NON-OPERATIVE TREATMENTS VS. PLACEBO/CONTROL (Recommendation Against)

The overall strength was downgraded for this option given the heterogeneity in treatment modalities, study quality, control cohort utilized, and follow-up time periods. Single studies evaluating acupressure, insulin injection, heat therapy, immobilization, oral diuretic, and oral NSAID for the treatment of CTS showed no significant difference at short term follow up (Asgari, 2020, Kamel 2019, Mansiz Kaplan 2019, Kocak Ulucakoy 2020, Chang 2020). Two studies showed moderate evidence that there was no significant difference between patient treatment with magnet therapy and controls (Colbert 2010 and Baute 2018). Patients treated with nutritional supplementation did not show improvement over controls in two studies (Paolucci 2018 and Faig-Marti 2017), however, showed improvement in a single study with very short term follow up (Marvulli 2021). There is strong evidence that oral anticonvulsants are not effective in the treatment of CTS with three out of four articles showing no significant difference between treatment and placebo groups (Hui 2011, Eftekharsadat 2015, Mehmetoglu 2018, Hesami 2018). Lastly, there is strong evidence against the use of phonophoresis to treat CTS (Boohong 2020 and Haghighat 2021).

Benefits/Harms of Implementation
The above treatments do not show a consistent significant difference from control groups and add to the time and monetary expense for patients suffering from CTS and to the health system (low value care). Moreover, adverse reactions from oral diuretics, NSAIDs and anticonvulsants are well recognized and are discouraged for non-operative treatment of CTS through this guideline.

Outcome Importance
As the above treatments do not show a difference in symptom improvement for CTS, they should not be recommended.

Cost Effectiveness/Resource Utilization
Given the lack of effectiveness of the above treatments are not considered cost effective to treat CTS.

Future Research
No long-term follow up studies are available to confirm the lack of effectiveness of these therapies, however, are likely not necessary, given the lack of short-term benefits.