Electroacupuncture combined with nighttime splinting may help alleviate pain from chronic carpal tunnel syndrome, according to a randomized controlled trial published in CMAJ (Canadian Medical Association Journal).

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Carpal tunnel syndrome is the most common reason for people with wrist, hand, and finger symptoms to visit the doctor. Almost 4% of the population suffers from chronic hand pain, numbness, and tingling caused by this nerve disorder.

Symptoms of Carpal Tunnel Syndrome

People with carpal tunnel syndrome experience a variety of symptoms that include:

• Mild occasional numbness
• Tingling
• Pins and needles sensation
• Burning
• Pain
• Weakness
• Loss of hand function

The symptoms are often worse at night and can sometimes be relieved by shaking or flicking the hands._[1] Carpal tunnel syndrome can get better on its own or can progress to loss of muscle mass as well as permanent nerve and muscle damage.

What Causes Carpal Tunnel Syndrome?

The carpal tunnel is located at the wrist on the palm side of the hand. It is formed by wrist bones on three sides and a ligament on the fourth. The median nerve, which provides muscle function and feeling in the hand, travels through the tunnel.

When the median nerve is squeezed by swollen tissues or compressed in some other way, nerve impulses are slowed or blocked from traveling through the nerve.

The exact cause of this compression is often unclear. Repetitive motions, such as forceful grasping or repetitive bending of the wrist, can cause swelling, thickening, or irritation of the membranes around the tendons in the carpal tunnel, and can put pressure on the median nerve.

Certain conditions are commonly associated with carpal tunnel syndrome, too, such as obesity, arthritis, hypothyroidism, diabetes mellitus, metabolic syndrome, migraines, certain autoimmune diseases, and a history of trauma to the wrist._[2,3] Other well-known risk factors are age, female gender, and pregnancy.

Diagnosis of Carpal Tunnel Syndrome

A physical examination of the hand and wrist is the first step, but it is not very reliable. If carpal tunnel syndrome is suspected, additional testing should be performed.

Nerve conduction testing involves a small electrode placed on the skin to generate a mild electrical current that stimulates the nerve. The impulse is measured in the hand. If there is damage to median nerve, the impulse will take longer than expected to get to the hand.

Electromyography, usually done as a second test, measures the degree of abnormal function of the muscles supplied by the median nerve. A small needle inserted into the muscle measures the impulse. If the nerve is severely compressed, the muscle will not perform normally.

Ultrasound and MRI may be used to identify swelling of the median nerve and abnormalities of the tunnel wall, its contents, and surrounding area, such as inflamed tendons.

Conventional Treatment of Carpal Tunnel Syndrome

The conventional treatment of carpal tunnel syndrome involves medication such as acetaminophen and nonsteroidal anti-inflammatory drugs for symptom relief. Splinting the wrist, especially at night, is often recommended to decrease the pressure on the median nerve by keeping the wrist straight. Cortisone injections are also used to temporarily relieve symptoms.

When these measures fail, a surgeon can perform carpal tunnel release surgery and open the tunnel to relieve the pressure on the median nerve. Less than 5% of surgery patients have recurrence of symptoms. Although surgery usually has positive outcomes, it is not without risk, including injury to nerves and tendons._[4]

Natural Treatment of Carpal Tunnel Syndrome

Before you opt for surgery, consider these evidence-based natural carpal tunnel syndrome therapies.

Low-Level Laser Therapy

Low-level laser therapy can reduce pain, inflammation, and swelling; and promote the healing of wounds, nerves, and deeper tissues.

Low-level lasers use non-thermal photons of light in the near infrared range to penetrate deeply into the skin and stimulate the release of ATP, leading to improved cellular function and decreased oxidative stress.

This sets in motion a cascade of downstream effects that ultimately lead to improved tissue repair and reduced inflammation._[5] Certain light wavelengths and intensities also have analgesic effects.
Studies show that laser therapy significantly improves carpal tunnel syndrome symptoms—improving grip strength, alleviating pain, reducing tingling and numbness, and improving nerve conduction and electromyography test results._[6-10] It has been found to be as effective as surgery for mild-to-moderate carpal tunnel syndrome._[11]

Researchers from Harvard Medical School recently concluded that “low-level laser therapy can be used effectively for nerve regeneration and pain relief.”5 Treatments are painless, free of side effects, and take only a few minutes, but are needed frequently, especially during the first couple of weeks. Many different kinds of healthcare providers, including MDs, chiropractors, and naturopathic doctors are now using low-level lasers.

Vitamin B6

Vitamin B6 plays an important role in several metabolic pathways involving nerve function. The majority of studies since the 1980s have found that supplementing with vitamin B6 significantly benefits carpal tunnel syndrome._[12]

The most common dose leading to positive results is 100 to 150 mg per day. A recent study found that 120 mg per day for three months significantly decreased pain, numbness, weakness, tingling, and clumsiness in handling objects._[13] Moreover, there were significant improvements in nerve conduction test results. The control group experienced none of these results.

B-Complex

The addition of other B vitamins may increase the effectiveness of vitamin B6. For instance, vitamin B2 (riboflavin) helps convert B6 into its more active form, pyridoxal 5′-phosphate and in one case, the combination of vitamin B2 and B6 was shown to be especially useful.14 Vitamin B12 is also a critical B vitamin for nerve function.

For these reasons, it is recommended that you take a B-complex vitamin twice daily. In addition to the B-complex, take enough extra vitamin B6 to provide you with a daily total of 120 to 150 mg. Do not take more than 200 mg of B6 per day. Take the B-complex and additional B6 for at least three months before assessing the results. After you’ve been experiencing improvement for a few months, decrease your dose of vitamin B6 to a total of 50 mg a day.

Alpha Lipoic Acid and GLA

If B vitamin supplementation as described above is not sufficient for controlling your carpal tunnel pain and other symptoms, adding alpha lipoic acid with either curcumin phytosome or gamma linolenic acid (GLA) could be effective.

Alpha lipoic acid is a powerful antioxidant with proven neuroprotective effects and a capacity to decrease nerve sensitivity to pain.15 GLA, one of the essential fatty acids and a major constituent of cell membranes, has anti-inflammatory effects when taken as a supplement.

A study of patients with moderately severe carpal tunnel syndrome found significant improvements in symptoms, functioning, and nerve conduction tests with a supplement combining alpha lipoic acid (600 mg per day) and GLA (360 mg per day)._[15]

Curcumin

Curcumin, a major active compound in turmeric, also has significant antioxidant and neuroprotective effects. Curcumin has also been found to be a potent anti-inflammatory and to help relieve pain.16 Curcumin phytosome is a specific formulation of curcumin that makes the curcumin more bioavailable._[16]

The combination of alpha lipoic acid (300 mg twice daily), curcumin phytosome (500 mg twice daily), and B vitamins (low doses) taken for three months before and after carpal tunnel surgery was found recently to significantly reduce nighttime pain after surgery._[16]

Other Strategies

Acupuncture and various massage and physical therapy techniques (exercises, stretching, joint and soft tissue mobilization) have also been found to significantly improve carpal tunnel symptoms and functionality compared to conventional treatments such as splinting and NSAIDs._[17-19] These natural modalities may be most useful when combined with supplementation and/or low-level laser therapy.

Summary

The symptoms of carpal tunnel syndrome are not to be taken lightly—long-term nerve and muscle damage can occur with severe and long-lasting nerve compression.

If you have carpal tunnel syndrome, look for local healthcare providers who offer low-level laser therapy and, if possible, begin a series of treatments.

Meanwhile, supplement with high-dose vitamin B6 combined with a B-complex supplement so that your total vitamin B6 dose is between 120 and 150 mg per day.

If you do not experience complete relief within two to three months, add in alpha lipoic acid (600 mg per day), curcumin phytosome (1000 mg per day), and/or GLA (at least 360 mg per day). Also consider acupuncture and/or massage to augment your treatment.

This article was originally published in 2016. It is regularly updated. 

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