Acupuncture for carpal tunnel syndrome: A systematic review and meta-analysis of randomized controlled trials

Carpal tunnel syndrome is one of the most common conditions affecting peripheral nerves, caused by compression of the median nerve at the wrist. This condition affects between 1% and 5% of the general population and 7% to 10% of working-age individuals, generating significant impacts on quality of life and public health costs. Symptoms include pain, numbness, and tingling in the region innervated by the median nerve, and may progress to muscle atrophy in more advanced cases. Treatment traditionally involves non-surgical options such as nighttime immobilization, anti-inflammatory medications, and corticosteroid injections, but evidence about the efficacy of these approaches remains limited.

This study represents a comprehensive systematic review with meta-analysis that evaluated the efficacy of acupuncture in the treatment of carpal tunnel syndrome. The researchers performed searches in multiple English and Chinese databases from inception until October 2022, selecting randomized controlled clinical studies that investigated the effects of acupuncture compared to other treatments or placebo. Sixteen studies with a total of 1,025 participants were included, analyzing both the use of acupuncture as standalone treatment and as complementary therapy. The methodological quality of the studies was evaluated using specific criteria, including tools to assess risk of bias and quality of reporting of acupuncture interventions.

The results showed distinct findings depending on how acupuncture was used. When employed as standalone treatment, acupuncture proved to be more effective than night splints in reducing pain intensity, but showed no significant differences in symptom severity or functional status. Compared with medications, acupuncture alone showed no advantages in improving symptoms or electrophysiological nerve parameters. On the other hand, when used as complementary therapy in combination with other conventional treatments, acupuncture demonstrated more consistent benefits, improving symptom severity, functional status, pain intensity, and nerve conduction parameters compared to conventional treatments alone.

For patients dealing with carpal tunnel syndrome, these results suggest that acupuncture may be a valuable therapeutic option, especially when used in conjunction with conventional treatments. The evidence indicates that combining acupuncture with other treatments may provide more effective symptom relief and wrist function improvement than isolated treatments. It is important to note that the studies reported few adverse events related to acupuncture, including mainly mild hematomas at application points and temporary skin irritation, suggesting it is a safe intervention. For health care professionals, these findings offer scientific evidence to consider acupuncture as part of an integrated therapeutic plan for patients with mild to moderate carpal tunnel syndrome.

The limitations of the study include the variable methodological quality of the analyzed studies, with only one study presenting low risk of bias, while most presented some methodological concerns. The heterogeneity between studies and the relatively small sample size also limited the strength of the conclusions. Many of the studies used subjective measures reported by patients themselves, which can introduce bias favorable to acupuncture. The researchers emphasize the need for more rigorously conducted studies, including comparisons with placebo acupuncture and objective measures of improvement, to establish more robust evidence about the efficacy of acupuncture in carpal tunnel syndrome.

Despite these limitations, the current evidence suggests that acupuncture as complementary therapy may offer real benefits for patients with this common condition.