Adverse Effects Of Pharmacological Treatment Research Articles

The Role of Physical Exercise in Chronic Musculoskeletal Pain: Best Medicine-A Narrative Review.

The aim of this paper is to provide a narrative review of the effects of physical exercise in the treatment of chronic musculoskeletal pain. Physical inactivity and sedentary behavior are associated with chronic musculoskeletal pain and can aggravate it. For the management of musculoskeletal pain, physical exercise is an effective, cheap, and safe therapeutic option, given that it does not produce the adverse effects of pharmacological treatments or invasive techniques. In addition to its analgesic capacity, physical exercise has an effect on other pain-related areas, such as sleep quality, activities of daily living, quality of life, physical function, and emotion. In general, even during periods of acute pain, maintaining a minimum level of physical activity can be beneficial. Programs that combine several of the various exercise modalities (aerobic, strengthening, flexibility, and balance), known as multicomponent exercise, can be more effective and better adapted to clinical conditions. For chronic pain, the greatest benefits typically occur with programs performed at light-to-moderate intensity and at a frequency of two to three times per week for at least 4 weeks. Exercise programs should be tailored to the specific needs of each patient based on clinical guidelines and World Health Organization recommendations. Given that adherence to physical exercise is a major problem, it is important to empower patients and facilitate lifestyle change. There is strong evidence of the analgesic effect of physical exercise in multiple pathologies, such as in osteoarthritis, chronic low back pain, rheumatoid arthritis, and fibromyalgia.

Nurse-supported care versus rheumatologist-led care in patients with rheumatoid arthritis at high disease activity: A retrospective study of two Chinese centers.

The European League Against Rheumatism recommendations for the management of rheumatoid arthritis advised the involvement of clinical nurses for the management of rheumatoid arthritis. However, The European League Against Rheumatism recommendations are difficult to apply to Chinese institutes. In China, the rheumatology nursing service is not widely adopted because the feasibility and quality of rheumatology nursing service have not been confirmed in the Chinese population by the Chinese authorities. The objectives of the study were to compare 2.5 years clinical outcomes of patients of rheumatoid arthritis (6 months history) with disease activity score 28-joint count with C-reactive protein (DAS28-CRP) > 5.1 who received nurse-supported care against those of patients who received rheumatologist-led care. Patients received 30 minutes/day and 6 times/week nurse-supported care (NC cohort, n = 127) or Patients had received 20 minutes session at every 3 months of conventional outpatient-based rheumatologist-led care (n = 131). Both types of care have involved the history of patients, care regarding effects and adverse effects of pharmacological treatments, patients education, overall well-being, everyday life, counseling, clarifications, and rehabilitation. Additionally, there were a cohort in which patients did not receive any nontreatment care (NN cohort, n = 141). All patients have definite depression and anxiety (hospital anxiety and depression scale Chinese version score ≥ 11) before nontreatment interventions. At 2.5 years of treatments with or without nontreatment interventions (EL) DAS28-CRP, depression, and anxiety scores of patients of the NC cohort were decreased as compared to their before any type of nontreatment interventions conditions and those of patients of the RC and NN cohorts at EL (P < .001 for all). At EL numbers of patients with moderate disease activity, (DAS28-CRP score: 3.2-5.1) and borderline depression and anxiety (hospital anxiety and depression scales Chinese version score: 8-10) were greater in the NC cohort than those of the RC and NN cohorts (P < .001 for all). Outpatient care satisfaction scores of patients of the NC cohort were higher than those of the RC [23 (27-17) vs 17 (21-14)] and NN [23 (7-17) vs 15 [18-12]) cohorts (P < .001 for both). Physiological and psychological conditions of patients with rheumatoid arthritis with DAS28-CRP > 5.1 are required to improve. Nurse-supported care is superior nontreatment compared to rheumatologist-led care in rheumatoid arthritis patients with high disease activity (Level of Evidence: IV; Technical Efficacy: Stage 5).

Esquizofrenia asociada a consumo de múltiples sustancias Responsabilidad profesional

Schizophrenia is a severe psychiatric disorder classified within the psychotic disorders. Patients usually present variable symptoms depending on the three symptomatic dimensions they suffer from, which generates delay in their early adherence to treatment. The clinical case of interest to be presented corresponds to a male patient in the fourth decade of life diagnosed with schizophrenia associated with multiple substance use, which was analyzed due to the adverse effects of pharmacological treatment following a psychotic episode. The pharmacological approach with patients suffering from this pathology should be aimed at counteracting the symptoms based on antipsychotics and the adverse effects caused by them as long as the disease is diagnosed in a timely manner. Keywords: Schizophrenia; antipsychotic agents; pathologyh; alcolism; haloperidol.

Does pharmacological treatment of depression in people with a primary brain tumour bring any benefits? A Cochrane Review summary with commentary.

Persons with primary brain tumour can suffer from depression. Depression may hinder rehabilitation intervention leading to further deterioration of patient's health and functioning. The Cochrane Review aimed to assess the effectiveness and adverse effects of pharmacological treatment of depression in people with a primary brain tumour. A Cochrane Review by Beevers et al. was summarized with comments. The review did not find any eligible studies from the 2090 studies screened which included randomized controlled trials, cohort studies and case-control studies. There is no high-quality evidence as to whether pharmacological treatments for depression in people with primary brain tumours are either effective or harmful.

Clinical Features of Bipolar Disorder Patients with Metabolic Syndrome: A Cross Sectional Clinic Based Study

IntroductionMetabolic Syndrome (MS) is highly prevalent in patients with bipolar disorder(BD), and may affect the functionality of this population.The increased rate of MS in BD might be due to poorer access to physical health care, unhealthy lifestyle related with psychiatric symptoms and adverse effects of pharmacological treatments.ObjectivesWe sought to compare differences in clinical features of patients with Bipolar Disorder Type 1 (BPD-1)with and without MS in euthymic period.MethodsThis study included 67 euthymic BPD-1 patients without MS and 33 age- and sex-matched BPD-1 patients with MS. All participants completed a sociodemographic form; took the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and Young Mania Rating Scale score. MS was diagnosed according to the International Diabetes Federation (IDF) criteria.ResultsAge at onset of disease was significantly lower in BPD-1 group with MS than without MS (p &lt; 0.05). Number of suicide attempts, psychiatric hospitalisation, was significantly higher in BPD-1 group with MS than without MS (p &lt; 0.05). Catatonic and melancholic depression were significantly more prevalent in the BPD-1 with MS than without MS (p &lt; 0.05). Having history of comorbid psychiatric diseases, mixed episodes, are significantly more prevalent in the BPD-1 with MS than without MS (p &lt; 0.05). There was not significant difference between groups in terms of the medication between groups (p&gt;0.05)ConclusionsOur findings suggest that MS might have an effect on the course of BD patients. The development and testing of interventions for preventing and treating the MS and its components in patients with BD might be important .DisclosureNo significant relationships.

Parents' Perspectives on Adverse Effects of Pharmacological Treatment of Depression on Parental Functioning

BackgroundA substantial number of parents receive pharmacological treatment for depression. Pharmacological treatment is known to reduce symptoms, but has also various side effects.AimThe present study aimed to explore possible adverse effects of pharmacological treatment for depression on parental functioning.MethodSix mothers and four fathers, diagnosed with depression, of children younger than 13 years were recruited via outpatient psychiatric clinics. Data was collected through individual semi-structured interviews and analyzed using thematic analysis.ResultsParents described how anxiety suppressants made them fatigued and drowsy which diminished their attention and ability to focus on the child. Moreover, antidepressants and anxiety suppressants were described to cause fatigue, emotional blunting, and restlessness, which made play and stimulation difficult. Emotional blunting, in turn, affected the parents' sense of commitment, empathy, and love for the child. Finally, parents raised concerns about child safety as hypnotics and anxiety suppressants made them unable to wake up at night.ConclusionsConsidering the substantial adverse effects described, parents of minor aged children within psychiatric care needs to be identified in order to offer systematic follow-ups of the effects of pharmacological treatment on parental functioning, and to make adjustments that are feasible from a parent and child perspective.

Natural Product-Derived Treatments for Attention-Deficit/Hyperactivity Disorder: Safety, Efficacy, and Therapeutic Potential of Combination Therapy.

Typical treatment plans for attention-deficit/hyperactivity disorder (ADHD) utilize nonpharmacological (behavioral/psychosocial) and/or pharmacological interventions. Limited accessibility to behavioral therapies and concerns over adverse effects of pharmacological treatments prompted research for alternative ADHD therapies such as natural product-derived treatments and nutritional supplements. In this study, we reviewed the herbal preparations and nutritional supplements evaluated in clinical studies as potential ADHD treatments and discussed their performance with regard to safety and efficacy in clinical trials. We also discussed some evidence suggesting that adjunct treatment of these agents (with another botanical agent or pharmacological ADHD treatments) may be a promising approach to treat ADHD. The analysis indicated mixed findings with regard to efficacy of natural product-derived ADHD interventions. Nevertheless, these treatments were considered as a “safer” approach than conventional ADHD medications. More comprehensive and appropriately controlled clinical studies are required to fully ascertain efficacy and safety of natural product-derived ADHD treatments. Studies that replicate encouraging findings on the efficacy of combining botanical agents and nutritional supplements with other natural product-derived therapies and widely used ADHD medications are also warranted. In conclusion, the risk-benefit balance of natural product-derived ADHD treatments should be carefully monitored when used as standalone treatment or when combined with other conventional ADHD treatments.

The Efficacy of Electroconvulsive Therapy in Major Depressive Disorder Relapsed or Unresponsive to Transcranial Magnetic Stimulation in Pregnancy: Three Case Studies

About 5-10% of women experience depression during pregnancy. The potentially adverse effects of pharmacological treatment (e.g. teratogenicity, toxicity, foetal developmental abnormalities and withdrawal symptoms) on both the mother and the foetus mean that psychopharmacological treatments have limited application for pregnant women. In these cases treatment needs to be tailored to the individual patient and non-pharmacological options may be appropriate. Transcranial Magnetic Stimulation (TMS) and Electroconvulsive treatment (ECT) may be viable alternatives for these patients. We report on three patients in their first trimester of pregnancy suffering from major depressive disorder (MDD). All three were initially treated with TMS and psychotherapy because of the reduced risk of side effects. Two patients failed to respond adequately to treatment and were switched to ECT. The third patient displayed an adequate response to TMS but failed to maintain the improvement. This patient had to receive ECT in the post-partum period due to on-going depressive symptoms. Subsequently this patient responded adequately to ECT. Further studies of novel, non-pharmacological treatment methods for MDD during pregnancy (such as TMS and ECT) and detailed investigations of the factors associated with treatment responses in such patients are needed. Our cases demonstrate the need to evaluate the effectiveness of TMS in larger samples of pregnant patients diagnosed with MDD.

Allergen-specific immunotherapy.

Allergen-specific immunotherapy is a potentially disease-modifying therapy that is effective for the treatment of allergic rhinitis/conjunctivitis, allergic asthma and stinging insect hypersensitivity. However, despite its proven efficacy in these conditions, it is frequently underutilized in Canada. The decision to proceed with allergen-specific immunotherapy should be made on a case-by-case basis, taking into account individual patient factors such as the degree to which symptoms can be reduced by avoidance measures and pharmacological therapy, the amount and type of medication required to control symptoms, the adverse effects of pharmacological treatment, and patient preferences. Since this form of therapy carries the risk of anaphylactic reactions, it should only be prescribed by physicians who are adequately trained in the treatment of allergy. Furthermore, injections must be given under medical supervision in clinics that are equipped to manage anaphylaxis. In this article, the authors review the indications and contraindications, patient selection criteria, and the administration, safety and efficacy of allergen-specific immunotherapy.

Postnatal affective disorders. Part 2: prevention and management

Women with a history of mental illness should be screened during early pregnancy, as the risk of recurrence following delivery is substantial. The risk of suicide in seriously mentally ill women is elevated following childbirth. Postpartum psychiatric illnesses respond to the same treatments as at other times; breastfeeding, however, limits medication choice. Mothers requiring admission to a psychiatric hospital following delivery should be admitted to a mother and baby unit unless contraindicated. Learning objectives: To recognise the risk factors and preventative measures for postnatal affective disorders. To discuss the psychological, pharmacological and social management. To understand the potential adverse effects of pharmacological treatment on the developing infant via breast milk. Ethical issues: Do the risks to both mother and infant of not treating postpartum psychiatric illness outweigh the risk to the infant of psychotropic medication? Please cite this article as: Oates M. Postnatal affective disorders. Part 2: prevention and management. The Obstetrician &amp; Gynaecologist 2008;10:231–235.

Pharmacological treatments for persistent non-malignant pain in older persons.

Persistent non-malignant pain is common, often neglected and under-treated among older persons. Some older adults do not complain because they consider chronic pain to be a characteristic of normal aging. Physicians have concerns regarding adverse effects of pharmacological treatment. The model of the World Health Organization for treatment of cancer pain is generally accepted and also recommended for persistent non-cancer pain. Furthermore, non-pharmacological treatment should complement drug treatment whenever possible. An initial assessment and possible treatment of underlying causes of pain are pertinent. Modern pharmacological pain management is based on non-opioid and opioid analgesics. NSAIDs are among the most widely prescribed class of drugs in the world. The new cyclo-oxygenase-2 inhibitors such as celecoxib and rofecoxib offer an alternative for the treatment of mild-to-moderate pain in patients with a history of gastric ulcers or bleeding. Paracetamol (acetaminophen) is being used widely for the management of mild pain across all age groups as it has moderate adverse effects at therapeutic dosages. For moderate pain, a combination of non-opioid analgesics and opioid analgesics with moderate pain relief properties (e.g. oxycodone, codeine, tramadol and tilidine/naloxone) is recommended. For severe pain, a combination of non-opioid analgesics and opioid analgesics with strong pain relief properties (e.g. morphine, codeine) is recommended. The least toxic means of achieving systemic pain relief should be used. For continuous pain, sustained-release analgesic preparations are recommended. Drugs should be given on a fixed time schedule, and possible adverse effects and interactions should be carefully monitored. Adjuvant drugs, such as antidepressants or anticonvulsants, can be very effective especially in the treatment of certain types of pain, such as in diabetic neuropathy. Effective pain management should result in decreased pain, increased function and improvement in mood and sleep.

Pharmacological treatments for acute migraine: quantitative systematic review

We wanted to compare the analgesic efficacy and adverse effects of pharmacological treatments for acute migraine through a systematic review of randomised controlled trials in patients with acute migraine pain of moderate to severe intensity. Trials were identified from systematic searching of bibliographic databases. For eletriptan information from all trials was supplied by Pfizer Inc. Outcomes sought were headache relief at 1 and 2 h, patients pain free at 2 h and sustained relief over 24 h for treatments compared with placebo. Numbers-needed-to-treat (NNTs) were calculated, together with relative benefit. Information on adverse effects was also collected. Comparisons of relative efficacy used the same definition of headache, the same degree of pain at the start of treatment and the same definitions of outcomes, and always compared with placebo. Forty-eight publications reporting on 54 trials were included in the meta-analyses, with 79 placebo comparisons for the primary outcome of headache relief at 2 h. Information on any outcome was available for nine oral medications, two intranasal medications and subcutaneous sumatriptan in 21,022 patients. For headache relief at 2 h NNTs ranged from 2.0 for subcutaneous sumatriptan 6 mg to 5.4 for naratriptan 2.5 mg. For patients pain free at 2 h NNTs ranged from 2.1 for subcutaneous sumatriptan 6 mg to 8.6 for aspirin 900 mg plus metoclopramide 10 mg. For sustained relief over 24 h NNTs ranged from 2.8 for eletriptan 80 mg to 8.3 for rizatriptan 5 mg. It was not possible to systematically review adverse effects data. Most interventions are effective. There is considerable information on relative efficacy for a number of outcomes.