* Investigate the cause of your CTS. If it’s a symptom of, say, rheumatoid arthritis or hypo/hyperthyroidism, treat that condition first.
* When not a symptom of a disease, it’s likely to be a structural problem, so try osteopathy (see box, p 11).
* If caused by repetitive movement, stop the activity to allow damaged tissue to recover and prevent irreversible nerve damage. If you can’t stop the activity, change careers or take time off work, then take regular breaks such as stopping keyboard work every hour or so. Specially designed equipment ensuring good posture and working position will also ease the strain on the wrists.
* Vitamin B6 (50-200 mg/day) has been proven to help. Up to 80 per cent of CTS sufferers are vitamin B6-deficient. B6 is a diuretic and aids function of the synovium (the tissue that makes the joint-lubricating fluid). Riboflavin, biotin, vitamins C and E, selenium and vitamin E (gamma-tocopherol) can also help. WDDTY panellist Melvyn Werbach recommends taking the active form of B6 - pyroxidal-5-phosphate - rather than pyridoxine.
* Eat a natural low-protein (no more than 50 g/day) diet. Avoid food colourings and drugs that may cause B6 or calcium deficiency, such as the Pill or HRT.
* Supplement with the enzyme bromelain, a natural anti-inflammatory and pain-reliever found in pineapple, and with docosahexaenoic (DHA), gamma-linolenic (GLA) and alpha-linolenic (ALA) essential fatty acids - all of which are also anti-inflammatory.
* For chronic pain, try cognitive behavioural therapy, which reduces pain as well as the anxiety and depression that can result from chronic pain (Am J Ind Med, 1999; 35: 232-45).
* Yoga can help stretch, strengthen and balance joints in the body, and aid pain reduction and grip strength (JAMA, 1999; 281: 2087).
* If these don’t work, control pain with low-level laser therapy, where a laser is used to stimulate acupressure points. Laser treatment rapidly stopped pain and tingling in the arms, hands and fingers of 35 patients in one study (Int J Clin Pharmacol Ther, 1995; 33: 208-11).
* Curcumin, as in the spice turmeric, is a potent anti-inflammatory when applied as a poultice with slaked lime (Ind J Exp Biol, 1972; 10: 235-6).
* Investigate the homoeopathic remedy Dichapetalum thunbergh D6 (Allg Homeop Zeit, 1960; 24: 127-30).