The Effectiveness of Oral Pain Medication and Corticosteroid Injections for Carpal Tunnel Syndrome-A Systematic Review.
To present an evidence-based overview of the effectiveness of oral pain medication and corticosteroid injections to treat carpal tunnel syndrome (CTS).
The Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro were searched for relevant systematic reviews and randomized controlled trials (RCTs).
DATA SELECTION AND EXTRACTION:
Two reviewers independently selected the studies, extracted the data on pain (VAS), function or recovery and assessed the methodological quality.
A best-evidence synthesis was performed to summarize the results of the included studies. Four reviews and nine RCTs were included. For oral pain medication strong and moderate evidence was found for the effectiveness of oral steroids versus placebo in the short-term. Moderate evidence was found in favor of oral steroids versus splinting in the short-term. No evidence was found for the effectiveness of oral steroids in the long-term. For corticosteroid injections, strong evidence was found in favor of a corticosteroid injection versus a placebo injection and moderate evidence was found in favor of corticosteroid injection versus oral steroids in the short-term. Also in short-term, moderate evidence was found in favor of a local versus a systematic corticosteroid injection. Higher doses of corticosteroid injections seem to be more effective in the midterm, however the benefits of corticosteroid injections were not maintained in the long-term.
The reviewed evidence supports that oral steroids and corticosteroid injections benefit patient with CTS particular in the short-term. Although a higher dose of steroid injections seems to be more effective in the midterm, the benefits of oral pain medication and corticosteroid injections were not maintained in the long-term.
Arch Phys Med Rehabil. 2018 Apr 4. pii: S0003-9993(18)30210-7. doi: 10.1016/j.apmr.2018.03.003. [Epub ahead of print]