JULY 5, 2002

Laser Therapy Relieves Carpal Tunnel Symptoms and Could Save Treatment Costs

CHICAGO—Stimulation of appropriate acupuncture points with red-beam laser light may reduce the pain and other symptoms of carpal tunnel syndrome (CTS), allowing patients to return to their previous work levels for up to three years, according to an article in the July issue of Archives of Physical Medicine and Rehabilitation.

Kyung-Ae K. Hahn, MD, a physical medicine and rehabilitation physician with the VA Boston Healthcare System, and colleagues studied 11 patients with mild to moderate CTS who had failed standard medical or surgical treatment to evaluate the effectiveness of low-level laser therapy (LLLT) and microamps transcutaneous electrical nerve stimulation (TENS) applied to acupuncture points. In the double-blind, placebo-control, crossover trial, the patients received two series of treatments, each lasting three to four weeks. One series was real; the other was a sham.

“All 11 patients resumed their previous work activities with less or no pain (e.g., computer typist, handyman work with cement laying and electrical wiring, house painter, plumber). All but one patient have remained stable in their pain reduction at one to three years follow-up,” the researchers write.

The researchers note that this is the first controlled study applying real and sham LLLT and microamp TENS to acupuncture points to treat CTS. The application of LLLT instead of using acupuncture needles to stimulate the acupuncture points had been reported in studies in China and other countries for more than two decades.

In a separate interview, Dr. Hahn said: “Outside of this controlled study with CTS patients, three patients with a different disorder, repetitive strain injury (RSI), have responded well with LLLT and the microamps TENS applied to the wrist/hand in a home treatment program. Some of the patients were college students, and one student purchased his own LLLT and microamps TENS and treated himself at home. They were able to use their computers at home without problems following the home treatment program.” 

“Carpal tunnel syndrome is rather common in an outpatient clinic setting if you really look for it. Most of the patients think it’s not really a big problem until they feel more pain and weakness of the hands.  I strongly feel that prognosis is better if you treat CTS early when it is easier to treat with wrist splints and ergonomic evaluation to avoid further median nerve damage.” Dr. Hahn said. “CTS patients can be greatly helped by physical medicine and rehabilitation physicians. They can examine patients, perform nerve conduction studies and electromyograms, confirm diagnosis, fit wrist splints, assign occupational therapy and provide education material.”

Following the treatment with the real LLLT plus microamps TENS on acupuncture points, the researchers found that seven of eight patients (87.5 percent) reported pain scores that were reduced by more than 50 percent. Six of eight cases (75 percent) reported McGill Pain Questionnaire scores ranging from 0 (n=4) to only 1 or 2 (n=2). The two patients who reported pain scores greater than two were moderate CTS cases. Clinical symptoms of CTS also decreased following the real treatment series but not after the sham treatment series. Following the sham treatment, a placebo effect was found in three of the 11 cases (27.3 percent).

CTS, compression of the median nerve as it passes from forearm to palm beneath the transverse carpal ligament, commonly occurs in workers who perform repetitive hand movements such as computer keyboard typing and assembly line work. Signs and symptoms associated with CTS include numbness and tingling of the thumb, index and middle fingers; decreased sensitivity in the fingers; pain that interrupts sleep and sometimes hand weakness. Treatments include adjusted work environment, wrist splinting, nonsteriodal anti-inflammatory drugs and steroid injections. In 1995, 50 percent of workers with CTS missed 30 days or more of work. Approximately 40 to 45 percent of cases eventually require surgery, with estimates of 460,000 procedures each year and a direct medical cost of over $1.9 billion.

The authors believe that a new conservative treatment applied at the early stages of CTS is needed to permit continued employment, prevent disability and reduce the need for surgery. The researchers estimate a $4,000 cost savings with LLLT and the microamps TENS per mild to moderate CTS case. In the United States, the estimated CTS case cost for nonsurgical intervention is $5,246 per case. LLLT and the microamps TENS stimulation of the acupuncture points is approximately $1,000. Supplemental home treatments are also possible with an equipment cost of $550 (red-beam laser pointer = $150, microamps TENS = $400).

The Archives of Physical Medicine and Rehabilitation is the official journal of the American Academy of Physical Medicine and Rehabilitation (AAPM&R). It is copublished with the American Congress of Rehabilitation Medicine.

(Arch Phys Med Rehabil. 2002;83:978-988)