Laser acupuncture for carpal tunnel syndrome: A randomized controlled trial using low-level laser intervention

INTERVENTION: laser acupuncture treatment indicates using Low level laser (class IIIb lasers, 400mw, near infrared, continuous wavelength, 810nm, LaserPenR, RJ‐LASER, Germany) in traditional Chinese acu‐points (PC ‐7 (Daling), PC‐6 (Neiguan)) on the affected side. Laser acupuncture consisted of once per day for five consecutive days followed by a two‐day break with a total of 20 sessions in four weeks period. Each stimulation was performed in the continuous wave mode for 1 minute. The energy transferred to the skin in a treatment of 1 minute was up to approximately 24 J/cm2. CONDITION: carpal tunnel syndrome PRIMARY OUTCOME: global symptom score (GSS) ; Primary outcome measure was the difference in modified GSS between the verum and placebo group. This scale has been used to evaluate treatment responses in various previous studies.This assessment was to rate clinical symptoms from 0 (no symptoms) to 10 (very severe symptoms) in the following five symptom categories: pain, numbness, tingling, weakness/clumsiness, and nocturnal awakening. Each patient was directly questioned, and each score was based on the patient’s subjective answers. Therefore, the maximum score was 50 (most severe symptoms) and the minimum score was 0 (absence of symptoms). To ensure consistency, the evaluating physician who scored the main outcome measure, GSS, was the same person on each occasion for each patient and was blinded to the type of treatment. Patients completed standard questionnaires at baseline and 2 and 4 weeks later. SECONDARY OUTCOME: Secondary outcomes measures were change in GSS reduction and all parameters of nerve conduction study (NCS) at different time phases compared to baseline and in comparison of verum laser acupuncture with placebo laser acupuncture. We defined a reduction of GSS more than 50% as good improvement, 30‐50% as moderate improvement, and less than 30%, being lost to follow‐up, showing APB muscle wasting, or receiving surgery or other conservative treatment as treatment failure for secondary outcome measures. INCLUSION CRITERIA: The inclusion criteria for treatment naïve patients, aged from 20 to 65, enrolled in this study were based on a combination of clinical and electrodiagnosis of mild or moderate idiopathic CTS. The CTS diagnosis was based on the presence of at least one of the following symptoms: 1) pain, numbness or paresthesia in the median nerve distribution; 2) precipitation of these sensory complaints by forceful or repetitive hand use which could be relieved by resting, rubbing and shaking the hands; and 3) awakening from sleep due to such sensory symptoms. The diagnosis was often supported by a positive Tinel’s sign or Phalen’s test. All patients with clinically diagnosed CTS demonstrated median neuropathy at the wrist, confirmed by the presence of one or more of the following standard electrophysiological criteria: 1) prolonged distal motor latency (DML) to the abductor pollicis brevis (APB) (abnormal = 4.7 ms; wrist to APB, 8 cm); 2) prolonged anti‐dromic distal sensory late