Nat Clin Pract Rheum
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Nat Clin Pract Rheum · Oct 2006
ReviewA review of work-participation, cost-of-illness and cost-effectiveness studies in ankylosing spondylitis.
Ankylosing spondylitis (AS) can have important socioeconomic consequences for individual patients and for society, as symptoms usually appear in the third decade of life. When compared with those of the general population, employment rates for AS patients are significantly decreased in men, but not in women; however, both sexes experience increased AS-related (partial) work disability. In addition, changes in type of work, working hours, and the need for help might be required. ⋯ Cost-effectiveness analyses for different AS therapies have shown variable results. The use of different methodologic approaches to assess the cost-effectiveness ratios makes the findings of such analyses difficult to compare with each other. This article examines the effect of AS on work participation, costs of illness and reviews cost-effectiveness analyses of AS treatments.
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Cognitive behavioral therapy (CBT) techniques offer short-term, goal-oriented psychotherapy. In this respect, it differs from classical psychoanalysis in emphasizing changes in thought patterns and behaviors rather than providing 'deep insight'. Importantly, the beneficial effects of CBT can be achieved in 10-20 sessions, compared with the many years required for classical psychoanalysis. ⋯ Sustained improvements in pain were most evident when individualized CBT was used to treat patients with juvenile fibromyalgia. The current data indicate that CBT, as a single treatment modality, does not offer any distinct advantage over well-planned group programs of education or exercise, or both. Its role in the management of fibromyalgia patients needs further research.
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Nat Clin Pract Rheum · Jul 2006
ReviewTherapy Insight: fibromyalgia--a different type of pain needing a different type of treatment.
In the past decade, we have made tremendous progress in our understanding of fibromyalgia, which is now recognized as one of many 'central' pain syndromes that are common in the general population. Specific genes that might confer an increased risk of developing fibromyalgia syndrome are beginning to be identified and the environment (in this case exposure to stressors) might also have a significant effect on triggering the expression of symptoms. After developing the syndrome, the hallmark aberration noted in individuals with fibromyalgia is augmented central pain processing. ⋯ The most efficacious compounds that are currently available include the tricyclic drugs and mixed reuptake inhibitors that simultaneously increase serotonin and norepinephrine concentrations in the central nervous system. Other compounds that increase levels of single monoamines (serotonin, norepinephrine or dopamine), and anticonvulsants also show efficacy in this condition. In addition to these pharmacologic therapies, which are useful in improving symptoms, nonpharmacologic therapies such as exercise and cognitive behavioral therapy are useful treatments for restoring function to an individual with fibromyalgia.
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Nat Clin Pract Rheum · Jul 2006
Randomized Controlled TrialDoes flexion-distraction help treat chronic low back pain?
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Nat Clin Pract Rheum · Apr 2006
Randomized Controlled TrialUtility of cognitive behavioral therapy as a treatment for insomnia in patients with fibromyalgia.