statistics v25.0 via Paired T-test, two-way repeated measures ANOVA, and McNemar's test. The laser group exhibited a mean lip anesthesia duration of 122.78 ± 2.26 min, while the sham laser group experienced 134.44 ± 21.8 min, indicating an 11.66-minute reduction in anesthesia duration for the laser group. (P < 0.001) Soft tissue trauma occurred in two sham laser group patients and one laser group patient, with no significant difference. (P = 1) The findings indicate that employing laser with defined parameters can reduce the length of IANB-induced anesthesia.

Photobiomodulation combination therapy as a new insight in neurological disorders: a comprehensive systematic review

Preclinical and clinical studies have indicated that combining photobiomodulation (PBM) therapy with other therapeutic approaches may influence the treatment process in a variety of disorders. The purpose of this systematic review was to determine whether PBM-combined therapy provides additional benefits over monotherapies in neurologic and neuropsychiatric disorders. In addition, the review describes the most commonly used methods and PBM parameters in these conjunctional approaches.To accomplish this, a systematic search was conducted in Google Scholar, PubMed, and Scopus databases through January 2024. 95 potentially eligible articles on PBM-combined treatment strategies for neurological and neuropsychological disorders were identified, including 29 preclinical studies and 66 clinical trials.According to the findings, seven major categories of studies were identified based on disease type: neuropsychiatric diseases, neurodegenerative diseases, ischemia, nerve injury, pain, paresis, and neuropathy. These studies looked at the effects of laser therapy in combination with other therapies like pharmacotherapies, physical therapies, exercises, stem cells, and experimental materials on neurological disorders in both animal models and humans. The findings suggested that most combination therapies could produce synergistic effects, leading to better outcomes for treating neurologic and psychiatric disorders and relieving symptoms.These findings indicate that the combination of PBM may be a useful adjunct to conventional and experimental treatments for a variety of neurological and psychological disorders.

Electrical Stimulation Use in Upper Extremity Peripheral Nerve Injuries

Peripheral nerve injuries can be debilitating and often have a variable course of recovery. Electrical stimulation (ES) has been used as an intervention to attempt to overcome the limits of peripheral nerve surgery and improve patient outcomes after peripheral nerve injury. Little has been written in the orthopaedic literature regarding the use of this technology. The purpose of this review was to provide a focused analysis of past and current literature surrounding the utilization of ES in the treatment of various upper extremity peripheral nerve pathologies including compression neuropathies and nerve transection. We aimed to provide clarity on the clinical benefits, appropriate timing for its employment, risks and limitations, and the need for future studies of ES.

Clinical efficacy of electroacupuncture-like magnetic therapy compared to conventional transcutaneous electrical nerve stimulation in individuals with carpal tunnel syndrome

This study aimed to evaluate the clinical efficacy of an electroacupuncture-like magnetic therapy (ELMT) and conventional transcutaneous electrical nerve stimulation (TENS) in patients with carpal tunnel syndrome (CTS). A prospective randomized controlled trial in single-centre was conducted. Thirty-four CTS patients confirmed by electrodiagnostic study were randomized into TENS or ELMT group and completed a six-week treatment program. TENS or ELMT treatment was applied on acupuncture point PC-6 (Neiguan) and one selected hand acupoint. Therapeutic exercises were also included after the electrophysical modality. Their physical signs, motor and sensory performances, Boston Carpal Tunnel Questionnaire (BCTQ) scores, and results of electrodiagnostic study were evaluated. After treatments, both groups demonstrated significantly decreased BCTQ scores and positive rate of Tinel's sign in the major symptomatic side, which indicated improvements in the symptom severity and physical functions. Significant increases in distal sensory amplitude and nerve conduction velocity of the median nerve were only found in the ELMT group. Our study found either conventional TENS or ELMT plus therapeutic exercises could improve the symptomatology and physical provocation sign of CTS. The ELMT has additional improvement in the nerve conduction in patients with CTS.

Clinical applications of electrical stimulation for peripheral nerve injury: a systematic review

Introduction

Peripheral nerve injuries are common neurologic injuries that are challenging to treat with current therapies. Electrical stimulation has been shown to accelerate reinnervation and enhance functional recovery. This study aims to review the literature on clinical application of electrical stimulation for peripheral nerve injury.

Methods

PubMed and Embase were sourced from 1995 to August 2022. Selection was based on predetermined inclusion/exclusion criteria. Eight hundred and thirty-five articles were screened with seven being included in this review.

Results

Two hundred and twenty-nine patients with peripheral nerve injuries were represented. Six of the studies were randomized controlled trials. A variety of nerve injuries were represented with all being in the upper extremity and supraclavicular region. Electrical stimulation protocols and evaluation varied. Electrodes were implanted in four studies with one also implanting the stimulator. Length of stimulation per session was either 20 mins or 1 h. Median stimulation frequency was 20 Hz. Stimulation intensity varied from 3 to 30V; pulse width ranged from 0.1 to 1.007 ms. Three protocols were conducted immediately after surgery. Patients were followed for an average of 13.5 months and were evaluated using electrophysiology and combinations of motor, sensory, and functional criteria.

Discussion

Patients who received electrical stimulation consistently demonstrated better recovery compared to their respective controls. Electrical stimulation for peripheral nerve injury is a novel treatment that has not been well-studied in humans. Our review illustrates the potential benefit in implementing this approach into everyday practice. Future research should aim to optimize protocol for clinical use.

Comparison of 4 weeks of cupping and Kinesio-taping on clinical and ultrasound outcomes of carpal tunnel syndrome during pregnancy

OBJECTIVE

To explore effect of cupping and Kinesio-taping techniques on clinical and ultrasound outcomes of carpal tunnel syndrome (CTS) during pregnancy.

METHODS

Thirty pregnant women suffering from CTS were randomly assigned into Kinesio-taping (n = 15) and cupping (n = 15) groups. In Kinesio-taping group, individuals underwent Kinesio-taping for three days, one day with no treatment, and three days with Kinesio-taping, continuing this procedure for four weeks. In cupping group, cupping was moved for 5 min with pressure of 50 mm-Hg on the carpal tunnel area. This procedure continued longitudinally in forearm area for 2 min. The therapeutic intervention of cupping group continued with eight sessions, two days a week for 4 weeks. Ultrasound outcomes including median nerve cross-sectional area through ultrasonography, and clinical outcomes including pain through visual analog scale and severity of symptoms and functional status through Boston questionnaire were measured in both groups before and after therapeutic program.

RESULTS

In both groups, a significant reduction was observed in all variables after treatment compared to pre-treatment (P < 0.001). In inter-group comparison, a significant improvement was found in outcomes of Boston questionnaire and ultrasound results about median nerve cross-sectional area at pisiform and hook of hamate in cupping group compared to Kinesio-taping at end of four weeks (P < 0.001).

CONCLUSION

Both cupping and Kinesio-taping improved clinical and ultrasound outcomes of CTS. However, efficacy of cupping compared to Kinesio-taping was better in improvement of median nerve cross-sectional area at hamate hook and pisiform levels, symptoms severity scale, and functional status scale, which makes the results clinically more applicable.

Electrical stimulation therapy for peripheral nerve injury

Peripheral nerve injury is common and frequently occurs in extremity trauma patients. The motor and sensory impairment caused by the injury will affect patients' daily life and social work. Surgical therapeutic approaches don't assure functional recovery, which may lead to neuronal atrophy and hinder accelerated regeneration. Rehabilitation is a necessary stage for patients to recover better. A meaningful role in non-pharmacological intervention is played by rehabilitation, through individualized electrical stimulation therapy. Clinical studies have shown that electrical stimulation enhances axon growth during nerve repair and accelerates sensorimotor recovery. According to different effects and parameters, electrical stimulation can be divided into neuromuscular, transcutaneous, and functional electrical stimulation. The therapeutic mechanism of electrical stimulation may be to reduce muscle atrophy and promote muscle reinnervation by increasing the expression of structural protective proteins and neurotrophic factors. Meanwhile, it can modulate sensory feedback and reduce neuralgia by inhibiting the descending pathway. However, there are not many summary clinical application parameters of electrical stimulation, and the long-term effectiveness and safety also need to be further explored. This article aims to explore application methodologies for effective electrical stimulation in the rehabilitation of peripheral nerve injury, with simultaneous consideration for fundamental principles of electrical stimulation and the latest technology. The highlight of this paper is to identify the most appropriate stimulation parameters (frequency, intensity, duration) to achieve efficacious electrical stimulation in the rehabilitation of peripheral nerve injury.

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.

Comparison of extracorporeal shock wave therapy and high-intensity laser therapy on pain, grip strength, and function in patients with lateral epicondylalgia: a randomized controlled study

This study aimed to compare the effects of extracorporeal shockwave therapy (ESWT) and high-intensity laser therapy (HILT) on pain, grip strength, and function in patients with lateral epicondylalgia. This prospective randomized controlled study included 42 patients (22 women and 20 men, mean age: 37) divided into 3 groups. The first group received physiotherapy (n = 14), the second received physiotherapy combined with ESWT (n = 14), and the third received physiotherapy combined with HILT (n = 14). All participants underwent 10 physiotherapy sessions for 2 weeks, 5 sessions per week. In addition to physiotherapy, the ESWT group received 4 ESWT sessions, 2 sessions per week, and the HILT group received 4 HILT sessions, 2 sessions per week. The outcomes were pain intensity as assessed by Visual Analog Scale, grip strength by hand dynamometer, and function by the Duruoz Hand Index and Patient-Rated Tennis Elbow Evaluation-Turkish version questionnaire. The participants were assessed at the beginning of the study (T1/week 0), at the end of treatment (T2/2nd week), and at follow-up (T3/6th week). At follow-up (T3), a significant improvement was observed in all outcomes compared to baseline (T1) in all groups (P < 0.05). Inter-group comparison of the mean differences between baseline and end values showed that the HILT group was superior in all outcomes (P < 0.05). This study showed that physiotherapy alone combined with ESWT and HILT positively affected the treatment of lateral epicondylalgia. Physiotherapy combined with HILT was found to be the most effective for improving pain, grip strength, and function. Clinical trial number: NCT674325.

Characterising the Features of 381 Clinical Studies Evaluating Transcutaneous Electrical Nerve Stimulation (TENS) for Pain Relief: A Secondary Analysis of the Meta-TENS Study to Improve Future Research

Background and Objectives: Characterising the features of methodologies, clinical attributes and intervention protocols, of studies is valuable to advise directions for research and practice. This article reports the findings of a secondary analysis of the features from studies screened as part of a large systematic review of TENS (the meta-TENS study). Materials and Methods: A descriptive analysis was performed on information associated with methodology, sample populations and intervention protocols from 381 randomised controlled trials (24,532 participants) evaluating TENS delivered at a strong comfortable intensity at the painful site in adults with pain, irrespective of diagnosis. Results: Studies were conducted in 43 countries commonly using parallel group design (n = 334) and one comparator group (n = 231). Mean ± standard deviation (SD) study sample size (64.05 ± 58.29 participants) and TENS group size (27.67 ± 21.90 participants) were small, with only 13 of 381 studies having 100 participants or more in the TENS group. Most TENS interventions were ‘high frequency’ (>10 pps, n = 276) and using 100 Hz (109/353 reports that stated a pulse frequency value). Of 476 comparator groups, 54.2% were active treatments (i.e., analgesic medication(s), exercise, manual therapies and electrophysical agents). Of 202 placebo comparator groups, 155 used a TENS device that did not deliver currents. At least 216 of 383 study groups were able to access other treatments whilst receiving TENS. Only 136 out of 381 reports included a statement about adverse events. Conclusions: Clinical studies on TENS are dominated by small parallel group evaluations of high frequency TENS that are often contaminated by concurrent treatment(s). Study reports tended focus on physiological and clinical implications rather than the veracity of methodology and findings. Previously published criteria for designing and reporting TENS studies were neglected and this should be corrected in future research using insights gleaned from this analysis.

Physical therapy versus radial extracorporeal shock wave therapy in the treatment of carpal tunnel syndrome: A randomized-controlled study

Objectives: This study aims to compare the efficacy of physical therapy (PT) and radial extracorporeal shock wave therapy (rESWT) in the treatment of carpal tunnel syndrome (CTS).

Patients and methods: Between May 2020 and July 2020, a total of 125 wrists of 95 patients (22 males, 73 females; mean age: 54.3±11.3 years; range, 19 to 69 years) with mild-to-moderate CTS were allocated into three groups and evaluated. The control group (Group 1, n=42) was treated with splinting and an exercise program. Group 2 (n=42) was treated with a total of three sessions of rESWT, splinting and an exercise program. Group 3 (n=41) was treated with a total of 15 sessions of PT modalities, splinting, and an exercise program. Each patient was evaluated before, three weeks and 12 weeks after treatment using a Visual Analog Scale (VAS), the Boston Carpal Tunnel Questionnaire (BCTQ), the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale, and electrodiagnostic testing.

Results: The reduction in VAS, BCTQ, LANSS, and improvement in sensory nerve conduction velocity were significantly greater at three and 12 weeks of follow-up in Groups 2 and 3, compared to Group 1 (p<0.001). A greater improvement was observed in all clinical parameters in Group 2, compared to Group 3 (p<0.001).

Conclusion: This is the first study to compare the treatment outcomes of PT and rESWT in the treatment of CTS. The results of this study show that both PT and rESWT are effective in the treatment of CTS; however, rESWT yields superior treatment effects compared to conventional PT. The practicalities of administering rESWT and its efficacy in the treatment of CTS may make it the treatment of choice.

Comparison of low power laser and kinesio taping for the treatment of carpal tunnel syndrome: A prospective randomized study

BACKGROUND

Although carpal tunnel syndrome (CTS) is a common neuromuscular disorder, studies on its conservative treatment are inadequate and contradictory.

OBJECTIVES

This study aimed to investigate and compare the effectiveness of low power laser therapy (LPLT) and Kinesio taping (KT) for the treatment of CTS.

METHODS

Sixty patients with CTS were included in this study. One group received 15 sessions of KT, and the second group underwent 15 sessions of LPLT within three weeks. All patients were assessed with hand grip strength (HGS), Visual Analogue Scale (VAS)-pain, Douleur Neuropathique-4 (DN4) score, Boston Questionnaire (BQ), and electroneuromyography before and after treatment.

RESULTS

Before treatment, all clinical and neurophysiological parameters were similar between the groups. After treatment, both groups significantly improved in terms of HGS, VAS-pain, DN4, and BQ. However, the LPLT group had significantly better HGS, VAS-pain, DN4, and BQ than the KT group. In addition, while median nerve motor distal latency and median nerve sensory conduction velocity improved significantly with treatment in both groups, the LPLT group's improvement was significantly better than that of the KT group.

CONCLUSIONS

In patients with CTS, both LPLT and KT were effective treatments. However, the LPLT group had significantly better improvements than the KT group.

The Effectiveness of Laser Acupuncture for Treatment of Musculoskeletal Pain: A Meta-Analysis of Randomized Controlled Studies

Objective

To evaluate the treatment effectiveness of laser acupuncture (LA) in patients with musculoskeletal pain.

Methods

Major electronic databases, including Medline, PubMed, Embase, Cochrane Library, CINAHL, and Scopus were searched to identify double-blind, randomized controlled trials of LA in musculoskeletal disorders. The primary outcome was the treatment efficacy for pain. The secondary outcomes included the comparison of disability, functional impairment, and dropout rate between LA and sham treatment, as well as the effect of sham treatment for pain. The results from included studies were synthesized with the random effects model.

Results

In total, 20 articles comprising 568 patients receiving LA and 534 patients receiving sham treatment were included in the current study. Our analysis showed LA significantly reduced pain (g=0.88, 95% confidence interval [CI]=0.35 to 1.42, p=0.001), disability (g=0.68, 95% CI=0.29 to 1.08, p<0.001), and functional impairment (g=0.67, 95% CI=0.32 to 1.03, p<0.001). Through meta-regression analysis, we found these effects were not moderated by mean age, the percentage of females, or treatment duration. Additionally, there was no significant difference between the two groups in dropout rate (risk ratio=0.73, p=0.08), and the sham treatment significantly reduced only pain intensity (g=0.54, 95% CI=0.32 to 0.77, p<0.001).

Conclusion

Our findings supported that LA significantly reduced pain, disability, and functional impairment in patients with musculoskeletal disorders. Further researches are required to determine the optimal therapeutic parameters and the suitable patients for receiving LA.

Protocol Registration

CRD42020190919.

A cartography of energy medicine: From subtle anatomy to energy physiology

The field of energy medicine (EM) is perhaps the most controversial branch of integrative medicine. Its core concept - the existence of an invisible healing energy - has not yet been validated by Western medicine, and the mechanism(s) of action of its techniques have not been fully elucidated. This paper addresses these problems by marshalling several types of evidence: basic science research into electromagnetic fields (EMF), subjective sensations experienced when receiving EM treatments, and clairvoyant perceptions of EM in action. The latter two sources of information, while not solid enough to meet current standards of scientific rigor, can nonetheless generate important new information. A hypothesis is then developed to explain these findings. First, the main components of the human subtle energy system are presented: the "subtle anatomy" of the meridians, of the energy centers and of the biofield. Several representative EM techniques are then analyzed to determine which specific components of that energy structure they impact. Next, EM's mechanisms of action are explored by describing how these altered energy dynamics can affect biologic processes. This subject is termed "energy physiology", in parallel with conventional medicine's foundation in anatomy and physiology. Finally, potential research into energy physiology is outlined that focuses on several common but distinctive experiences which are not fully explained by the current mechanistic biomedical model. Plausible and testable energy-based explanations are proposed for phantom limb pain, emotional entrainment in groups, unusually rapid symptom response to EM, and the invisible templates that guide cell growth and differentiation. This analysis is intended to serve as a guide to future clinical and research explorations into the multidimensional nature of human beings. As Western medicine develops technologies that can generate objective empiric evidence in these subtle domains, we will be able to more fully understand the energetic components of health and illness.

The Safety of Laser Acupuncture: A Systematic Review

Objective: Laser acupuncture has become increasingly attractive in clinical practice, especially for patients with needle phobias well as elderly people and children. However, literature concerning the safety of laser acupuncture has been limited. This systematic review synthesizes the current available literature on the safety of laser acupuncture. Methods: Ovid MEDLINE,^® Epub Ahead of Print, In-Process & Other Non-Indexed Citations Daily, Ovid Embase, Scopus, and EBM Reviews-Cochrane Central Register of Controlled Trials databases were searched for available randomized controlled trials (RCTs) on laser acupuncture. Safety data were extracted from the included studies. Adverse events (AEs) data were extracted and assessed in terms of severity and causality. Results: Of 737 articles, 21 RCTs were included. The majority of these RCTs reported that laser acupuncture was safe, without AEs; 6 trials reported AEs (including tingling, pain flare-ups, and transient fatigue). All AEs were mild and resolved spontaneously within 24 hours. The causal relationship between AEs and laser acupuncture was felt to be "certain" in 4 studies, "probable" in 1 study, and "possible" in 1 study. AEs were collected and monitored by evaluation methods in 7 trials: 5 with AE questionnaires, 1 with a checklist, and 1 with oral reports. Conclusions: Laser acupuncture appears to be a safe therapy associated with few mild and transient AEs. However, given the heterogeneity of current studies, large, well-designed placebo-controlled RCTs with rigorous evaluation methods are needed to assess the safety of laser acupuncture more completely.

Light-emitting diode photobiomodulation therapy for non-specific low back pain in working nurses: A single-center, double-blind, prospective, randomized controlled trial

BACKGROUND

Low back pain (LBP) affects approximately 51% to 57% of hospital nurses and nurses' aides in Europe. New high-risk groups include home- and long-term-care nurses and physiotherapists. A number of European countries are experiencing a shortage of healthcare workers. Light therapy has been shown to be an effective treatment for various musculoskeletal disorders, including lateral epicondylitis, temporomandibular joint pain, carpal tunnel syndrome, and delayed-onset muscle soreness. A systematic review and meta-analysis demonstrated that low-level laser therapy is an effective method for relieving non-specific chronic low back pain (NSCLBP). However, the efficacy of light-emitting diode (LED) therapy for NSCLBP is disputed. This study aims to evaluate the effect of LED therapy on NSCLBP.

METHODS AND ANALYSIS

We conducted a prospective, double-blind, randomized placebo-controlled trial of 148 patients with NSCLBP. The patients were randomly assigned to 2 groups: intervention group, where patients received LED photobiomodulation therapy 3 times a week for 2 weeks, and the sham group, where patients had sham therapy 3 times a week for 2 weeks. Primary outcome measures included the visual analog scale for pain, lumbar active range of motion assessments, and chair-rising times. Secondary outcome measures included a multidimensional fatigue inventory, fear-avoidance beliefs questionnaire, and the Oswestry disability index. The outcome measures were assessed before therapy and 2weeks, 4 weeks, 8 weeks, 12 weeks, and 6 months after the first interventions were completed.

DISCUSSION

This study is a prospective, single-center, double-blind, randomized, controlled study. This study aims to research the efficacy of a 2-week LED program for NSCLBP working nurse. Our results will be useful for patients, working nurses, nurses' aides, and other healthcare workers with chronic low back pain.

TRIAL REGISTRATION NUMBER

NCT04424823.

Comparison of two manual therapy techniques in patients with carpal tunnel syndrome: A randomized clinical trial

Background

Manual therapy techniques are part of physiotherapy treatment of carpal tunnel syndrome (CTS) which are classified into two groups including nerve mobilization and mechanical interface mobilization. The aim of the study was to find which manual therapy method-technique directed to mechanical interface and nerve mobilization-has superior beneficial effects on clinical and electrophysiological findings in conservative management of patients with CTS.

Methods

Thirty patients with CTS participated into two groups namely: mechanical interface and nerve mobilization in this randomized clinical trial. The intervention was performed three times weekly for 4 weeks. Mechanical interface mobilization was directed to structures around the median nerve at the forearm and wrist. Techniques of median nerve gliding and tension were used in the nerve mobilization group. The outcome measures included visual analogue scale (VAS), symptom severity scale (SSS), hand functional status scale (FSS) and motor and sensory distal latencies of median nerve. Paired t-test and ANCOVA were used for statistical analysis.

Results

At the end of the 4^th week of the treatment, the mean of VAS, SSS and FSS significantly improved in both groups (p<0.05), but the difference was not significant between the two groups (P>0.05). Although the mean of motor and sensory distal latencies of median nerve at the end of the treatment period only improved in the nerve mobilization group (p<0.05), the difference was not significant between the two groups (P>0.05).

Conclusion

Mechanical interface mobilization and nerve mobilization techniques are not superior to each other in reducing pain and improving hand symptoms and functional status.

Effectiveness of Low-Level Laser Therapy compared to Ultrasound in Patients With Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis

Introduction: Carpal tunnel syndrome (CTS) is the most common type of peripheral entrapment neuropathy that occurs in the wrist area in a space called the carpal tunnel. Low-level laser therapy (LLLT) and ultrasound are among the most common methods of physical modalities for treating CTS; the effectiveness of these 2 methods and the superiority of one over the other are not agreed among experts. Methods: In the present systematic review and meta-analysis study, the most important databases including PubMed, Cochrane Library, Scopus, Centre for Reviews and Dissemination, Science Direct, Trip medical database and Google Scholar were searched using appropriate keywords and specific strategies without time limitation to collect data. The collected data was analyzed using the meta-analytic method and the random-effects model. The heterogeneity among studies was examined using I2 . The data were analyzed using Review Manager Software. Results: From among 108 related studies, 49 cases were entered for the first stage. After the final examination, 6 studies were selected for meta-analysis. The total number of patients in these 6 studies was 403; 204 subjects were in the LLLT group and 199 subjects were in the ultrasound group. The results of the meta-analyses showed that there was no significant difference between these 2 therapeutic methods in terms of pain relief, symptom severity scale (SSS), functional status scale (FSS), motor latency, sensory latency, hand grip strength, and motor amplitude. Conclusion: Based on the meta-analyses, there was no significant difference between the 2 LLLT and ultrasound methods; in other words, they had similar effectiveness in improving the condition of patients with CTS. However, the authors believe that arriving at conclusions in this area requires high-quality and large size studies.

Laser Acupuncture for Carpal Tunnel Syndrome: A Single-Blinded Controlled Study

Objectives: This study aimed to compare the efficacy of laser acupuncture (LA) treatment with that of placebo LA treatment in patients with idiopathic, mild-to-moderate carpal tunnel syndrome (CTS), as measured by subjective symptom assessments and objective changes in nerve conduction studies (NCSs). Design: A randomized, single-blinded, controlled study. Settings: A Teaching Hospital in the Taichung, Taiwan between March 2013 and November 2013. Subjects: 84 consecutive treatment-naive patients with CTS. Interventions: Participants were randomly divided into two treatment arms: (1) LA, administered at traditional Chinese acu-points on the affected side, once a day, 5 times a week, for 4 weeks (N = 43); and (2) placebo LA, administered using the same device and protocol, with the LA device switched off (N = 41). Outcome measures: Patients completed the Global symptom score (GSS) at baseline and two and four weeks later. The primary outcome was changes in GSS. NCSs were performed at baseline and repeated at the end of the study as a secondary outcome. Results: There was a significantly greater reduction in GSS in the LA group than in the placebo group at week 2 (-9.30 ± 4.94 vs. -2.29 ± 4.27, respectively, P < 0.01) and at week 4 (-10.67 ± 5.98 vs. -2.90 ± 5.61, respectively, P < 0.01). However, NCSs did not show significant difference between the two groups. Conclusions: LA may be more effective than placebo LA in the treatment of mild-to-moderate idiopathic CTS in terms of subjective measurement. For patients who fear needle-based treatment, such as acupuncture or local injections, or those who do not opt for early surgical decompression, LA treatment can be considered as an effective and alternative form of acu-points stimulation therapy.

Efficacy of laser acupuncture for carpal tunnel syndrome: A study protocol for a prospective double-blind randomized controlled trial

INTRODUCTION

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy that causes hand discomfort and work disability. Since no satisfactory conventional treatments for mild to moderate CTS exist, we apply complementary alternative medicine (CAM) to this problem. Laser acupuncture (LA), a new, non-invasive therapy which uses low-level-laser therapy (LLLT) in acupuncture could help to manage CTS. However, only one small randomized, double-blind and crossover trial had been conducted, which is not enough to provide an evidence-based assessment of the effects of LA on CTS.

OBJECTIVES

The aim of this study protocol is to investigate the efficacy of LA therapy on patients with mild to moderate CTS through sonography of the median nerve and offer clear parameters of LLLT.

METHODS

This study protocol is a prospective double-blind randomized controlled trial. Forty subjects aged 20 to 80 years old and diagnosed as having mild to moderate CTS will be randomly assigned to the intervention group (real LA, 3-sessions a week for 2 weeks) and control group (sham LA, 3-sessions a week for 2 weeks). All subjects will be asked to wear night splints as the fundamental management approach. The laser parameters will include a wavelength of 808 nm, power output of 300 mW and power density of 300 mW/mm, with ten seconds of treatment for each acupuncture point (PC4, PC6, PC7, PC8, LI4, LI10, LI11, HT3, HT7, and LU10). Sham LA treatment will be applied without any laser power output. The primary outcome will be based the Boston Carpal Tunnel Syndrome Questionnaire and secondary outcomes included a visual analog scale, cross sectional area of median nerve by sonography and electrophysiological test before interventions and after 2, 4, 8, 12 weeks postintervention.

TRIAL REGISTRATION

ClinicalTrials.gov (Identifier: NCT03580265).

The relationship of pain on the upper extremity functions and quality of life in patients with carpal tunnel syndrome

BACKGROUND AND OBJECTIVES

The aim of study was researching the relationship of pain in patients with carpal tunnel syndrome on Quality of Life (QoL) and upper limb functionality.

METHODS

Demographical and physical measurements were performed by a physiotherapist. Pain levels were measured by Visuel Analog Scale at rest, on motion and in fatique, and the patients' results were recorded. Functionality levels were evaluated by 'Boston Carpal Tunnel Syndrome Questionnaire' and QoL by 'Short Form 12' (SF-12). Patients had 10 sessions of the physiotherapy and rehabilitation program. Assessments were repeated 1 month later.

RESULTS

The mean age 49.97 ± 11.15 years of 28 patients were included. While pre- and post-treatment between pain and functionality evaluation found a significant relationship (p< 0.05); there was no significant relationship in QoL (SF-12 p> 0.05).

CONCLUSIONS

As a result while we found statistical differences between pain and symptomatic status; there were no statistical differences between functionality, daily living activities and QoL. Appropriate rehabilitation programs should be taken into consideration to help patients obtain functionality, daily living activities and QoL.

Is manual therapy based on neurodynamic techniques effective in the treatment of carpal tunnel syndrome? A randomized controlled trial

OBJECTIVE:

The aim of this study was to evaluate the efficacy of manual therapy based on neurodynamic techniques in conservative treatment of carpal tunnel syndrome.

DESIGN:

Randomized controlled trial.

SETTING:

Several medical outpatient clinics in the south of Poland.

PARTICIPANTS:

The study included 103 patients with mild and moderate carpal tunnel syndrome (mean age = 53.95, SD = 9.5) years, who were randomly assigned to a neurodynamic techniques group (experimental group, n = 58) or a group without treatment (control group, n = 45).

INTERVENTION:

Neurodynamic techniques were used in the experimental group. Treatment was conducted twice weekly (20 sessions). Control group did not receive treatment.

MAIN MEASURES:

Nerve conduction study, pain, symptom severity and functional status of Boston Carpal Tunnel Questionnaire, and strength of cylindrical and pincer grips were assessed at baseline and immediately after treatment (nerve conduction study one month after treatment).

RESULTS:

Baseline assessment revealed no group differences in any assessed parameters ( P > 0.05). There were significant differences between groups after treatment, including nerve conduction (e.g. sensory conduction velocity: experimental group: 38.3 m/s, SD = 11.1 vs control group: 25.9 m/s, SD = 7.72, P  < 0.01). Significant changes also occurred in pain (experimental group: 1.38, SD = 1.01 vs control group: 5.46, SD = 1.05, P < 0.01), symptom severity (experimental group: 1.08, SD = 0.46 vs control group: 2.87, SD = 0.68, P < 0.01), and functional status (experimental group: 1.96, SD = 0.64 vs control group: 2.87, SD = 1.12, P < 0.01). There were no group differences in strength ( P > 0.05).

CONCLUSION:

The use of neurodynamic techniques in conservative treatment for mild to moderate forms of carpal tunnel syndrome has significant therapeutic benefits.

Clinical evidence and mechanisms of growth factors in idiopathic and diabetes-induced carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is an entrapment neuropathy caused by compression and irritation of the median nerve, which travels through the carpal tunnel in the wrist. Increased fibrosis is a hallmark of the development and pathology of CTS. Different growth factors have been demonstrated to play a potential role in the development of CTS. Studies have described an increase in the expression of growth factors, including Transforming Growth Factor (TGF-β), Vascular Endothelial Growth Factor (VEGF) and interleukins (growth factors for immune and inflammatory cells) in SSCT (sub-synovial connective tissue) in CTS patients. Additionally, SSCT fibrosis is also marked by increased activation of canonical TGF-β second messenger Smads, increased expression of downstream fibrotic mediators such as connective tissue growth factor (CTGF), increased production of collagen type I, II, III and IV, and decreased expression of matrix metalloproteinases. Anti-fibrotic such as anti-TGF treatment may prove beneficial in idiopathic patients, however, anti VEGF therapy can be successful in the diabetic CTS patients. The present review describes the clinical evidence stating the role of different growth factors in the development of fibrosis in idiopathic and diabetes induced CTS.

Conservative therapeutic management of carpal tunnel syndrome

ABSTRACT Carpal tunnel syndrome is the most prevalent nerve compression and can be clinically or surgically treated. In most cases, the first therapeutic alternative is conservative treatment but there is still much controversy regarding the most effective modality of this treatment. In this study, we critically evaluated the options of conservative treatment for carpal tunnel syndrome, aiming to guide the reader through the conventional options used in this therapy.

Low-level laser therapy for carpal tunnel syndrome

BACKGROUND

The role of low-level laser therapy (LLLT) in the management of carpal tunnel syndrome (CTS) is controversial. While some trials have shown distinct advantages of LLLT over placebo and some other non-surgical treatments, other trials have not.

OBJECTIVES

To assess the benefits and harms of LLLT versus placebo and versus other non-surgical interventions in the management of CTS.

SEARCH METHODS

On 9 December 2016 we searched CENTRAL, MEDLINE, Embase, and Science Citation Index Expanded for randomised controlled trials (RCTs). We also searched clinical trial registries for ongoing studies. We checked the references of primary studies and review articles, and contacted trial authors for additional studies.

SELECTION CRITERIA

We considered for inclusion RCTs (irrespective of blinding, publication status or language) comparing LLLT versus placebo or non-surgical treatment for the management of CTS.

DATA COLLECTION AND ANALYSIS

Two review authors independently identified trials for inclusion and extracted the data. For continuous outcomes, we calculated the mean difference (MD) or standardised mean difference (SMD) with a 95% confidence interval (CI) using the random-effects model, calculated using Review Manager. For dichotomous data, we reported risk ratio (RR) and 95% CI.

MAIN RESULTS

We identified 22 trials randomising 1153 participants that were eligible for inclusion; nine trials (525 participants, 256 randomised to LLLT) compared LLLT with placebo, two (150 participants, 75 randomised to LLLT) compared LLLT with ultrasound, one compared LLLT with placebo and LLLT with ultrasound, two compared LLLT with steroid injection, and one trial each compared LLLT with other non-surgical interventions: fascial manipulation, application of a pulsed magnetic field, transcutaneous electrical nerve stimulation (TENS), steroid injection, tendon gliding exercises, and applying a wrist splint combined with non-steroidal anti-inflammatory drugs. Three studies compared LLLT as part of multiple interventions. Risk of bias varied across the studies, but was high or unclear in most assessed domains in most studies. Most studies were small, with few events, and effect estimates were generally imprecise and inconsistent; the combination of these factors led us to categorise the quality of evidence for most outcomes as very low or, for a small number, low. At short-term follow-up (less than three months), there was very low-quality evidence for any effect over placebo of LLLT on CTS for the primary outcome of Symptom Severity Score (scale 1 to 5, higher score represents worsening; MD -0.36, 95% CI -0.78 to 0.06) or Functional Status Scale (scale 1 to 5, higher score represents worsened disability; MD -0.56, 95% CI -1.03 to -0.09). At short-term (less than three months) follow-up, we are uncertain whether LLLT results in a greater improvement than placebo in visual analogue score (VAS) pain (scale 0 to 10, higher score represents worsening; MD -1.47, 95% CI -2.36 to -0.58) and several aspects of nerve conduction studies (motor nerve latency: higher score represents worsening; MD -0.09 ms, 95% CI -0.16 to -0.03; range 3.1 ms to 4.99 ms; sensory nerve latency: MD -0.10 ms, 95% CI -0.15 to -0.06; range 1.8 ms to 3.9 ms), as the quality of the evidence was very low. When compared with placebo at short-term follow-up, LLLT may slightly improve grip strength (MD 2.58 kg, 95% CI 1.22 to 3.95; range 14.2 kg to 25.23 kg) and finger-pinch strength (MD 0.94 kg, 95% CI 0.43 to 1.44; range 4.35 kg to 5.7 kg); however, the quality of evidence was low. Only VAS pain and finger-pinch strength results reached the minimal clinically important difference (MCID) as previously published. We are uncertain about the effect of LLLT in comparison to ultrasound at short-term follow-up for improvement in VAS pain (MD 2.81, 95% CI 1.21 to 4.40) and motor nerve latency (MD 0.61 ms, 95% CI 0.27 to 0.95), as the quality of evidence was very low. When compared with ultrasound at short-term follow-up, LLLT may result in slightly less improvement in finger-pinch strength (MD -0.71 kg, 95% CI -0.94 to -0.49) and motor nerve amplitude (MD -1.90 mV, 95% CI -3.63 to -0.18; range 7.10 mV to 9.70 mV); however, the quality of evidence was low. There was insufficient evidence to assess the long-term benefits of LLLT versus placebo or ultrasound. There was insufficient evidence to show whether LLLT is better or worse in the management of CTS than other non-surgical interventions. For all outcomes reported within these other comparisons, the quality of evidence was very low. There was insufficient evidence to assess adverse events, as only one study reported this outcome.

AUTHORS' CONCLUSIONS

The evidence is of very low quality and we found no data to support any clinical effect of LLLT in treating CTS. Only VAS pain and finger-pinch strength met previously published MCIDs but these are likely to be overestimates of effect given the small studies and significant risk of bias. There is low or very low-quality evidence to suggest that LLLT is less effective than ultrasound in the management of CTS based on short-term, clinically significant improvements in pain and finger-pinch strength. There is insufficient evidence to support LLLT being better or worse than any other type of non-surgical treatment in the management of CTS. Any further research of LLLT should be definitive, blinded, and of high quality.

Efficacy of low-level laser therapy in carpal tunnel syndrome management: a systematic review and meta-analysis

We performed this meta-analysis to investigate the efficacy of low-level laser therapy (LLLT), a physiotherapy modality with anti-inflammatory and analgesic effects, in the management of mild-to-moderate carpal tunnel syndrome (CTS). We searched PubMed, Web of Knowledge, Scopus, Cochrane Central, and Virtual Health Library for randomized controlled trials (RCTs) that compared the effects of LLLT with or without splinting versus placebo on functional and electromyographic outcomes in CTS. All outcomes were pooled as mean differences (MD) under the inverse variance or random effects model, using the statistical add-in (MetaXL, version 5.0). Eight RCTs (473 patients/631 wrists) were eligible for the final analysis. The overall effect estimates did not favor LLLT therapy group over placebo in all primary outcomes: visual analogue scale (MD -1.11, 95% CI [-2.58, 0.35]), symptom severity scale score (MD -1.41, 95% CI [-5.12, 2.29]), and functional status scale score (MD -1.33, 95% CI [-3.27, 0.61]). However, LLLT was superior to placebo in terms of grip strength (MD 2.19, 95% CI [1.63, 2.76]) and inferior to placebo in terms of sensory nerve action potential (MD -2.74, 95% CI [-3.66, -1.82]). Laser therapy is superior to placebo in terms of improving the grip strength; however, no significant difference was found between both groups in terms of functional status improvement, pain reduction, or motor electrodiagnostic evaluations. Further high-quality trials with longer follow-up periods are required to establish the efficacy of LLLT for CTS treatment.

Effect of manual therapy and neurodynamic techniques vs ultrasound and laser on 2PD in patients with CTS: A randomized controlled trial

STUDY DESIGN

Randomized controlled trial.

INTRODUCTION

Two-point discrimination (2PD) test can be used to assess both clinical condition and the effects of therapy in carpal tunnel syndrome (CTS) patients.

PURPOSE OF THE STUDY

To determine whether there are specific differences in 2PD between symptomatic and asymptomatic hands in CTS patients and to evaluate the impact of 2 therapy regimes on 2PD in patients with CTS.

METHODS

Therapy for the neurodynamic mobilization group was based on manual therapy and neurodynamic techniques. Therapy for the electrophysical modalities group was based on red and infrared laser and ultrasound therapy using a contact method applied in the transverse ligament area. Therapeutic cycle consisted of 20 therapy sessions delivered at twice-weekly intervals.

RESULTS

After therapy, 2PD in the symptomatic limbs in the neurodynamic mobilization and electrophysical modalities groups significantly improved (p < .001). However, there was no statistically significant difference between the treatment groups.

CONCLUSIONS

Both therapy programs used in this study were beneficial for improving 2PD.

LEVEL OF EVIDENCE

2.

Acupuncture for the Treatment of Peripheral Neuropathy: A Systematic Review and Meta-Analysis

OBJECTIVES

Neuropathy and its associated pain pose great therapeutic challenges. While there has been a recent surge in acupuncture use and research, little remains known about its effects on nerve function. This review aims to assess the efficacy of acupuncture in the treatment of neuropathy of various etiologies.

METHODS

The Medline, AMED, Cochrane, Scopus, CINAHL, and clintrials.gov databases were systematically searched from inception to July 2015. Randomized controlled trials (RCTs) assessing acupuncture's efficacy for poly- and mononeuropathy were reviewed. Parallel and crossover RCTs focused on acupuncture's efficacy were reviewed and screened for eligibility. The Scale for Assessing Scientific Quality of Investigations in Complementary and Alternative Medicine was used to assess RCT quality. RCTs with score of >9 and active control treatments such as sham acupuncture or medical therapy were included.

RESULTS

Fifteen studies were included: 13 original RCTs, a long-term follow-up, and a re-analysis of a prior RCT. The selected RCTs studied acupuncture for neuropathy caused by diabetes, Bell's palsy, carpal tunnel syndrome, human immunodeficiency virus (HIV), and idiopathic conditions. Acupuncture regimens, control conditions, and outcome measures differed among studies, and various methodological issues were identified. Still, the majority of RCTs showed benefit for acupuncture over control in the treatment of diabetic neuropathy, Bell's palsy, and carpal tunnel syndrome. Acupuncture is probably effective in the treatment of HIV-related neuropathy, and there is insufficient evidence for its benefits in idiopathic neuropathy. Acupuncture appears to improve nerve conduction study parameters in both sensory and motor nerves. Meta-analyses were conducted on all diabetic neuropathy and Bell's palsy individual subject data (six RCTs; a total of 680 subjects) using a summary estimate random effects model, which showed combined odds ratio of 4.23 (95% confidence interval 2.3-7.8; p < 0.001) favoring acupuncture over control for neuropathic symptoms.

CONCLUSIONS

Acupuncture is beneficial in some peripheral neuropathies, but more rigorously designed studies using sham-acupuncture control are needed to characterize its effect and optimal use better.

Low-power laser therapy for carpal tunnel syndrome: effective optical power

Low-power laser therapy has been used for the non-surgical treatment of mild to moderate carpal tunnel syndrome, although its efficacy has been a long-standing controversy. The laser parameters in low-power laser therapy are closely related to the laser effect on human tissue. To evaluate the efficacy of low-power laser therapy, laser parameters should be accurately measured and controlled, which has been ignored in previous clinical trials. Here, we report the measurement of the effective optical power of low-power laser therapy for carpal tunnel syndrome. By monitoring the backside reflection and scattering laser power from human skin at the wrist, the effective laser power can be inferred. Using clinical measurements from 30 cases, we found that the effective laser power differed significantly among cases, with the measured laser reflection coefficient ranging from 1.8% to 54%. The reflection coefficient for 36.7% of these 30 cases was in the range of 10-20%, but for 16.7% of cases, it was higher than 40%. Consequently, monitoring the effective optical power during laser irradiation is necessary for the laser therapy of carpal tunnel syndrome.

Laser acupuncture attenuates oxaliplatin-induced peripheral neuropathy in patients with gastrointestinal cancer: a pilot prospective cohort study

BACKGROUND

Oxaliplatin is a platinum compound that is widely used in the treatment of some solid tumours. Oxaliplatin-induced peripheral neuropathy (OIPN) in the upper and lower extremities is the major adverse side effect and represents the main dose-limiting factor of this drug. The aim of this single-arm study was to evaluate the feasibility and effects of laser acupuncture (LA) in the treatment of OIPN in patients with advanced gastrointestinal cancers.

METHODS

17 gastrointestinal cancer survivors (14 colorectal and 3 gastric cancers), who had been treated with oxaliplatin-based chemotherapies, were recruited. Low-level laser stimulation (50 mW) bilaterally at PC6, PC7, PC8, P9, LU11, SP6, KI3, BL60, KI1, and KI2 was administered for 20 min/point for 12 sessions over 4 weeks. The pain quality assessment scale (PQAS), chemotherapy-induced neurotoxicity questionnaire (CINQ), oxaliplatin-specific neurotoxicity scale (OSNS), quantitative touch-detection threshold (using von Frey filaments), and cold-triggered pain withdrawal latency (using the cold-water immersion test) were measured before and after completion of the 12 treatment sessions.

RESULTS

PQAS, CINQ, and OSNS scores, as well as touch-detection threshold and cold-trigger pain withdrawal latency all improved significantly after LA in the cancer patients with OIPN (p<0.05). LA significantly relieved both oxaliplatin-induced cold and mechanical allodynia and also decreased the incidence and severity of neurotoxicity symptoms in the patients' upper and lower extremities and impact on their daily activities (all p<0.05).

CONCLUSIONS

Following treatment with LA, neurotoxicity symptoms were significantly improved in cancer patients with OIPN. Further randomised controlled trials are needed to evaluate the role of LA as a therapeutic option in the management of OIPN.

Effectiveness of low-level laser on carpal tunnel syndrome: A meta-analysis of previously reported randomized trials

BACKGROUND

Low-level laser therapy (LLLT) has been applied in the treatment of carpal tunnel syndrome (CTS) for an extended period of time without definitive consensus on its effectiveness. This meta-analysis was conducted to evaluate the effectiveness of low-level laser in the treatment of mild to moderate CTS using a Cochrane systematic review.

METHODS

We conducted electronic searches of PubMed (1966-2015.10), Medline (1966-2015.10), Embase (1980-2015.10), and ScienceDirect (1985-2015.10), using the terms "carpal tunnel syndrome" and "laser" according to the Cochrane Collaboration guidelines. Relevant journals or conference proceedings were searched manually to identify studies that might have been missed in the database search. Only randomized clinical trials were included, and the quality assessments were performed according to the Cochrane systematic review method. The data extraction and analyses from the included studies were conducted independently by 2 reviewers. The results were expressed as the mean difference (MD) with 95% confidence intervals (CI) for the continuous outcomes.

RESULTS

Seven randomized clinical trials met the inclusion criteria; there were 270 wrists in the laser group and 261 wrists in the control group. High heterogeneity existed when the analysis was conducted. Hand grip (at 12 weeks) was stronger in the LLLT group than in the control group (MD = 2.04; 95% CI: 0.08-3.99; P = 0.04; I = 62%), and there was better improvement in the visual analog scale (VAS) (at 12 weeks) in the LLLT group (MD = 0.97; 95% CI: 0.84-1.11; P < 0.01; I = 0%). The sensory nerve action potential (SNAP) (at 12 weeks) was better in the LLLT group (MD = 1.08; 95% CI: 0.44-1.73; P = 0.001; I = 0%). However, 1 included study was weighted at >95% in the calculation of these 3 parameters. There were no statistically significant differences in the other parameters between the 2 groups.

CONCLUSION

This study revealed that low-level laser improve hand grip, VAS, and SNAP after 3 months of follow-up for mild to moderate CTS. More high-quality studies using the same laser intervention protocol are needed to confirm the effects of low-level laser in the treatment of CTS.

A systematic review of conservative treatment of carpal tunnel syndrome

Objective : To assess the effectiveness of conservative therapy in carpal tunnel syndrome.

Data sources : A computer-aided search of MEDLINE and the Cochrane Collaboration was conducted for randomized controlled trials (RCTs) from January 1985 to May 2006.

Review methods : RCTs were included if: (1) the patients, with clinically and electrophysiologically confirmed carpal tunnel syndrome, had not previously undergone surgical release, (2) the efficacy of one or more conservative treatment options was evaluated, (3) the study was designed as a randomized controlled trial. Two reviewers independently selected the studies and performed data extraction using a standardized form. In order to assess the methodological quality, the criteria list of the Cochrane Back Review Group for systematic reviews was applied. The different treatment methods were grouped (local injections, oral therapies, physical therapies, therapeutic exercises and splints).

Results : Thirty-three RCTs were included in the review. The studies were analysed to determine the strength of the available evidence for the efficacy of the treatment. Our review shows that: (1) locally injected steroids produce a significant but temporary improvement, (2) vitamin B6 is ineffective, (3) steroids are better than non-steroidal anti-inflammatory drugs (NSAIDs) and diuretics, but they can produce side-effects, (4) ultrasound is effective while laser therapy shows variable results, (5) exercise therapy is not effective, (6) splints are effective, especially if used full-time.

Conclusion : There is: (1) strong evidence (level 1) on efficacy of local and oral steroids; (2) moderate evidence (level 2) that vitamin B6 is ineffective and splints are effective and (3) limited or conflicting evidence (level 3) that NSAIDs, diuretics, yoga, laser and ultrasound are effective whereas exercise therapy and botulinum toxin B injection are ineffective.

The effects of ultrasound and alternating current on the laser penetration in the tissue

The visible (VIS) and near-infrared (NIR) lasers are now widely used in therapeutic and other medical applications. Some of these applications require to deliver the laser energy deep toward the desired tissue target or organ. The aim of this in vitro study is to investigate practically whether the modulation of laser energy by employing the therapeutic ultrasound or electrical energies can increase the penetration depth of the laser light inside the tissue. Such modulation was implemented in this study by coupling the (c.w.) diode and Nd:YAG laser energies with the ultrasound or AC current simultaneously as they pass through preprepared ex vivo bovine muscular tissue strips. Two wavelengths of diode lasers were used, 637 and 808 nm beside the 1064-nm Nd:YAG laser. The results showed a noticeable decrease of these laser attenuation factors as they pass through the tissue strips in the presence of the ultrasound or AC energies. By using this coupling modulation, the capability of increasing the laser penetration depths inside the tissue was confirmed without having to increase their applied power.

Placebo-controlled investigation of low-level laser therapy to treat carpal tunnel syndrome

OBJECTIVE

This study investigated the short-term efficacy of low-level laser therapy (LLLT) in patients with mild to moderate carpal tunnel syndrome (CTS), lasting for <1 year.

METHODS

Seventy-nine patients with CTS were included in this double-blind, placebo-controlled study, and randomly divided in two treatment groups: Experimental group (EG), active laser group (40 patients); and control group (CG), placebo (sham) laser group (39 patients). A GaAlAs diode laser [780 nm, 30 mW continuous wave (CW), 0.785 cm(2), 38.2 mW/cm(2)] was applied in contact with four points perpendicularly to the skin over the carpal tunnel area for 90 sec per point (2.7 J, 3.4 J/cm(2)/point). Both groups were treated five times per week, once a day over 2 weeks, followed by 10 treatments every other day for 3 weeks, that is, for a total of 20 treatments. Clinical assessment, including visual analogue scale (VAS) pain rating, Tinel's sign, and median nerve conduction studies (NCSs) were evaluated before, and 3 weeks after, the last LLLT treatment.

RESULTS

Significant reduction in pain, reduction in the percentage of patients with a positive Tinel's sign, and shortening of sensory and motor latency time in the NCS examination was observed in the experimental LLLT group (but not in the control group).

CONCLUSIONS

This study has observed and documented the statistically significant short-term effects of LLLT on CTS patients in comparison with a placebo group. The results support this conclusion, especially if the LLLT is applied in the earlier stages of CTS, and with mild to moderate cases.

Modern acupuncture-like stimulation methods: a literature review

Acupuncture therapy has been proved to be effective for diverse diseases, symptoms, and conditions in numerous clinical trials. The growing popularity of acupuncture therapy has triggered the development of modern acupuncture-like stimulation devices (ASDs), which are equivalent or superior to manual acupuncture with respect to safety, decreased risk of infection, and facilitation of clinical trials. Here, we aim to summarize the research on modern ASDs, with a focus on featured devices undergoing active research and their effectiveness and target symptoms, along with annual publication rates. We searched the popular electronic databases Medline, PubMed, the Cochrane Library, and Web of Science, and analyzed English-language studies on humans. Thereby, a total of 728 studies were identified, of which 195 studies met our inclusion criteria. Electrical stimulators were found to be the earliest and most widely studied devices (133 articles), followed by laser (44 articles), magnetic (16 articles), and ultrasound (2 articles) stimulators. A total of 114 studies used randomized controlled trials, and 109 studies reported therapeutic benefits. The majority of the studies (32%) focused on analgesia and pain-relief effects, followed by effects on brain activity (16%). All types of the reviewed ASDs were associated with increasing annual publication trends; specifically, the annual growth in publications regarding noninvasive stimulation methods was more rapid than that regarding invasive methods. Based on this observation, we anticipate that the noninvasive or minimally invasive ASDs will become more popular in acupuncture therapy.

Comparison of high-intensity laser therapy and ultrasound treatment in the patients with lumbar discopathy

The aim of the present study was to evaluate the efficiency of high intensity laser and ultrasound therapy in patients who were diagnosed with lumbar disc herniation and who were capable of performing physical exercises. 65 patients diagnosed with lumbar disc were included in the study. The patients were randomly divided into three groups: Group 1 received 10 sessions of high intensity laser to the lumbar region, Group 2 received 10 sessions of ultrasound, and Group 3 received medical therapy for 10 days and isometric lumbar exercises. The efficacy of the treatment modalities was compared with the assessment of the patients before the therapy at the end of the therapy, and in third month after the therapy. Comparing the changes between groups, statically significant difference was observed in MH (mental health) parameter before treatment between Groups 1 and 2 and in MH parameter and VAS score in third month of the therapy between Groups 2 and 3. However, the evaluation of the patients after ten days of treatment did not show significant differences between the groups compared to baseline values. We found that HILT, ultrasound, and exercise were efficient therapies for lumbar discopathy but HILT and ultrasound had longer effect on some parameters.

Efficacies of Acupuncture and Anti-inflammatory Treatment for Carpal Tunnel Syndrome

This study compared the efficacies of acupuncture and anti-inflammatory treatment in patients with carpal tunnel syndrome (CTS). Fifty patients with mild to moderate CTS were randomly divided into two groups. Both groups received night wrist splints as the standard conservative treatment for 1 month. The acupuncture group also received eight sessions of acupuncture therapy (twice a week for 4 weeks). The control group received 400 mg of ibuprofen three times a day for 10 days. The visual analog scale (VAS) score, the score on the Boston Carpal Tunnel Questionnaire for Functional Status and Symptom Severity (BCTQ FUNCT and SYMPT), and the electrodiagnostic findings were evaluated at baseline and 1 month after treatment. At the final follow up, significant improvements were found in both groups (p < 0.05). Statistically significant improvements were observed in the VAS score, the score on the global BCTQ FUNCT and SYMPT, and the electrodiagnostic findings, but not in the distal motor latency (DML), in the acupuncture group (p < 0.05). Our findings indicate that acupuncture affected the score on the global BCTQ FUNCT and SYMPT, the VAS score, and the electrodiagnostic findings, except the DML, more than ibuprofen did and that acupuncture might be an effective treatment for CTS.

Clinical effectiveness of acupuncture for carpal tunnel syndrome

Acupuncture and electroacupuncture treatments of symptomatic carpal tunnel syndrome (CTS) may improve symptoms and aid nerve repair as well as improve sensory and motor functions. However, limited evidence is available regarding the effects of these treatments based on comprehensive evaluation methods. This research completed the treatment and evaluation of 26 patients with confirmed CTS. Participants were divided into two treatment groups based on a modified neurophysiological grading scale. Of the total number of participants, 15 received acupuncture and 11 received electroacupuncture on both upper limbs. Acupoints were PC-7 (Daling) and PC-6 (Neiguan) along the pericardial meridian compatible with the median nerve tract. The treatment program consisted of 24 sessions of 15 min duration over 6 weeks. After electroacupuncture treatments, symptom severity was evaluated using the short clinical questionnaire by Lo and Chiang, which indicated improvements in the respective symptom severity score. After the acupuncture treatment, grip strength in the major symptomatic side in CTS patients could be significantly increased. Electrophysiology evaluation likewise indicated a significant increase in the distal median motor amplitude of the palm-wrist segment. In addition, Tinel's sign significantly decreased in the major symptomatic side. Our findings indicated that electroacupuncture could improve symptomatology, while acupuncture could exert positive therapeutic effects for CTS patients, as evidenced by improved symptomatology, grip strength, electrophysiological function, and physical provocation sign.

Effects of neuromobilization maneuver on clinical and electrophysiological measures of patients with carpal tunnel syndrome

[Purpose] The aim of this study was to investigate the efficacy of neuromobilization combined with routine physiotherapy in patients with carpal tunnel syndrome through subjective, physical, and electrophysiological studies. [Subjects and Methods] Twenty patients with carpal tunnel syndrome (totally 32 hands) were assigned two groups: treatment and control groups. In both groups, patients received the routine physiotherapy. In addition to the routine physiotherapy, patients in the treatment group received neuromobilization. The symptoms severity scale, visual analogue scale, functional status scale, Phalen’s sign, median nerve tension test, and median nerve distal sensory and motor latency were assessed. [Results] There were significant improvements in the symptoms severity scale, visual analogue scale, median nerve tension test, and Phalen’s sign in both groups. However, the functional status scale and median nerve distal motor latency were significantly improved only in the treatment group. [Conclusion] Neuromobilization in combination with routine physiotherapy improves some clinical findings more effectively than routine physiotherapy. Therefore, this combination can be used as an alternative effective non-invasive treatment for patients with carpal tunnel syndrome.

Low-level laser therapy with a wrist splint to treat carpal tunnel syndrome: a double-blinded randomized controlled trial

The efficacy of low-level laser therapy (LLLT) was evaluated in a total of 66 patients with mild to moderate carpal tunnel syndrome (CTS) with a double-blinded randomized controlled study. The patients were randomly assigned into two groups. Group I received 15 sessions of a gallium-aluminum-arsenide laser treatment at a dosage of 18 J per session over the carpal tunnel area with neutral wrist splint. Group II received placebo laser therapy with neutral wrist splint. The patients were evaluated with the following parameters: (1) clinical parameters which consisted of visual analog scale, symptom severity scale, functional status scale, and pinch strength and grip strength before the treatment and at 5- and 12-week follow-ups and (2) electroneurophysiological parameters from nerve conduction study which were evaluated before the treatment and at 12-week follow-up. Fifty nine patients (112 hands: unilateral CTS = 6 hands and bilateral CTS = 106 hands) completed the study. Both groups I and II had n = 56 hands. Improvements were significantly more pronounced in the LLLT-treated group than the placebo group especially for grip strength at 5- and 12-week follow-ups. At 12-week follow-up, distal motor latency of the median nerve was significantly improved in the LLLT group than the placebo group (p < 0.05). LLLT therapy, as an alternative for a conservative treatment, is effective for treating mild to moderate CTS patients. It can improve hand grip strength and electroneurophysiological parameter with a carry-over effect up to 3 months after treatment for grip strength of the affected hands.