scholarly journals Non-Pharmacological Treatment Options for Patients with Fibromyalgia

2018 ◽  
Vol 8 (3) ◽  
pp. 165-169
Author(s):  
Md Shahidur Rahman
Keyword(s):  
Pharmacological Treatment ◽  
Soft Tissues ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Chronic Fatigue ◽  
Treatment Modalities ◽  
Pharmacological Interventions ◽  
Beneficial Effects

Fibromyalgia is a generalized chronic pain syndrome characterized by widespread pain and tenderness to palpation at multiple anatomically defined soft tissues and associated with depression, anxiety, insomnia, cognitive dysfunction, chronic fatigue, and autonomic dysfunction. In 2010, American College of Rheumatology modified classification criteria defined in 1990. This is one of the most common musculoskeletal complaints in physician’s chambers. For lack of specific pharmacological treatment options, non-pharmacological treatment modalities are found to have some immediate efficacy and a variable efficacy in the long term. We searched literatures and reviewed randomized controlled trials for possible predictors of outcome in fibromyalgia. The effects of non-pharmacological interventions are limited and positive outcomes largely disappear in the long term. However, within the various populations with fibromyalgia, treatment outcomes showed considerable individual variations. Subgroups of patients with high levels of psychological distress may benefit from non-pharmacological interventions. Some of the relevant published articles demonstrated the beneficial effects of non-pharmacological treatment options, specially exercise, cognitive behavioral therapy and alternative and complementary medicine, in the context of non-availability of specific pharmacotherapy.J Enam Med Col 2018; 8(3): 165-169

scholarly journals Chronic Fatigue Syndrome: A Case Report Highlighting Diagnosing and Treatment Challenges and the Possibility of Jarisch–Herxheimer Reactions if High Infectious Loads Are Present

Healthcare ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1537
Author(s):  
Rachel K. Straub ◽  
Christopher M. Powers
Keyword(s):  
Case Report ◽  
Chronic Fatigue Syndrome ◽  
Treatment Options ◽  
Tube Feeding ◽  
Chronic Fatigue ◽  
Medical Interventions ◽  
System Disease ◽  
Fatigue Syndrome ◽  
Harsh Reality

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex multi-system disease with no cure and no FDA-approved treatment. Approximately 25% of patients are house or bedbound, and some are so severe in function that they require tube-feeding and are unable to tolerate light, sound, and human touch. The overall goal of this case report was to (1) describe how past events (e.g., chronic sinusitis, amenorrhea, tick bites, congenital neutropenia, psychogenic polydipsia, food intolerances, and hypothyroidism) may have contributed to the development of severe ME/CFS in a single patient, and (2) the extensive medical interventions that the patient has pursued in an attempt to recover, which enabled her to return to graduate school after becoming bedridden with ME/CFS 4.5 years prior. This paper aims to increase awareness of the harsh reality of ME/CFS and the potential complications following initiation of any level of intervention, some of which may be necessary for long-term healing. Treatments may induce severe paradoxical reactions (Jarisch–Herxheimer reaction) if high infectious loads are present. It is our hope that sharing this case will improve research and treatment options for ME/CFS.

scholarly journals Rewriting One Patient’s Story of Disrupted Sleep

2019 ◽  
pp. 161-172
Author(s):  
Samantha Domingo ◽  
Michelle L. Drerup
Keyword(s):  
Social Support ◽  
Treatment Adherence ◽  
Relaxation Training ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
Cognitive Restructuring ◽  
Sleep Hygiene ◽  
Sleep Restriction ◽  
Insomnia Disorder

This chapter covers treatment options for individuals with chronic insomnia disorder. We describe the effectiveness of cognitive behavioral therapy for insomnia (CBT-i) and various modalities of delivery of the treatment. CBT-i is an alternative treatment for insomnia that has been demonstrated to be as successful as pharmacological therapies in the short term, and more effective in the long term. CBT-i comprises sleep restriction, stimulus control, relaxation training, sleep hygiene, and cognitive restructuring. The authors examine group CBT-i as a way to increase social support and enhance treatment adherence. Computerized CBT-i is a newer option to provide increased access to this treatment.

Treatments for Pathological Gambling and Other Impulse Control Disorders

2007 ◽  
pp. 561-578 ◽  
Author(s):  
Jon E. Grant ◽  
Marc N. Potenza
Keyword(s):  
Pathological Gambling ◽  
Pharmacological Treatment ◽  
Impulse Control ◽  
Behavioral Therapy ◽  
Impulse Control Disorders ◽  
Long Term Effects ◽  
Drug Treatments

Several controlled outcome studies (Type 1 and Type 2) suggest that specific behavioral (e.g., cognitive-behavioral therapy [CBT]) and pharmacological (e.g., naltrexone, nalmefene, lithium) treatments significantly reduce the symptoms of pathological gambling in the short term compared with wait-list or placebo. Although long-term effects of manual-based CBT have been observed in several small studies, the long-term benefits of pharmacological treatment have not been adequately tested. No studies combining behavioral and pharmacological therapies have been published to date. Thus, the potential benefit of combining behavioral and drug treatments for pathological gambling remains to be investigated systematically. Although several studies (Type 1 and Type 2) suggest that CBT is effective for trichotillomania, pharmacological treatment studies for this disorder have shown mixed results. Similarly, controlled pharmacological studies (Type 1 and Type 2) of compulsive buying have demonstrated mixed results. Limited treatment studies exist for other impulse control disorders (kleptomania, intermittent explosive disorder), although various pharmacological and psychological treatments have shown promise in uncontrolled studies.

scholarly journals Update on the Treatment of Idiopathic Hypersomnia

2019 ◽  
Vol 5 (4) ◽  
pp. 207-214
Author(s):  
M. S. Schinkelshoek ◽  
R. Fronczek ◽  
G. J. Lammers
Keyword(s):  
Treatment Options ◽  
Pharmacological Therapy ◽  
Small Sample ◽  
Treatment Modalities ◽  
Lifestyle Advice ◽  
Pharmacological Interventions ◽  
First Choice ◽  
Idiopathic Hypersomnia ◽  
Small Sample Sizes

Abstract Purpose of Review Idiopathic hypersomnia is an incapacitating disorder with a profound impact on daytime performance and quality of life. The most commonly used treatment modalities are lifestyle advice and pharmacological therapy. We present an update on the evidence concerning treatment options for idiopathic hypersomnia. Recent Findings Evidence for non-pharmacological interventions is lacking; improvement in symptoms on introducing these interventions is often less pronounced than in narcolepsy. Additional pharmacological treatment is therefore usually initiated. The few treatment studies that have been performed are hampered by small sample sizes and the use of variable and often insufficiently validated outcome parameters for the whole spectrum of idiopathic hypersomnia symptoms. Conclusion Evidence on treatment is scarce. Since the efficacy of modafinil is consistently described and there is much experience with this substance, it is reasonable to start with modafinil as a first choice treatment. Methylphenidate and dexamphetamine are good alternatives. In the future, newer drugs such as sodium oxybate, pitolisant, and solriamfetol might be authorized for use in idiopathic hypersomnia.

scholarly journals Outcomes from stereotactic surgery for essential tremor

2018 ◽  
Vol 90 (4) ◽  
pp. 474-482 ◽  
Author(s):  
Robert Francis Dallapiazza ◽  
Darrin J Lee ◽  
Philippe De Vloo ◽  
Anton Fomenko ◽  
Clement Hamani ◽  
...  
Keyword(s):  
Essential Tremor ◽  
Focused Ultrasound ◽  
Neurological Complications ◽  
Treatment Modalities ◽  
Beneficial Effects ◽  
Appropriate Treatment ◽  
Long Term Follow Up ◽  
Added Benefit ◽  
One Year

There are several different surgical procedures that are used to treat essential tremor (ET), including deep brain stimulation (DBS) and thalamotomy procedures with radiofrequency (RF), radiosurgery (RS) and most recently, focused ultrasound (FUS). Choosing a surgical treatment requires a careful presentation and discussion of the benefits and drawbacks of each. We conducted a literature review to compare the attributes and make an appraisal of these various procedures. DBS was the most commonly reported treatment for ET. One-year tremor reductions ranged from 53% to 63% with unilateral Vim DBS. Similar improvements were demonstrated with RF (range, 74%–90%), RS (range, 48%–63%) and FUS thalamotomy (range, 35%–75%). Overall, bilateral Vim DBS demonstrated more improvement in tremor reduction since both upper extremities were treated (range, 66%–78%). Several studies show continued beneficial effects from DBS up to five years. Long-term follow-up data also support RF and gamma knife radiosurgical thalamotomy treatments. Quality of life measures were similarly improved among patients who received all treatments. Paraesthesias, dysarthria and ataxia were commonly reported adverse effects in all treatment modalities and were more common with bilateral DBS surgery. Many of the neurological complications were transient and resolved after surgery. DBS surgery had the added benefit of programming adjustments to minimise stimulation-related complications. Permanent neurological complications were most commonly reported for RF thalamotomy. Thalamic DBS is an effective, safe treatment with a long history. For patients who are medically unfit or reluctant to undergo DBS, several thalamic lesioning methods have parallel benefits to unilateral DBS surgery. Each of these surgical modalities has its own nuance for treatment and patient selection. These factors should be carefully considered by both neurosurgeons and patients when selecting an appropriate treatment for ET.

Clinical considerations for the management of pediatric patients with attention-deficit/hyperactivity disorder

2013 ◽  
Vol 2 (11) ◽  
pp. 362-369
Author(s):  
Dustin Linn ◽  
Andrea Murray ◽  
Thomas Smith ◽  
David Fuentes
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
English Language ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
Time Frame ◽  
Chronic Health Condition ◽  
Hyperactivity Disorder ◽  
Long Term Treatment

Introduction: Attention-deficit/hyperactivity disorder (ADHD) is a chronic health condition presenting with symptoms of hyperactivity, impulsivity, and/or inattention in early childhood, adolescence and adulthood. Many patients will persist with associated symptoms throughout their life and may require long term treatment to maintain adequate control. Objective: The purpose of this article is to review the current literature in regards to diagnosis, treatment, and management of ADHD in the pediatric and adolescent population. Methods: A search was conducted using PubMed, Medline, Ovid, and CINHAL with a focus on studies and reviews in the English language from 2008 – 2013, featuring pediatric/adolescent patients across the ages of 4–17 years using the terms: “management”, “attention-deficit”, “hyperactivity”, and “treatment.” Literature referenced prior to the five-year time frame outlined herein provided foundational information on diagnostics and medications. Discussion: Stimulants, in conjunction with behavioral therapy, are standard first line treatments used in ADHD. While stimulant medications have been shown to be effective in treating symptoms associated with ADHD, there are a variety of concerns that may prevent their use. These concerns are related to adverse consequences, many of which are not supported by concrete evidence. Other pharmacotherapy options such as norepinephrine reuptake inhibitors and selective alpha-2 adrenergic agonists are typically reserved as second line options. The use of novel and emerging complementary therapies will also be explored. Conclusion: Patients diagnosed with ADHD must be thoroughly evaluated when making decisions regarding treatment. Many studies and reviews support the efficacy of pharmacotherapy in treatment of ADHD; however, there is insufficient evidence regarding long-term safety of the medications. Further research is warranted to evaluate current treatment options and associated risks and benefits to guide the clinician in optimal management of these patients.

scholarly journals Skin directed treatment of cutaneous T-cell lymphomas, case report

2020 ◽  
Vol 96 (5) ◽  
pp. 212-218
Author(s):  
Melánia Pozsgai ◽  
◽  
Rolland Gyulai ◽  
Csaba Gyömörei ◽  
Zsuzsanna Lengyel
Keyword(s):  
T Cell ◽  
Mycosis Fungoides ◽  
Treatment Options ◽  
Disease Stage ◽  
Treatment Modalities ◽  
T Cell Lymphomas ◽  
Choice Of Treatment ◽  
Puva Treatment ◽  
Show Lymph Node

Cutaneous T-cell lymphomas are rare diseases with significant differences in their clinical course and prognosis. The choice of treatment basically depends on the stage, in the early stages of the disease only skin directed treatment is recommended. With most of the treatment modalities, complete cure is not possible, only long-term remission can be achieved. The authors report the case of a 52-year-old female patient who developed extensive annular, erythematous, infiltrated plaques in the spring of 2019. Histological examination confirmed mycosis fungoides, imaging did not show lymph node or other organ involvement. Given the disease (stage IB), PUVA treatment was initiated. After a total of 21 sessions of phototherapy from September 2019, the patient underwent complete remission. The authors provide a detailed review of skin directed treatment options for mycosis fungoides based on current international recommendations.

scholarly journals Spinal Cord Stimulation for Complex Regional Pain Syndrome: A Case Study of a Pregnant Female

2016 ◽  
Vol 3;19 (3;3) ◽  
pp. E487-E493
Author(s):  
Shaik Ahmed
Keyword(s):  
Spinal Cord ◽  
Complex Regional Pain Syndrome ◽  
Spinal Cord Stimulation ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Conclusive Evidence ◽  
Treatment Modalities ◽  
Child Bearing ◽  
The Impact

Background: Spinal cord stimulation (SCS) is a form of neuromodulation, used to treat chronic neuropathic pain refractory to conventional medical management. Spinal cord stimulators are treatment options when intractable chronic pain has not responded to more conventional treatment modalities. Currently, the use of SCS is contraindicated in pregnancy. Nevertheless, many SCS/ neuromodulation recipients are women of child bearing age who may become pregnant. There are no published reports that focus on the possible side effects of SCS or neuromodulation therapy on human fertility, fetal development, pregnancy, delivery, or lactation. Objectives: The purpose of this current report is to present a case study on the use of SCS/ neuromodulation during pregnancy. Study Design: Presentation of the case of a 24 year old female who became pregnant after receiving an SCS implantation for pain control secondary to complex regional pain syndrome (CRPS). The SCS was in use at the time of conception but deactivated when patient became aware of her pregnancy and intermittently reactivated for five minute intervals throughout the entire pregnancy. Results: Currently very little documented evidence is available regarding the safety of using a SCS/ neuromodulator during pregnancy; therefore its use during pregnancy is contraindicated. Available literature suggests that, women who have chosen to keep the SCS/neuromodulator activated during pregnancy have delivered healthy babies without any life threatening complications. Limitations: Case presentations do not provide conclusive evidence of treatment effectiveness. This data is only preliminary and future studies should be used to assess outcomes and measures to provide quantification of the SCS implantation during pregnancy. Conclusions: Women of child bearing age who are recipients of SCS/neuromodulation implantation should be informed of the limited knowledge available regarding the impact of SCS/ neuromodulation use during pregnancy. For current recipients, decisions about ongoing use during pregnancy should be an individual decision based on the potential risks and benefits. Key words: Pregnancy and complex regional pain syndrome, pregnancy and reflex sympathetic dystrophy, pregnancy and spinal cord stimulators, pregnancy and electromagnetic fields, and pregnancy and neuromodulator.

Treatment Options for Depression: Women and Primary Service Providers

1999 ◽  
Vol 5 (2) ◽  
pp. 38 ◽  
Author(s):  
Bernadette Hood ◽  
Ronnie Egan ◽  
Heather Gridley ◽  
Christine Brew
Keyword(s):  
Pharmacological Treatment ◽  
Professional Training ◽  
Qualitative Methodology ◽  
Service Providers ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Psychosocial Interventions ◽  
Research Literature ◽  
Treatment Modalities ◽  
Primary Service

A substantive quantitative research literature base exists exploring aspects of treatment for depression. Major themes to emerge from this literature include the use of general practitioners (GPs) in preference to psychiatrists for treatment and the negative public attitudes toward the use of pharmacological treatment strategies for depression. The study reported in this paper utilises a qualitative methodology to explore the experiences and attitudes of women currently being treated for depression. Specifically the paper focusses on the women's attitudes toward psychological versus medical treatment options for the disorder. Attitudes toward treatment modalities of medical and non-medical primary service providers are also investigated. Several significant findings emerged from the study. Women interviewed expressed a sense of personal responsibility for both the occurrence and management of depression.Consequent to this belief psychosocial interventions were critical to 'getting well'. Medication was viewed positively by all women, not as a treatment for depression, rather as a means of relieving the extreme symptoms of the illness, therefore providing space for psychosocial interventions. Medical and non-medical service providers expressed an acceptance of the need for integrating psychological and pharmacological treatment strategies though all providers acknowledged their lack of skills in incorporating treatments outside of their professional training. The study provides insight into the belief structures which influence participants' behaviours, presenting a less polarised view of attitudes toward psychological and pharmacological interventions than suggested by the current quantitative literature.

Aanpak en behandelingsopties voor congenitale melanocytaire naevi

2021 ◽  
Author(s):  
A. VANNESTE ◽  
M. GARMYN ◽  
M.-A. MORREN
Keyword(s):  
Treatment Options ◽  
Neurological Complications ◽  
Treatment Modalities ◽  
Melanocytic Nevi ◽  
The Central Nervous System ◽  
Magnetic Resonance Imaging Mri ◽  
Long Term Prognosis ◽  
Congenital Melanocytic Nevi

Management and treatment options in congenital melanocytic nevi Congenital melanocytic nevi (CMN) are benign collections of nevus cells in the skin. They are present at birth or arise during the first weeks of life. Depending on the size, they appear in 1 in 100 to 500.000 live births. CMN are associated with a variety of benign conditions such as benign proliferations, certain facial characteristics or subtle endocrine dysfunctions as well as malign developments such as melanoma and neurological complications. The risk for these complications strongly depends on the clinical phenotype. Magnetic resonance imaging (MRI) has a strong value in estimating the risk of these complications. A normal MRI of the central nervous system results in a lower risk of developing melanoma and neurological complications because of the thorough follow-up and early capture. Although there are various treatment modalities, a shift to more conservative treatment is seen. Little is known about the long term prognosis after treatment of CMN. This article tries to give a recommendation for treatment and follow-up of CMN based on the current literature.

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