Current medical research and opinion
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Many patients with chronic pain experience pain-related sleep disturbances, such as difficulty falling and staying asleep and less restful sleep. Evidence suggests that pain and sleep exist in a bidirectional relationship in which pain causes sleep disturbance and sleep disturbance intensifies pain. This association can impair a patient's daily function and decrease quality of life. Evidence suggests that patients with chronic pain can use opioid analgesics or other pain medications to control their pain and, in turn, improve some measures of sleep. This may include subjective sleep measures such as increased sleep time, and, as evidenced in recent studies, objective sleep measures such as sleep efficiency. ⋯ Pain control achieved with pharmacotherapy, specifically opioid therapy, may help to improve sleep in patients for which opioid therapy is appropriate.
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Multicenter Study
Efficacy and tolerability of a 5% lidocaine medicated plaster for the topical treatment of post-herpetic neuralgia: results of a long-term study.
Evaluation of long-term efficacy and safety of the 5% lidocaine medicated plaster for neuropathic pain symptoms in patients with post-herpetic neuralgia (PHN). ⋯ This study suggests that long-term treatment with the 5% lidocaine medicated plaster may provide substantial and maintained reductions in pain intensity, and that it is continuously well tolerated in patients suffering from peripheral neuropathic pain associated with previous herpes zoster infection. These findings support the use of the 5% lidocaine medicated plaster as one of the first-line therapies in this population.
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Multicenter Study
Physicians' attitudes and adherence to use of risk scores for primary prevention of cardiovascular disease: cross-sectional survey in three world regions.
To evaluate physicians' attitudes and adherence to the use of risk scores in the primary prevention of cardiovascular disease (CVD). ⋯ Based on a survey conducted in a 'real-world' setting, risk scores are generally not used by a majority of physicians to guide primary prevention in asymptomatic persons at intermediate risk for CVD. Appropriate prescribing of lipid-lowering therapy in such patients is equally neglected. Changing physicians' attitudes towards the use of CVD risk scores is one of several challenges that need to be addressed to reduce the world-wide burden of CVD.
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Baseline clinical and health-related quality of life (HRQoL) data from a phase 2, multi-site, international, randomized, controlled trial were analyzed to: (1) characterize the health status of patients with relapsing-remitting multiple sclerosis (RRMS), (2) explore cross-sectional relationships between HRQoL and clinical measures, and (3) evaluate differences in HRQoL scores for subsequent validation as minimally important differences (MID). ⋯ Clinical and HRQoL assessments documented health impairments in physical functioning, fatigue, and cognition among these RRMS patients with relatively short disease duration. HRQoL data varied with clinical measures and contributed new information regarding disease burden. The association between clinical and HRQoL measures was limited to cross-sectional analysis and requires confirmation in longitudinal datasets. These findings reflect an ambulatory, early-stage RRMS population that was mostly European in location or descent. The PAMSI also requires further validation as a measure of patient health status.
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Patients with high cardiovascular risk are prevalent in ambulatory care. To achieve adequate blood pressure control, such patients require higher drug doses and/or combination therapy. We aimed to assess the efficacy and safety of losartan 100 mg as monotherapy or in fixed-dose combination with hydrochlorothiazide 25 mg. ⋯ In high-risk patients, treatment with losartan 100 mg or losartan/HCTZ 100/25 mg was effective and well tolerated, irrespective of comorbidity. These findings from a real-life setting are in line with those from randomized controlled trials.