I use a ring flash (an old vivitar one, macroflash 5000 I think?) and even at 1/60th sync, I don't struggle hand held.
The flash duration is very short, I don't know the actual speed. So I use a tamron adaptall 90mm 2.5, the matching optical extender to get a 180mm 1:1 lens f5.6. This offers *just* enough light for acceptable focusing, although that is by far the hardest part. A true 1:1 lens that lets in more light would be a huge advantage here.
Then I stop down to whatever I need, usually an effect f 22 or smaller for depth of field and shoot. Effectively the only light is the flash duration so my effective shutter speed is in the thousandths of a second.
Takes practice though, and I must admit, I only got the feel for it when I transferred said lens to a nikon d200 and could get results immediately, educating me on the sort of film speeds that work at various distances. Cheater, I am.