Professional Documents
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Tunnel Syndrome
Robert P. Blankfield, MD, MS, Cathy Sulzmann, RN, Linda Goetz Fradley, RN,
Amy Artim Tapolyai, MBA, and Stephen J. Zyzanski, PhD
Background: Alternative medical therapies are widely utilized, but there are few objective data to evalu-
ate the effectiveness of these techniques. The purpose of this study was to determine whether one alter-
native therapy, Therapeutic Touch (TT), can improve objective indices of median nerve function in pa-
tients with carpal tunnel syndrome.
Methods: Participants with electrodiagnostically confirmed carpal tunnel syndrome were randomly
assigned in single-blind fashion to receive either TT or sham therapeutic touch once weekly for 6 con-
secutive weeks. The distal latency of the median motor nerve along with visual analog assessments of
pain and relaxation were measured before and after each treatment session.
Results: Twenty-one participants completed the study. Changes in median motor nerve distal laten-
cies, pain scores, and relaxation scores did not differ between participants in the TT group and partici-
pants in the sham treatment group, either immediately after each treatment session or cumulatively.
Immediately after each treatment session, however, there were improvements from baseline among all
the outcome variables in both groups.
Conclusions: In this small study, TT was no better than placebo in influencing median motor nerve
distal latencies, pain scores, and relaxation scores. The changes in the outcome variables from baseline
in both groups suggest a possible physiologic basis for the placebo effect. (J Am Board Fam Pract 2001;
14:335– 42.)
Because alternative healing techniques are widely which the practitioner uses the hands in a nontac-
used by patients,1–3 distinguishing those treatments tile manner as a focus to facilitate the healing pro-
that are effective from those that are not has rele- cess. The theory underlying TT is that human
vance for a great many patients who use these beings are energy fields, and energy can be directed
therapies. For nonpharmacologic alternative med- from one person to another.6
ical therapies, most of the claims of efficacy have Using sham therapeutic touch as a control, pre-
been based on studies using subjective outcome vious studies have shown that TT significantly re-
variables, usually assessments of pain or anxiety. duces subjective measures of pain,7,8 facilitates
The absence of objective documentation of effec- wound healing,9,10 and reduces anxiety.11
tiveness has resulted in skepticism or indifference Because objective data to corroborate the sub-
on the part of most physicians. jective benefits attributed to TT are lacking, and
One form of alternative therapy, Therapeutic because carpal tunnel syndrome is a pain syndrome
Touch (TT), is a contemporary interpretation of for which there is an objective correlate to the
several ancient healing practices. TT was devel- subjective symptoms of pain and discomfort, the
oped in the late 1960s and early 1970s by Dolores current study was designed to test whether TT can
Krieger, PhD, RN, and Dora Kunz.4,5 It is a con- improve objective indices of median nerve function
sciously directed process of energy exchange during in patients with carpal tunnel syndrome.
Methods
Submitted, revised, 28 February 2001.
From the Department of Family Medicine (RPB, AAT, Patient Selection
SJZ), Case Western Reserve University School of Medicine, Participants were recruited through physician of-
Cleveland; the University Hospitals Primary Care Physician
Practice (RPB), Berea; and the MetroHealth Medical Center fices, advertisements in the city newspaper, and
(CS, LGF), Cleveland, Ohio. Requests for reprints should notices posted at the study site. Before enrolling in
be addressed to Robert P. Blankfield, MD, MS, University
Hospitals Primary Care Physician Practice, Berea Health the study, eligible participants were required to
Center, 200 Front St, Suite 101, Berea, OH 44017. have a diagnosis of carpal tunnel syndrome con-
SD ⫽ standard deviation.
Table 2. Changes in Median Motor Nerve Distal Latencies, Pain Scores, and Relaxation Scores Between Initial
Treatment Session (Before First Session) and Last Treatment Session (Before Sixth Session) for Therapeutic Touch
(n ⴝ 11) and Sham Treatment (n ⴝ 10) Groups.
Therapeutic Touch Sham Treatment P
Variable No. ⫾ SD No. ⫾ SD Value
Mean initial motor distal latency (msec) 5.4 ⫾ 0.9 6.1 ⫾ 1.8 .36
Mean motor distal latency before last 5.2 ⫾ 1.1 5.9 ⫾ 1.0 .15
treatment (msec)
SD - standard deviation.
*n ⫽ 3 for therapeutic touch group, n ⫽ 5 for sham treatment group.
†
n ⫽ 4 for therapeutic touch group, n ⫽ 4 for sham treatment group.
Mean change in motor distal latency (msec) ⫺.21 ⫾ .32* ⫺.16 ⫾ .17† .71
Mean change in pain score ⫺.65 ⫾ .89‡ ⫺1.11 ⫾ 1.41§ .36
Mean change in relaxation score㛳 ⫺.81 ⫾ 1.11¶ ⫺1.39 ⫾ 1.50** .44
SD ⫽ standard deviation.
*For difference from baseline, P ⫽ .06.
†
For difference from baseline, P ⫽ .01.
‡
For difference from baseline, P ⫽ .08.
§
For difference from baseline, P ⫽ .04.
㛳
n ⫽ 7 for therapeutic touch group, n ⫽ 6 for sham treatment group.
¶
For difference from baseline, P ⫽ .11.
**For difference from baseline, P ⫽ .07.
scores, and relaxation scores averaged for the 6 tion, duration of carpal tunnel syndrome, previous
weeks of treatment (Table 3). There were signifi- treatments for carpal tunnel syndrome, associated
cant immediate differences from baseline for par- medical conditions, initial median motor nerve dis-
ticipants in the sham treatment group in terms of tal latency, initial pain score, and initial relaxation
median motor nerve distal latencies and pain scores score.
(negative scores indicate improvement). There was Table 4 compares the total number of partici-
a trend toward an immediate difference in relax- pants treated during TT sessions (those partici-
ation scores in the sham treatment group, and there pants initially assigned to TT plus those initial
was a trend toward an immediate difference from sham treatment participants who crossed over) with
baseline in terms of median motor nerve distal the total number of participants treated during
latencies, pain scores, and relaxation scores for par- sham treatment sessions (those participants initially
ticipants in the TT group. assigned to sham treatment plus those initial TT
Six participants in each group crossed over to participants who crossed over). There were no sig-
the other treatment after a washout period. There nificant differences between the two groups in
were no significant differences between the partic- terms of changes in median motor nerve distal
ipants who crossed over and those who did not in latencies, changes in pain scores, and changes in
terms of age, sex, ethnicity, marital status, educa- relaxation scores. There were significant immediate
Table 4. Immediate Changes in Median Motor Nerve Distal Latencies, Pain, and Relaxation Scores After
Intervention for All Participants Who Received Therapeutic Touch (n ⴝ 17) and Sham Treatment (n ⴝ 16).
Therapeutic Touch Sham Treatment P
Variable No. ⫾ SD No. ⫾ SD Value
Change in motor distal latency (msec) ⫺.21 ⫾ .29* ⫺.20 ⫾ .25† .95
Change in pain score ⫺.63 ⫾ 1.10‡ ⫺1.19 ⫾ 1.20§ .18
Change in relaxation score㛳 ⫺.90 ⫾ 1.21¶ ⫺1.33 ⫾ 1.22** .40
SD - standard deviation.
*For difference from baseline, P ⫽ .01.
†
For difference from baseline, P ⫽ .005.
‡
For difference from baseline, P ⫽ .03.
§
For difference from baseline, P ⫽ .001.
㛳
n ⫽ 13 for therapeutic touch group, n ⫽ 11 for sham treatment group.
¶
For difference from baseline, P ⫽ .02.
**For difference from baseline, P ⫽ .005.