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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This paper reports an audit of clinical outcome in 455 consecutive patients (1100 consultations) presenting for private homeopathic treatment of a chronic illness in which conventional treatment had either: failed, reached a plateau in effect, or was contra-indicated by side effects, age or condition of the patient. Three hundred and four patients (66.8%) derived benefit from homeopathic treatment. One hundred and forty-eight patients (32.5%) were able to stop or maintain a substantial reduction in their conventional drugs. The 10 most frequent clinical conditions treated were eczema, anxiety, depression, osteoarthritis, asthma, back pain, chronic cough, chronic fatigue, headaches and essential hypertension. These 195 patients constitute 43% of the total, 151 of them (77%) were improved. The success rate of treatment is similar between age ranges. There was a difference in outcome between the sexes in adults: 296 females treated, success rate 71.3%; 159 males treated, success rate 58.5%. Two patients (0.4%) had prolonged aggravation of their presenting complaints apparently attributable to homeopathic treatment.
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PMID:Audit of outcome in 455 consecutive patients treated with homeopathic medicines. 1622 98

As life expectancy increases every decade, the incidence and prevalence of osteoarthritis (OA) also will increase. Despite progress in our knowledge of the pathophysiology of OA, the management of OA-mediated pain continues to challenge physicians. Concern regarding the cardiovascular effects of cyclooxygenase-2 inhibitors and the gastrointestinal and renal side effects of nonsteroidal anti-inflammatory drugs (NSAIDs) in general has limited the use of these medications in the management of chronic non-cancer pain. Appropriately dosed and monitored use of opioids for OA pain, when more conservative methods have failed, has potentially fewer life-threatening complications associated with it than the more commonly and often less successfully employed pharmacotherapeutic approaches to care. When used as part of a multimodal approach to pain control, opioids are a safe and effective treatment for joint pain, including that of OA. Patients for whom NSAIDs are contraindicated, or for whom combined acetaminophen, tramadol, and NSAID therapy is ineffective, may be started on low-dose opioids and titrated as needed and tolerated. Patient education and informed consent, exercise, complementary medicine, and the use of a controlled substance agreement increases the likelihood of patient compliance with treatment guidelines, improving functional capacity and quality of life.
Curr Pain Headache Rep 2005 Dec
PMID:The use of opioids in the treatment of osteoarthritis: when, why, and how? 1628 39

Because migraine has features in common with episodic monophasic pain disorders (such as postoperative or posttraumatic pain) and with chronic pain disorders (such as osteoarthritis or painful neuropathy), it is often considered an episodic-chronic disorder. In clinical practice, the chronic aspects of migraine are addressed using preventive treatment strategies, while the episodic attacks are addressed by acute treatment strategies. Acute treatment strategies have generally been supported by clinical trial designs that focus on single attacks, whereas preventive treatment strategies evaluate multiple attacks over a period of time. Recently, long-term acute treatment clinical designs have emerged that may inform the design of clinical trials for other episodic-chronic disorders. After reviewing traditional acute treatment clinical trials, we focus here on study methods designed to evaluate treatment and management strategies for migraine over multiple attacks, including outcomes that assess the chronic-episodic nature of migraine (such as headache recurrence and consistency of relief), rather than relief from single attacks. We also discuss end points that reflect the treatment needs of patients, such as disability and health-related quality of life. The traditional randomized controlled trial designed to assess treatment efficacy for a single attack is insufficient to address the broader set of issues that arise in clinical practice. We consider clinical trials strategies designed to address the more complex clinical and policy requirements for meeting the needs of those with migraine.
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PMID:Clinical trials of acute treatments for migraine including multiple attack studies of pain, disability, and health-related quality of life. 1638 4

In Germany, acupuncture is one of the most frequently used complementary and alternative therapies. In the year 2000, we initiated three large projects in co-operation with statutory health insurance companies to assess the effectiveness, safety and costs of acupuncture in patients with chronic headache, low back pain and pain due to osteoarthritis. Our findings showed that acupuncture was more effective than conventional standard treatment, treatment without acupuncture or a waiting list control. A significant difference between acupuncture and sham acupuncture was only seen for arthritis of the knee; for the other diagnoses, both forms of acupuncture showed similar effects. Whether the effects of acupuncture are due primarily to specific or unspecific mechanisms appears to depend on the diagnosis and should be investigated in further studies.
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PMID:[Acupuncture. Clinical studies on efficacy and effectiveness in patients with chronic pain]. 1689 49

Fibromyalgia is a common disorder of diffuse musculoskeletal pain. Several rheumatic diseases can mimic fibromyalgia, and a clinician would not want to miss these diagnoses because of their potential long-term sequelae, such as progressive joint damage or life- or organ-threatening disease if they remain untreated. This paper discusses the typical clinical presentations of selected rheumatic diseases (systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis, polymyalgia rheumatica, and osteoarthritis) then highlights the key features in history, laboratory testing, and radiographic imaging that aid the clinician in differentiating between fibromyalgia and these rheumatic diseases.
Curr Pain Headache Rep 2006 Oct
PMID:Update on rheumatologic mimics of fibromyalgia. 1694 47

We report a case of aseptic meningitis thought to be associated with chronic sulindac use in a patient with osteoarthritis. The patient was hospitalized with an acute onset of headache, nuchal rigidity, nausea, and blurred vision. Brain imaging was unremarkable and a lumbar puncture revealed a lymphocytic pleocytosis. No infectious source was identified. The patient reported taking sulindac over the past year, it was discontinued, and symptoms promptly resolved. This case underscores the importance of obtaining a thorough drug history in conjunction with the knowledge of causative medications associated with aseptic meningitis. Given the widespread use of nonsteroidal anti-inflammatory drugs, clinicians must recognize that aseptic meningitis is a possible adverse effect of these medications.
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PMID:Aseptic meningitis associated with chronic sulindac use for osteoarthritis: a case report. 1770 6

Traditionally, clinicians have relied heavily on the use of NSAIDs to treat the pain of osteoarthritis, as numerous studies have proven these agents effective. However, controversy has arisen regarding their use as first-line therapy, due to increasing awareness of their cardiovascular risks. One of these agents, rofecoxib, was withdrawn from the market in 2004 due to these concerns. Since that time, numerous studies have illustrated that many of the NSAIDs, both the selective cyclooxygenase-2 inhibitors and the traditional non-selective agents, may confer similar risks of cardiovascular toxicity. Although these agents may still be useful in many patients, concerns over side effects have begun to limit their use, and patients and clinicians are reaching for alternate agents. This review highlights the evidence behind the effectiveness of other, non-NSAID pharmacologic options in the treatment of pain and inflammation in osteoarthritis.
Curr Pain Headache Rep 2007 Dec
PMID:The post-NSAID era: what to use now for the pharmacologic treatment of pain and inflammation in osteoarthritis. 1817 75

Patients with rheumatoid arthritis and osteoarthritis have relied upon NSAIDs as a cornerstone of their analgesic regime for decades. The choice of anti-inflammatory agents broadened for this group of patients when the selective inhibitors of cyclooxygenase-2 enzyme were developed. Much has been published in the past few years regarding the superior gastrointestinal safety of this class of drugs when compared with traditional NSAIDs. Their triumphant debut was swiftly followed by the emergence of data detailing their associated increased serious cardiovascular risks. This also led to a reevaluation of data concerning more traditional NSAIDs, and surprisingly, a similar trend was seen. The US Food and Drug Administration has recommended that both classes of drugs carry a black box warning with regard to gastrointestinal and cardiovascular risks.
Curr Pain Headache Rep 2007 Dec
PMID:The problem with NSAIDs: what data to believe? 1817 76

Acupuncture (AP) is effective for the treatment of postoperative and chemotherapy-induced nausea/vomiting and for postoperative dental pain. Several recent randomized trials have provided strong evidence for beneficial AP effects on chronic low-back pain and pain from knee osteoarthritis. For many other chronic pain conditions, including headaches, neck pain, and fibromyalgia, the evidence supporting AP's efficacy is less convincing. AP's effects on experimental pain appear to be mediated by analgesic brain mechanisms through the release of neurohumoral factors, some of which can be inhibited by the opioid antagonist naloxone. In contrast to placebo analgesia, AP-related pain relief takes considerable time to develop and to resolve. Thus, some of the long-term effects of AP analgesia cannot be explained by placebo mechanisms. Furthermore, it appears that some forms of AP are more effective for providing analgesia than others. Particularly, electro-AP seems best to activate powerful opioid and non-opioid analgesic mechanisms.
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PMID:Mechanisms of acupuncture analgesia: effective therapy for musculoskeletal pain? 1817 1

A prognostic approach to defining chronic pain has been proposed as an alternative to traditional definitions based on retrospective duration of pain. While this new approach performs well in low back pain (LBP), headache and orofacial pain, it is not known whether it translates to regional pain syndromes with an underlying pathological component, such as osteoarthritis (OA). We investigated the performance of this approach in a population-based cohort of older adults reporting knee pain, with a spectrum of radiographic knee OA. 676 adults (50 years+) attended a research clinic and were followed up at 18 months and 3 years. Risk scores were calculated using pain intensity, pain duration, pain-related activity, number of pain sites and depressive symptoms, measured at baseline and at 18 months. These scores were used to determine the probability of future clinically significant knee pain, defined as Chronic Pain Grade II-IV, at 18 months and at 3 years using logistic regression. Cut-points on the risk score were applied to determine groups at intermediate (probability >or=0.2), possible (>or=0.5) and probable (>or=0.8) risk of clinically significant knee pain. Discriminative ability of the risk scores, determined by area under the ROC curve, was high (0.78-0.82), varied little by radiographic severity and was superior to pain duration alone. The derived cut-points suggested a lower threshold for each of the risk groups than the previous LBP work. This prognostic approach to defining chronic pain appears to translate well to knee pain. Different cut-points for defining risk groups may be needed for different pain syndromes.
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PMID:A prognostic approach to defining chronic pain: application to knee pain in older adults. 1858 51


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