Medications & CAM for CTS

Carpal Tunnel Syndrome - Medications

Medicine is often used to treat symptoms of carpal tunnel syndrome. Medicine may relieve swelling, inflammation, and pain in the wrist or hand. Reducing swelling in the wrist will relieve pressure on the median nerve in the carpal tunnel and relieve carpal tunnel symptoms.

Medication Choices
Nonsteroidal anti-inflammatory drugs (NSAIDs)
• the most commonly used medicines for carpal tunnel syndrome.
• NSAIDs relieve pain and inflammation and are available with or without a prescription. But a review of research suggests that NSAID treatment for 2 and 4 weeks may not improve carpal tunnel symptoms.
• NSAIDs may be most effective if the tendon is inflamed.
• Although studies have not shown NSAIDs to be effective for carpal tunnel syndrome, they may help relieve your symptoms.

What are the side-effects of NSAIDs?
NSAIDs can be obtained over-the-counter, but that does not mean they are with out potentially serious side-effects. The most common side-effect is irritation of the stomach. The cause of this is thought to be due to the effect on the stomach lining. If the irritation is severe, it may lead to bleeding ulcers, and potentially serious complications.

B4 taking NSAIDS be sure to let your doctor know about other medical problems you have, especially hypertension, asthma, kidney, or stomach problems. In addition, let your doctor know other medications you may be taking, and if you have any known allergies to medications.

NSAIDs should NOT be used if:
• You are pregnant
• You are breastfeeding
• You have a history of stomach ulcers
• You are taking blood thinning medication

NSAIDs should be used only under CLOSE physician supervision if:
• You have asthma
• You have liver problems
• You have heart problems
• You have kidney problems

Corticosteroids
• effective treatment option when NSAIDs do not effectively relieve pain and inflammation.
• But corticosteroids are powerful anti-inflammatory drugs and have side effects that should be considered.
• Corticosteroids can be taken in pill form or injected into the wrist by a doctor.
• Usually are not used until nonsurgical treatments (such as rest, ice, splints, and anti-inflammatory medicines) have been tried for several weeks with no improvement.
• Often provide temporary relief (for several weeks or more). Injected corticosteroids usually provide longer-lasting results than those taken by mouth (oral), but oral or injected medicines rarely provide permanent relief from carpal tunnel symptoms.
• Must be used with caution because both oral and injected forms have potentially serious side effects.

Cortisone injection
How does the cortisone injection help?

Cortisone is a powerful anti-inflammatory medication. Cortisone is not a pain relieving medication, it only treats the inflammation. When pain is decreased from cortisone it is because the inflammation is diminished. By injecting the cortisone into a particular area of inflammation, very high concentrations of the medication can be given while keeping potential side-effects to a minimum. Cortisone injections usually work within a few days, and the effects can last up to several weeks.

Are there side effects?
Yes. Probably the most common side-effect is a 'cortisone flare,' a condition where the injected cortisone crystallizes and can cause a brief period of pain worse than before the shot. This usually lasts a day or two and is best treated by icing the injected area.
Another common side-effect is whitening of the skin where the injection is given. This is only a concern in people with darker skin, and is not harmful, but patients should be aware of this.

Other side-effects of cortisone injections, although rare, can be quite serious. The most concerning is infection, especially if the injection is given into a joint. The best prevention is careful injection technique, with sterilization of the skin using iodine and/or alcohol. Also, patients with diabetes may have a transient increase in their blood sugar which they should watch for closely.

Because cortisone is a naturally occurring substance, true allergic responses to the injected substance do not occur. However, it is possible to be allergic to other aspects of the injection, most commonly the betadine many physicians use to sterilize the skin.

Animal studies have shown effects of weakening of tendons and softening of cartilage with cortisone injections. Repeated cortisone injections multiply these effects and increase the risk of potential problems. This is the reason many physicians limit the number of injections they offer to a patient.

Complementary and alternative treatments
Complementary and alternative treatments are sometimes used to help with the symptoms of tingling, numbness, weakness, or pain felt in the fingers or hand. Some of these treatments include:
• Acupuncture - suggested as a useful treatment for some of the symptoms of carpal tunnel syndrome. Because it is commonly used, the U.S. National Institutes of Health is currently studying the effectiveness of acupuncture for treating carpal tunnel syndrome.
• Yoga - helpful in relieving pain in the hand.
• Manipulation therapies, such as chiropractic - involve realignment of joints and bones by twisting, pulling, or pushing movements in the wrist and in the forearm, upper arm, shoulder, upper back, and neck.
• Vitamin B6 - help prevent or reduce carpal tunnel symptoms. High doses of vitamin B6 can cause nerve problems (neuropathy). Talk to your doctor before using vitamin B6 supplements.
REFERENCE:
http://www.webmd.com/pain-management/carpal-tunnel/carpal-tunnel-syndrome-other-treatment
http://orthopedics.about.com/cs/carpaltunnel/a/carpaltunnel_3.htm