The Efficacy of Boswellia carterii Oleogel in Pain Relief and Functional Improvement Among Patients with Carpal Tunnel Syndrome: A Triple-Blind Randomized, Controlled Trial

Abstract

Objectives: The current study aimed at investigating the effectiveness of a topical herbal extract, Boswellia carterii (BC), on pain relief and functional improvement in patients with carpal tunnel syndrome (CTS) versus placebo in a randomized, controlled trial (RCT). Methods: The current study was conducted on 36 patients with mild or moderate levels of bilateral CTS (both hands were involved in all the subjects). Subjects were randomly assigned into two groups receiving either topical oleogel of BC or placebo for six weeks. All the patients were instructed to use wrist splinting; 29 subjects completed the study. The efficacy of topical BC in symptom relief and functional improvement of CTS was evaluated two and six weeks after the intervention using the Visual Analogue scale (VAS) for pain, pain-free grip strength (PFGS), Nerve Conduction study (NCS), and Boston CTS questionnaire (BQ). Results: The subjects in both groups had similar demographics and baseline clinical features. The topical use of BC oleogel led to a significant improvement in VAS scores, symptoms severity score (SSS), functional status scale (FSS), and PFGS in comparison with the baseline level. The baseline VAS score of the intervention group was 5.7 ± 2.9, which decreased to 3.4 ± 1.5 two weeks and 2.7 ± 2.1 six weeks after the intervention (P-value = 0.001). SSS decreased from 29.53 ± 9.4 to 20.93 ± 6.4 and 18.80 ± 6.8 in the same follow-up time points, respectively (P-value = 0.001). The corresponding figures related to FSS were 18.35 ± 6.1, 15.07 ± 7.0, and 12.93 ± 3.79, respectively (P-value = 0.007). PFGS was 6.9 ± 2.6 at pre-intervention, which increased to 7.29 ± 1.7 and 7.65 ± 1.8 two and six weeks after treatment, respectively (P-value = 0.01). Except for grip-strength, the improvement was significantly superior to that of the placebo group. Both VAS and SSS indicated that the topical oleogel of BC achieved a better symptom relief than placebo. On the other hand, no remarkable preference was observed between the two groups in terms of improvement in electrodiagnostic parameters (P ⟩ 0.05). Conclusions: According to the current study findings, the topical application of BC oleogel among patients with CTS improved pain and functional status, remarkably more than placebo. However, no significant changes were observed in electrodiagnostic parameters.