Pharmacologic and Neurodynamic Interventions for Carpal Tunnel Syndrome: A Randomized Clinical Trial.

Abstract

To compare the short-term effects of pharmacologic treatment and manual neurodynamic therapy (MNT) on pain, upper-limb function, and kinesiophobia in adults with mild-to-moderate carpal tunnel syndrome (CTS). Randomized, controlled clinical trial. A single tertiary care hospital. One hundred seventy-nine adults (aged 18-70y) with mild-to-moderate CTS confirmed by clinical and electrophysiological criteria (N=179). Participants were randomly assigned to receive gabapentin, ibuprofen-arginine, MNT, or waiting-list control for 4 weeks. Pain intensity (visual analog scale), upper-limb disability (Quick Disabilities of the Arm, Shoulder, and Hand questionnaire), and kinesiophobia (Tampa Scale for Kinesiophobia-17). Outcomes were assessed at baseline and at 4 weeks. Compared with the waiting-list control group, all active interventions were associated with greater short-term improvements in patient-reported outcomes. The largest reduction in pain intensity (visual analog scale) was observed in the ibuprofen group (-19.3 mm [95% confidence interval (CI), -21.4 to -17.3]), followed by the gabapentin group (-10.0 mm [95% CI, -12.2 to -7.9]) and the MNT group (-4.7 mm [95% CI, -6.9 to -2.4]). Similar patterns were observed for upper-limb disability (Quick Disabilities of the Arm, Shoulder, and Hand questionnaire) and kinesiophobia (Tampa Scale for Kinesiophobia-17), with greater improvements in the intervention groups than in the waiting-list control group. Reductions in pain intensity were independently associated with improvements in disability and kinesiophobia, respectively. In adults with CTS, pharmacologic and neurodynamic interventions were associated with short-term improvements in symptoms and functional outcomes compared with control, although the durability of these effects beyond the immediate follow-up period remains uncertain.