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Query: UMLS:C0278080 (physical dependence)
 1,658 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Spinal cord injury (SCI) can cause paralysis; sensory impairment; autonomic nervous system dysfunction; and bowel, bladder, and sexual dysfunction. These impairments may lead to immobility, physical dependence, and alterations in lifestyle and self-esteem. The addition of chronic, intractable pain to these impairments can be truly devastating. Chronic pain superimposed on spinal cord injury can virtually drain the individual of strength, motivation, and will. For the spinal cord injury survivor who already faces functional loss, severe pain can further restrict even the diversional activities that are available. Thus, it may become impossible for the individual to escape his or her pain even temporarily. The various medical, physical, and surgical treatments considered to be efficacious in treating this pain are reviewed. However, although chronic pain in SCI may be managed by these therapies, a permanent cure may not result.
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PMID:Clinical management of chronic pain in spinal cord injury. 163 73

This article compares panic disorder (PD) medications and discusses long-term therapy. In a review of the literature, monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), and benzodiazepines prove effective in treating PD. MAOIs treat comorbid depression; frequent side effects are dizziness and orthostatic hypotension. SSRIs are better tolerated than MAOIs, producing mild anticholinergic effects, but also producing gastrointestinal side effects and sexual dysfunction. Benzodiazepines are generally well tolerated when titrated gradually; moderate sedation is the most common short-term side effect. Long-term risks are physical dependence and withdrawal reactions. One hundred six PD patients were enrolled in a double-blind, 8-month, placebo-controlled trial of alprazolam and imipramine. In the 8-week short-term phase, daily dosages were titrated up to 10 mg/day of alprazolam and 250 mg/day of imipramine. The greatest number of dropouts occurred during this phase (lack of improvement and/or side effects). Alprazolam patients had a significantly more rapid onset of improvement and lower adverse events and attrition rates. In the 6-month maintenance period, patients continued short-term treatment. Patients receiving either alprazolam or imipramine developed tolerance to some side effects. At maintenance-phase completion, 62% of the alprazolam-group patients and 26% of both the imipramine- and placebo-group patients were panic free (p<0.01). Dosages were tapered to zero over 3 weeks; one third of the alprazolam patients could not discontinue. During the unblinded, 15-month follow-up, patients received open treatment selected by personal physicians on an as-needed basis. At the end of follow-up, all patients were reassessed. Patients who had completed both short-term and maintenance phases were far more likely to be panic-free (85% vs. 55%; p<0.01). PD is chronic and recurrent, and 8 months is an effective treatment period. Maintenance treatment does not lead to tolerance, even with benzodiazepines. Dose tapering must be very gradual. Completion of a long-term maintenance program strongly predicts remission.
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PMID:Panic disorder: long-term pharmacotherapy and discontinuation. 987 8

Less than one third of people afflicted with generalized anxiety disorder (GAD) experience spontaneous remission, and the symptoms of GAD wax and wane throughout a person's life. The burden of GAD may be reduced with psychopharmacologic therapy. The medications with the most evidence of efficacy in GAD are the benzodiazepines, including a new long-acting formulation of alprazolam. These drugs have a low incidence of side effects but may cause physical dependence, withdrawal, and sedation. Antidepressants are also efficacious in GAD but act less quickly than benzodiazepines. Tricyclic antidepressants such as imipramine may substantially reduce symptoms of anxiety but are not considered a first-line therapy because of their side effects spectrum. The extended-release formulation of venlafaxine and selective serotonin reuptake inhibitors such as paroxetine and sertraline are also efficacious in GAD. While their association with sexual dysfunction may be intolerable for some adults, these drugs may be more appropriate than the benzodiazepines because their chronic use does not lead to dependence. Buspirone also significantly reduces symptoms of GAD and is associated with less sexual dysfunction than SSRIs and less sedation than benzodiazepines. Combining antidepressant and benzodiazepine therapy or medication treatment and psychotherapy may lead to an increase in improvement in patients not responding to 1 treatment approach alone. The most effective treatment for managing the recurrent symptoms of this chronic disorder will remain unknown until more long-term studies using both drug and nondrug therapies are conducted. Remission rates are still only about 40%, signifying the need for improved treatment interventions.
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PMID:Pharmacotherapy of generalized anxiety disorder. 1256 13

Anxiety disorders are persistent impairing diseases, with often chronic course and suffering from symptoms throughout a life-span. The medication with the most evidence of efficacy is the benzodiazepines having a low incidence of side effects but may cause physical dependence, withdrawal and sedation. The use of these drugs should be limited to the acute treatments during the first several weeks in combination with an SSRI or and SNRI for the treatment of the acute phase. After three to four weeks, when antidepressants become effective, benzodiazepine dose should be tapered over a one week period. Among the antidepressants, the SSRI and the SNRI are considered a first-line therapy because of their favourable side effect spectrum compared to tricyclic antidepressants. However, the association with side effects such as nausea, sweating, sexual dysfunction and gastrointestinal problems and insomnia may be intolerable for a number of patients. Combining antidepressants and benzodiazepine therapy or medication treatment and psychotherapy may lead to an increase in improvement in patients not responding to one treatment approach alone. The most effective treatment for managing the recurrent symptoms of this chronic disorder are still unknown and other studies and approaches are in need as remission rates are still only about 40%.
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PMID:[Treatment strategies in anxiety disorders--an update]. 1949 38