Nature clinical practice. Rheumatology
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Nat Clin Pract Rheumatol · Jul 2008
Are cannabinoids a new treatment option for pain in patients with fibromyalgia?
Preliminary studies suggest that the synthetic cannabinoid nabilone might be an effective therapy in patients with fibromyalgia. Skrabek et al. performed a double-blind, randomized, placebo-controlled clinical trial to analyze the effects of nabilone on pain and quality of life in patients with fibromyalgia. ⋯ Patients who received placebo (n = 18) experienced no change throughout the study. Although nabilone was not associated with serious adverse effects, some patients did experience drowsiness, dry mouth, vertigo and ataxia as a result of treatment.
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Properly conducted meta-analyses that are based on systematic reviews of the literature allow the conclusive synthesis of accumulating scientific evidence. Systematic reviews, with or without meta-analyses, offer a more objective appraisal of the available evidence compared with traditional narrative reviews. ⋯ The validity of meta-analyses depends on the methodological quality of the included studies, the eligibility criteria used for the meta-analysis, and the various reporting biases. In this Review we examine the analytical strengths of, and the main problems encountered by, both systematic reviews and meta-analyses, focusing on how to best assess the validity of each for the practicing clinician.
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Nat Clin Pract Rheumatol · Feb 2008
ReviewChronic nonmalignant pain: a challenge for patients and clinicians.
Chronic pain is widely regarded as a condition that is triggered by various factors, including physical, socio-cultural and psychological deficiencies (that is, maladaptive beliefs). These factors are important in the development and maintenance of this unpleasant experience, which consequently requires a biopsychosocial treatment approach. Pain is a multifaceted sense, the perception of which is personal. ⋯ High-quality randomized controlled trials indicate that multidisciplinary pain programs represent the best therapeutic option for the management of patients with complaints associated with complex chronic pain. The prevalence and the costs--both direct and indirect--that are attributed to chronic pain are increasing; however, not enough is being done to sufficiently and effectively treat chronic pain. There is, therefore, a need for well-designed, interdisciplinary, internationally comparable, and widely distributed pain programs, both in outpatient and inpatient settings, to contribute to the prevention of some future pain diseases.
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Nat Clin Pract Rheumatol · Dec 2007
Case ReportsChronic recurrent multifocal osteomyelitis: what is it and how should it be treated?
Chronic recurrent multifocal osteomyelitis (CRMO) is the most severe form of chronic nonbacterial osteomyelitis. In children and adolescents, chronic nonbacterial osteomyelitis predominantly affects the metaphyses of the long bones, but lesions can occur at any site in the skeleton. Other organs (the skin, eyes, gastrointestinal tract and lungs) can also be affected. Clinical diagnosis is often difficult because the symptoms and course of disease vary significantly. We present a 10-year-old girl diagnosed with CRMO involving several vertebrae, the femur and the metatarsus. ⋯ The patient's condition improved whilst being treated with NSAIDs for 3 months; however, the patient had an allergic skin reaction to this therapy. Treatment was switched to sulfasalazine, accompanied by 3 weeks of therapy using oral prednisone, but sulfasalazine was discontinued 2 months later because the patient exhibited a minor elevation in the levels of liver enzymes. The patient was free of musculoskeletal symptoms for 6 months, at which time she started to complain again about pain in her back and bowel. Multimodal therapy, consisting of mesasalazine, corticosteroids (budesonide) and azathioprine, induced clinical remission of Crohn's disease.