Drug Treatments for CTS?
Hi, I first had CTS symptoms in my right hand about three years ago, it sorted itself out pretty quickly and all was well. It then began again though more intensely 9 months ago in mid-July, again in my right hand. This time it didn't ease so in mid-August I saw my GP. He referred me for a NCS which confirmed mild CTS in my right hand. I had a corticosteroid injection (hand looked like Shrek's!) in December which, after a few days, helped. But about 3-4 weeks later the problem returned only slightly different. This time the numbness was back but also a sort of 'twanging' sensation when I stretched out my arm, to pick something up off the floor for example. Meanwhile my left hand began to start in the same way, going numb at night, I kept waking up thinking I was in bed with a dead body, until I realised it was 'attached' to me! I began with pain in my elbow too. I was also finding that my right hand was going cold at times. I was sent off for an MRI scan of my neck, an x-ray of my right elbow and a repeat NCS. MRI normal, x-ray normal. When I had the second NCS the guy who did it said that he didn't think I'd been 'warmed up enough' last time and spent quite a while warming my hands up between hot water bottles. After he had done the NCS he said that he could see that I had CTS in my right hand, also lesser so in my left hand and that my ulnar nerve was also performing slower than it should. He would suggest surgery to my right wrist and see how things go with my left wrist and right elbow. I'm now waiting to see the consultant about next steps but having spoken to his secretary I'm told that I have 'mild' CTS in the right wrist but nothing was said about my left hand or my right ulnar nerve. If surgery is decided as the best way forward I will go on a waiting list which is currently 6-7 months long! Having had very poor sleep for the last 9 months with no prospect of relief I phoned my GP somewhat in despair, I am utterly exhausted, I can see why some might use sleep deprivation as a form of torture! He suggested trying a drug, can't remember what it was called now, amitriptyline(?) it used to used as an antidepressant. So I am now wondering what on earth to do. If it is impacting my life this much and it's only 'mild' what are the options? Do I try the drug? Do I accept surgery if it is recommended? Mostly though I'd qlike some decent sleep. I'd quite like to know what the long term 'prognosis' might entail, I am at my wits end being so tired, I dread going to bed because I know it will be yet another disturbed night and I will struggle to function in the morning. Thoughts?
Thanks, yes I have tried splints at night. Initially they provided a little respite but then it went quite the other way and I now find that they make it much worse at night. I am up in Moray, north east Scotland. I think the GP was thinking of trying the amitriptyline (10mg progressing to 30mg) in the hope that it may help with sleep as this is a significant problem. I don't know whether to try the amitriptyline or not now!
Well it's not a drug that carries major risks - you can always stop it if it achieves nothing or produces troublesome side effects but there are no published trials of amitriptyline for CTS that I know of so there is simply no evidence to say whether it helps or not. The situation with gabapentin is a bit different, there are at least two trials of that, neither of which showed any great benefit. It's probably worth checking out the splints page on this site to see if yours are adjusted correctly. A second steroid injection is probably the best bet, making sure that an adequate dose is used. I'm sorry it's apparently such a long queue - I thought most of the UK was managing CTS surgery moderately quickly now following the previous government's emphasis on 18 week pathways from opriginal referral to treatment - though Wales seems to have been lagging a bit - but I'm always curious to hear actual reports of what is happening elsewhere. JB
Hi...I am waiting for results of blood test, but my doctor feels that I probably have cts. Have been woken up every night for at least two months with pains in both my hands. He has put me on amitriptyline which I started taking two nights ago. First night had mild relief and slept better. Second night was woken again with pain and was awake for an hour or so. Both days after taking the drug I have felt completely exhausted. Unable to do much until early afternoon. Going to keep going with the drugs until I see my doctor again in a weeks time.
I wish someone would do a proper placebo trial of amitriptiline for CTS an then we would know whether it is worth trying or not. Splints and steroid injection definitely help so I would be more inclined to stick with those proven treatments initially rather than experimenting with unproven medications. JB
As a quick first aid measure have you tried a splint at night? If you do end up on a 6-7 month waiting list which is pretty long (where is this?) - then you could always try a second injection in the meantime as a holding measure. Second injections are sometimes more successful than first. There is no good evidence to support the use of amitriptyline and trials of gabapentin, which is also tried by some GPs in this situation have so far come up with negative results so splints and steroid injection should be the mainstay of conservative treatment rather than tablets. JB