M H Chang1, H T Chiang, S S Lee, L P Ger, Y K Lo. 1. Veterans General Hospital-Kaohsiung, and Department of Neurology, National Yang-Ming Medical University, Taiwan.
Abstract
BACKGROUND: Conservative treatment of mild to moderate carpal tunnel syndrome (CTS) is variable. OBJECTIVE: To evaluate the effectiveness of commonly used oral medications such as diuretics, nonsteroid anti-inflammatory drugs (NSAIDs), and steroids in the treatment of CTS. METHODS: Prospective, randomized, double-blind and placebo-controlled study of patients with clinical symptoms and signs of CTS, confirmed by standard electrodiagnosis. Baseline assessments included a standardized symptom questionnaire, rating five categories of symptoms (pain, numbness, paresthesia, weakness/clumsiness, and nocturnal awakening) on a scale from 0 (no symptoms) to 10 (severe). The total score in each of the five categories was termed the global symptom score (GSS). After baseline assessment, patients were randomized to the following treatment arms: 1) 4 weeks of placebo (n = 16); 2) 4 weeks of diuretic (trichlormethiazide, 2 mg daily; n = 16); 3) 4 weeks of NSAID-slow release (SR) (tenoxicam-SR, 20 mg daily; n = 18); and 4) 2 weeks of prednisolone, 20 mg daily, followed by another 2-week dosage of 10 mg daily (n = 23). Results of follow-up assessments in the second and the fourth weeks were identical to baseline scores. The changes in GSS were analyzed to determine the statistical difference. RESULTS: No significant reduction from baseline GSS was seen at second, and fourth weeks in the placebo, NSAID-SR, and diuretic groups. However, the mean score at 4 weeks in the steroid group decreased significantly from a baseline of 27.9 +/- 6.9 to 10 +/- 7.4. CONCLUSION: For patients with mild to moderate CTS who opt for conservative treatment, corticosteroids are of greater benefit.
RCT Entities:
BACKGROUND: Conservative treatment of mild to moderate carpal tunnel syndrome (CTS) is variable. OBJECTIVE: To evaluate the effectiveness of commonly used oral medications such as diuretics, nonsteroid anti-inflammatory drugs (NSAIDs), and steroids in the treatment of CTS. METHODS: Prospective, randomized, double-blind and placebo-controlled study of patients with clinical symptoms and signs of CTS, confirmed by standard electrodiagnosis. Baseline assessments included a standardized symptom questionnaire, rating five categories of symptoms (pain, numbness, paresthesia, weakness/clumsiness, and nocturnal awakening) on a scale from 0 (no symptoms) to 10 (severe). The total score in each of the five categories was termed the global symptom score (GSS). After baseline assessment, patients were randomized to the following treatment arms: 1) 4 weeks of placebo (n = 16); 2) 4 weeks of diuretic (trichlormethiazide, 2 mg daily; n = 16); 3) 4 weeks of NSAID-slow release (SR) (tenoxicam-SR, 20 mg daily; n = 18); and 4) 2 weeks of prednisolone, 20 mg daily, followed by another 2-week dosage of 10 mg daily (n = 23). Results of follow-up assessments in the second and the fourth weeks were identical to baseline scores. The changes in GSS were analyzed to determine the statistical difference. RESULTS: No significant reduction from baseline GSS was seen at second, and fourth weeks in the placebo, NSAID-SR, and diuretic groups. However, the mean score at 4 weeks in the steroid group decreased significantly from a baseline of 27.9 +/- 6.9 to 10 +/- 7.4. CONCLUSION: For patients with mild to moderate CTS who opt for conservative treatment, corticosteroids are of greater benefit.
Authors: Teryl Nuckols; Craig Conlon; Michael Robbins; Michael Dworsky; Julie Lai; Carol P Roth; Barbara Levitan; Seth Seabury; Rachana Seelam; Steven M Asch Journal: J Occup Environ Med Date: 2017-01 Impact factor: 2.162
Authors: Teryl K Nuckols; Craig Conlon; Michael Robbins; Michael Dworsky; Julie Lai; Carol P Roth; Barbara Levitan; Seth Seabury; Rachana Seelam; Douglas Benner; Steven M Asch Journal: Muscle Nerve Date: 2018-02-01 Impact factor: 3.217