Clinical rheumatology
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Clinical rheumatology · Feb 2002
Randomized Controlled Trial Clinical TrialBuprenorphine in a transdermal therapeutic system--a new option.
Advanced patch technology has yielded a novel transdermal therapeutic system (TDS) for the rate-controlled systemic delivery of buprenorphine. Buprenorphine TDS is available in three strengths with release rates of 35, 52.5 and 70 microg/h over 72 h, corresponding to daily doses of 0.8, 1.2 and 1.6 mg, respectively. In total, 445 patients with chronic pain of malignant or non-malignant origin requiring long-term treatment with potent opioid analgesics were enrolled in the clinical trial programme. ⋯ Typical opioid-related adverse events were reported with a low incidence and mild intensity. In an open follow-up study 239 patients elected to continue treatment with buprenorphine TDS. The confirmation of clinical benefit, coupled with a high level of patient compliance and improved quality of life, substantiate the usefulness of buprenorphine TDS in a practical setting.
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Pain is the most common reason for patients seeking advice from their physician. One adult in five suffers from chronic pain. In general, musculoskeletal pain, often in the form of arthritis, non-articular rheumatism, peripheral neuropathies and low back disorders, represents the most common cause of chronic non-malignant pain (CNMP). ⋯ The effectiveness of opioids for chronic pain goes unchallenged, but issues of potential dependence, abuse, and social and legal concerns have rendered their use in CNMP controversial. Numerous consensus statements, guidelines and policies have been issued by a variety of advocate organisations for the treatment of CNMP with opioids. Undertreatment of chronic pain persists despite the availability of drugs and other therapies for effective pain management.
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Clinical rheumatology · Feb 2002
Case ReportsBuprenorphine treatment of patients with non-malignant musculoskeletal diseases.
Adequate pain control is vital in the treatment of patients with musculoskeletal disease. These diseases are characterised by a number of pain-induced vicious circles, and satisfactory control of pain acts to disrupt these self-perpetuating processes. Consequently, early mobilisation can be achieved in patients with painful osteoporotic vertebral fractures, low back pain and sciatica, for example. ⋯ When simple analgesics are not sufficient, the use of opioid-type analgesics is justified. Buprenorphine transdermal therapeutic system (TDS) is a novel formulation of a well-tolerated and highly effective drug for satisfactory pain control that can also be used in patients with chronic non-malignant pain (CNMP) due to musculoskeletal diseases. Three case reports are presented to illustrate the effectiveness of buprenorphine TDS in such patients.
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A 53-year-old man presented with gouty arthritis. A physical examination and haematological and biochemical tests showed that he had chronic myeloid leukemia. ⋯ The arthritis subsided completely within 2 weeks. He continues in haematologic remission (on interferon) with no further recurrence of the gout.
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Clinical rheumatology · Jan 2000
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of melatonin in patients with fibromyalgia: a pilot study.
The aim of the study was to determine the possible effect of melatonin treatment on disturbed sleep, fatigue and pain symptoms observed in fibromyalgia (FM) patients. Twenty-one consecutive patients with FM were included in an open 4-week-duration pilot study. Before and after treatment with melatonin 3 mg at bedtime, patients were evaluated using tender point count by palpation of 18 classic anatomical regions, pain score in four predesignated areas, pain severity on a 10 cm visual analogue scale (VAS), sleep disturbances, fatigue, depression, anxiety, and patient and physician global assessments, also by a VAS. ⋯ Lower levels of aMT-6S were found in FM patients compared with normal median controls (+/-SD, 9.16 +/- 7.9 microg/24 h vs 16.8 +/- 12.8 microg/24 h) (p = 0.06). Although this is an open study, our preliminary results suggest that melatonin can be an alternative and safe treatment for patients with FM. Double-blind placebo controlled studies are needed.