Can Natural Therapies Ease Carpal Tunnel Syndrome?
Carpal tunnel syndrome is the result of the compression and entrapment of the median nerve as it runs through the carpal tunnel in the wrist and upper palm. It is typically symptomized with pain in the wrists and a significant reduction of hand, arm and wrist mobility. It also can produce numbness in the thumb, fingers, hand and wrist. Often this numbness and pain will occur during the night.
Often the syndrome will begin showing itself with some tingling in the thumbs and fingers, which can slowly progress into pain – often termed neuropathy. While repetitive motion can worsen the condition, CTS has been linked to such internal issues as diabetes or lack of glucose control, arthritis, obesity, pharmaceutical use, stress and nutritional deficiencies. It is often related to other neuropathic conditions elsewhere in the body.
As few medications are known to help the condition, surgery is often resorted to. The typical surgery today is called endoscopic carpal tunnel release.
Some natural therapies have been shown to help carpal tunnel syndrome
Most recently, researchers from Milan’s Sesto San Giovanni Hand Surgery Unit have determined that a combination of alpha-lipoic acid, curcumin phytosome, and B-group vitamins helps ease pain and increase motion in carpal tunnel syndrome.
The researchers randomly separated 180 patients with carpal tunnel syndrome into three groups. The patients were all scheduled to receive surgery to decompress the median nerve – a conventional therapy for carpal tunnel.
The researchers gave one group a combination supplement twice a day for three months – prior to the surgery. They gave a second group the supplement twice a day three months before the surgery and three months after the surgery. A third group served as the control group – they were not given any supplementation program prior to or after the surgery.
The researchers found that those taking the supplementation program fared significantly better than those patients not taking the supplements. Those taking the supplements before and after surgery had fewer nocturnal symptom scores and better Phalen testing than the control group.
The researchers concluded:
“We conclude that oral supplementation with alpha-lipoic acid, curcumin phytosome, and B-group vitamins twice a day both before and after surgery is safe and effective in CTS patients scheduled to undergo surgical decompression of the median nerve.”
Other research has indicated that lipoic acid and curcumin can reduce pain and increase motion in carpal tunnel syndrome. In a 2013, Italian researchers tested 135 patients with neuropathic pain including low back pain and/or carpal tunnel syndrome with a supplement containing the curcumin phytosome, lipoic acid and piperine (found in black pepper and the Ayurvedic herb Piper longum) in a formulation called Lipicur.
The researchers found that the supplement significantly reduced pain by more than 66% among the patients, and reduced the patients’ intake of dexibuprofen – which the patients were also taking as part of their therapy.
What is Lipoic Acid?
Lipoic acid or alpha-lipoic acid is readily available in many whole foods, but in supplement form it is typically synthesized from octanoic acid. It is considered a organosulfur element because of its sulfur atoms.
Alpha-lipoic acid has been found to reduce neuropathy in other research. A 2006 study among 89 diabetic polyneuropathy patients found that ALA significantly reduced pain and impairment among the group taking ALA versus a placebo.
What about B vitamins?
B vitamins have a long history of application in neuropathy. Vitamin B6 and vitamin B12 have had the most focus. However, clinical evidence of their effects to reduce pain or improve movement is weak. Combination studies such as the one shown above seem to indicate usefulness, but it remains to be seen whether its benefit lies in simply reducing deficiency or whether they are therapeutic in themselves.
What about Curcumin and Piperine?
A therapeutic benefit of curcumin in carpal tunnel syndrome is backed by other research evidence that shows turmeric and its central constituent, curcumin, has the ability to reduce inflammation and to some degree, neuropathic pain.
Piperine from either black or long pepper, has also been shown to reduce inflammation, along with being a potent antioxidant.
As to whether these natural strategies provide any type of cure or resolution to carpal tunnel syndrome, this remains to be proven. Certainly remediating the cause, especially if it is related to a poor diet, type 2 diabetes, obesity or other nutritional factors, is worth consideration. But its progression can be debilitating and should nevertheless involve the consultation and advice from a medical doctor trained in neuropathic disorders.
Di Pierro F, Settembre R. Safety and efficacy of an add-on therapy with curcumin phytosome and piperine and/or lipoic acid in subjects with a diagnosis of peripheral neuropathy treated with dexibuprofen. J Pain Res. 2013 Jul 3;6:497-503. doi: 10.2147/JPR.S48432. Print 2013. Erratum in: J Pain Res. 2013;6:641.
Ziegler D, Ametov A, Barinov A, et al. Oral treatment with alpha-lipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial. Diabetes Care. 2006;29:2365–2370.
Graham B. Nonsurgical treatment of carpal tunnel syndrome. J Hand Surg Am. 2009 Mar;34(3):531-4. doi: 10.1016/j.jhsa.2009.01.010.
Taylor-Gjevre RM, Gjevre JA, Strueby L, Boyle CA, Nair B, Sibley JT. Treatments for carpal tunnel syndrome: who does what, when … and why? Can Fam Physician. 2007 Jul;53(7):1186-90.
Ryan-Harshman M, Aldoori W. Carpal tunnel syndrome and vitamin B6. Can Fam Physician. 2007 Jul;53(7):1161-2.
Granados-Soto V, Sánchez-Ramirez G, la Torre MR, Caram-Salas NL, Medina-Santillán R, Reyes-García G. Effect of diclofenac on the antiallodynic activity of vitamin B12 in a neuropathic pain model in the rat. Proc West Pharmacol Soc. 2004;47:92-4.
Di Geronimo G, Caccese AF, Caruso L, Soldati A, Passaretti U. Treatment of carpal tunnel syndrome with alpha-lipoic acid. Eur Rev Med Pharmacol Sci. 2009 Mar-Apr;13(2):133-9.
Kapoor S. Clinical applications of alpha-lipoic acid in the management of neurological disorders besides carpal tunnel syndrome. Eur Rev Med Pharmacol Sci. 2009 Sep-Oct;13(5):401-2.
Tanaka H. [Old or new medicine? Vitamin B12 and peripheral nerve neuropathy]. Brain Nerve. 2013 Sep;65(9):1077-82.
Ferreira N, Santos SA, Domingues MR, Saraiva MJ, Almeida MR. Dietary curcumin counteracts extracellular transthyretin deposition: insights on the mechanism of amyloid inhibition. Biochim Biophys Acta. 2013 Jan;1832(1):39-45. doi: 10.1016/j.bbadis.2012.10.007.
Sabina EP, Nagar S, Rasool M. A role of piperine on monosodium urate crystal-induced inflammation–an experimental model of gouty arthritis. Inflammation. 2011 Jun;34(3):184-92. doi: 10.1007/s10753-010-9222-3.
Bang JS, Oh da H, Choi HM, Sur BJ, Lim SJ, Kim JY, Yang HI, Yoo MC, Hahm DH, Kim KS. Anti-inflammatory and antiarthritic effects of piperine in human interleukin 1beta-stimulated fibroblast-like synoviocytes and in rat arthritis models. Arthritis Res Ther. 2009;11(2):R49. doi: 10.1186/ar2662.