Milnacipran Hydrochloride in the Treatment of Fibromyalgia Syndrome: Safety, Efficacy and Tolerability

2012 ◽  
Vol 4 ◽  
pp. CMT.S2247
Author(s):  
Howard S. Smith ◽  
Patrick D. Meek
Keyword(s):  
Behavioral Therapy ◽  
Treatment Options ◽  
Common Adverse Effect ◽  
Chronic Widespread Pain ◽  
Physical Medicine ◽  
Federal Drug Administration ◽  
Nonrestorative Sleep ◽  
The Us ◽  
Pharmacologic Agents

Fibromyalgia is a central sensitization disorder characterized by chronic widespread pain, nonrestorative sleep, fatigue, cognitive dysfunction as well as a number of somatic symptoms; that reduces physical/emotional function/quality of life. Treatment options include: Patients education, behavioral medicine strategies, (eg, cognitive behavioral therapy), physical medicine strategies (eg, exercise/aerobic and strength training), and pharmacologic agents. Currently there are three agents approved by the US Federal Drug Administration for the treatment of Fibromyalgia: pregabalin, duloxetine, and milnacipran. Milnacipran is a norepinephrine-serotonin reuptake inhibitor that is only approved in the US for fibromyalgia. It has 3-fold increased selectivity for norepinephrine compared to serotonin. Milnacipran is well absorbed (85% bioavailability), has a half-life of 6-8 hours, and does not undergo cytochrome P450 metabolism. Milnacipran in doses of 50 mg PO BID to 100 mg PO BID has been shown to have efficacy for fibromyalgia. The most common adverse effect is nausea.

scholarly journals Article Commentary: A Research Agenda for Appearance Changes Due to Breast Cancer Treatment

2008 ◽  
Vol 2 ◽  
pp. BCBCR.S784 ◽  
Author(s):  
Mugdha Dabeer ◽  
Michelle Cororve Fingeret ◽  
Fatima Merchant ◽  
Gregory P. Reece ◽  
Elisabeth K. Beahm ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Treatment Options ◽  
Breast Cancer Treatment ◽  
Cancer Treatments ◽  
Detection Techniques ◽  
The Us ◽  
Women’S Perceptions

Breast cancer is one of the most prevalent forms of cancer in the US. It is estimated that more than 180,000 American women will be diagnosed with invasive breast cancer in 2008. Fortunately, the survival rate is relatively high and continually increasing due to improved detection techniques and treatment methods. However, maintaining quality of life is a factor often under emphasized for breast cancer survivors. Breast cancer treatments are invasive and can lead to deformation of the breast. Breast reconstruction is important for restoring the survivor's appearance. However, more work is needed to develop technologies for quantifying surgical outcomes and understanding women's perceptions of changes in their appearance. A method for objectively measuring breast anatomy is needed in order to help both the breast cancer survivors and their surgeons take expected changes to the survivor's appearance into account when considering various treatment options. In the future, augmented reality tools could help surgeons reconstruct a survivor's breasts to match her preferences as much as possible.

The Nature of Insomnia

CNS Spectrums ◽  
2007 ◽  
Vol 12 (S10) ◽  
pp. 3-5 ◽  
Author(s):  
Thomas Roth
Keyword(s):  
Behavioral Therapy ◽  
Clinical Information ◽  
Negative Results ◽  
Behavioral Therapies ◽  
Insomnia Treatment ◽  
Treatment Use ◽  
Patients Experience ◽  
Pharmacologic Agents ◽  
Impaired Quality

AbstractInsomnia is a disorder characterized by chronic sleep disturbance associated with daytime disability or distress, such as memory impairment and fatigue, that occurs despite adequate opportunity for sleep. Insomnia may present as difficulty falling/staying asleep or as sleep that is nonrestorative. Studies show a strong correlation between insomnia and impaired quality of life. Pain conditions and depression are commonly associated with insomnia, either as secondary or comorbid conditions. In addition, a greater incidence of anxiety, alcohol and drug dependence, and cardiovascular disease is found in people with insomnia. Data indicate insomnia results from over-engaged arousal systems. Insomnia patients experience increased metabolic rate, body temperature, and heart rate, and elevated levels of norepinephrine and catecholamines. Pharmacologic options for the treatment of insomnia include benzodiazepine hypnotics, a selective melatonin receptor agonist, and sedating antidepressants. However, insomnia may be best treated with cognitive-behavioral therapy and instruction in good sleep hygiene, either alone or in concert with pharmacologic agents. Studies on the effects of insomnia treatment use variable methodologies or do not publish negative results, and there are currently no studies of treatment focusing on morbidity. Further research is necessary to better understand the effects of insomnia therapies on medical and psychiatric disorders.In this Clinical Information Supplement, Thomas Roth, PhD, describes the nature of insomnia and its pathophysiology. Next, Andrew D. Krystal, MD, MS, reviews morbidities associated with insomnia. Finally, Joseph A. Lieberman III, MD, MPH, provides an overview of therapeutics utilized in patients with insomnia, including behavioral therapies and pharmacologic options.

Panic Disorder: Broadening Conceptualizations and Improving Treatment

CNS Spectrums ◽  
2005 ◽  
Vol 10 (S12) ◽  
pp. 4-4 ◽  
Author(s):  
Mark H. Pollack
Keyword(s):  
Panic Disorder ◽  
Psychological Factors ◽  
Behavioral Therapy ◽  
Explanatory Models ◽  
Cognitive Behavioral ◽  
Medical Comorbidity ◽  
Complex Interplay ◽  
Fear And Anxiety ◽  
Pharmacologic Agents

Attempts to understand the underlying etiology of panic disorder have, at times, oscillated between reductionistic biologic or psychologic characterizations that have put pharmacotherapists and cognitive-behavioral therapists on opposite sides of a fence with patients caught in the middle. However, research emerging over the last couple of decades is pointing to a more complex interplay between dysregulated neurobiological systems and psychological factors that influence the manifestations of fear and anxiety and permit a more nuanced view of the etiology of panic disorder while pointing to potential rational strategies for treating patients. The articles in this supplement explore a range of explanatory models relevant to the underlying etiology of panic disorder, and then focus on treatment, including pharmacologic agents, and a paradigm in which cognitive-behavioral therapy (CBT) can be efficiently and effectively integrated with pharmacotherapy in an attempt to optimize patient care.In the first article, David Baldwin, MB, BS, DM, FRCPsych, discusses the burden of panic disorder to patients and society; the difficulties associated with misdiagnosis and inadequate treatment; the challenges imposed by excess healthcare utilization, reduced quality of life, and psychiatric and medical comorbidity; and the implications for therapeutics.

An international pilot study of asynchronous teleconsultation for oropharyngeal dysphagia

2013 ◽  
Vol 19 (2) ◽  
pp. 75-79 ◽  
Author(s):  
Georgia A Malandraki ◽  
Vasiliki Markaki ◽  
Voula C Georgopoulos ◽  
Jaime L Bauer ◽  
Ioannis Kalogeropoulos ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Treatment Options ◽  
Oropharyngeal Dysphagia ◽  
Severity Index ◽  
Rater Agreement ◽  
Point Scale ◽  
The Us ◽  
Independent Review ◽  
Greek Hospital

We investigated whether an expert's consultation provided via telemedicine could improve the quality of care for patients with dysphagia. A trained clinician completed videofluoroscopic swallowing studies (VFSS) of 17 consecutive patients in a Greek hospital. The videofluoroscopic images were then stored on a website for independent review by an expert Speech and Language Pathologist in the US. An extra Rater evaluated 20% of all data for additional reliability testing. Eight diagnostic indicators of swallowing impairment and an overall subjective severity index were recorded for each study. Clinicians were also asked to choose from ten common treatment options for patients with dysphagia. There was good inter-rater agreement for most of the diagnostic indicators examined (ranging from 78% to 90%; kappa = 0.52-0.71) between all three Raters. Agreement on overall severity ratings was exact for more than half of the patients and within one-point on the 4-point scale for all other patients except one. However, the quality of care would have been substandard for more than half of the patients if teleconsultation had not been employed. In settings where a swallowing expert is not available and real-time telemedicine is not feasible, the use of asynchronous teleconsultation can produce better quality of care for patients with dysphagia.

scholarly journals Behavioral Intervention versus Pharmacotherapy or Their Combinations in the Management of Overactive Bladder Dysfunction

2009 ◽  
Vol 2009 ◽  
pp. 1-10 ◽  
Author(s):  
Khanh Tran ◽  
Robert M. Levin ◽  
Shaker A. Mousa
Keyword(s):  
Overactive Bladder ◽  
Behavioral Intervention ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
Cost Effective ◽  
Pharmacological Therapy ◽  
Anticholinergic Drugs ◽  
Life Threatening ◽  
Bladder Symptoms

Overactive bladder syndrome (OAB) refers to individuals with the following symptoms: urinary urgency, increased urinary frequency, and urge incontinence. These symptoms are not life threatening but can cause embarrassment and significantly impact quality of life. There are numerous treatment options for OAB, including behavioral therapy, traditional pharmacological therapy or a combination of the two. These options are considered the mainstay of treatment for OAB. We carried out a comprehensive systematic review of the available literature on the effectiveness of behavioral intervention, anticholinergic drugs, and their combination in the management of adults with overactive bladder, with emphasis on results from clinical trials and primary literature. Each treatment intervention is efficacious, and the choice should be based on the patient's severity of symptoms, tolerability, compliance and satisfaction with the treatment. Based on available literature, management of OAB using a combination of behavioral therapy and drug intervention is the most efficacious in terms of patient satisfaction, perceived improvement, and reduction of bladder symptoms. It is also the most practical and cost effective for optimal management of patients with OAB. Pharmacological treatment, in addition to behavioral therapy, remains important in the management of adults with OAB syndrome.

Chronic venous disorder registry: A new perspective

2013 ◽  
Vol 29 (7) ◽  
pp. 415-427 ◽  
Author(s):  
Yung-Wei Chi ◽  
Marlin Schul ◽  
Kathleen Gibson ◽  
Mel Rosenblatt ◽  
Lowell Kabnick ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Best Practice ◽  
Treatment Options ◽  
Data Capture ◽  
Health Burden ◽  
The Us ◽  
Modern System ◽  
New Perspective ◽  
State Of Art

Chronic venous disorder is one of the most prevalent medical conditions in the US that carries significant economic and health burden. The knowledge into venous pathophysiology, how it develops, and the true quality of life benefits of various treatment options are largely unknown. A truly meaningful clinical data capture system specifically for venous disorder may provide answers to the paucity of data. We describe a modern system to capture research and best practice data using the state of art information technology.

Treatment options for sundowning in patients with dementia

2014 ◽  
Vol 4 (4) ◽  
pp. 189-195
Author(s):  
Joseph Blais ◽  
Monica Zolezzi ◽  
Cheryl A. Sadowski
Keyword(s):  
Treatment Options ◽  
Biological Clock ◽  
Bright Light ◽  
Light Therapy ◽  
Supportive Evidence ◽  
Bright Light Therapy ◽  
First Line ◽  
Pharmacologic Management ◽  
Pharmacologic Agents

Objective. To review the evidence for the pharmacologic and non-pharmacologic management of sundowning in patients with dementia. Methods. Databases were searched using the terms sundown, circadian, chronobiological, biological clock, elderly, aged, geriatric, and senior. Studies selected for inclusion assessed potential interventions for the treatment of sundowning or nocturnal agitation. Results. A total of thirteen individual studies and two systematic reviews were evaluated. Study design and outcomes varied, but many measured sleep and nocturnal agitation. Non-pharmacologic interventions that may be of benefit include bright light therapy, music therapy, and aromatherapy. Pharmacologic therapies generally provided minimal benefit and were associated with safety concerns. Supportive evidence was found for the use of melatonin and antipsychotics. Evidence for antidepressants, donepezil, and dronabinol was weaker. Supportive evidence for the use of benzodiazepines was not found and thus cannot be recommended in elderly patients as they are more susceptible to their adverse effects. Conclusion. The number of studies on the management of sundowning is limited and the quality of evidence supporting its treatment is weak. Non-pharmacologic interventions are first line due to safety. Pharmacologic agents are recommended as second line treatment options, in particular antipsychotics and melatonin.

Payers, patients, and physicians understanding of quality of life, functional status, and their importance relative to survival in triple-negative breast cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18156-e18156
Author(s):  
Richard Edward White ◽  
Jennifer Floyd ◽  
Maria L. Lankford ◽  
Stewart Kaufman ◽  
Reshma L. Mahtani
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Functional Status ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Treatment Options ◽  
Clinical Endpoints ◽  
The Us ◽  
Oncology Treatment

e18156 Background: Value has taken center stage in US oncology treatment as evidenced by the growth of value frameworks and value-based pricing/contracting. These efforts include assessment of quality of life (QoL), survival, and functional status (FS), but the perspectives of payers, patients, and physicians are relatively unknown. We explored the relationships between QoL, FS, and survival in triple negative breast cancer (TNBC) and their importance relative to each other among the 3 key interviewed groups. Methods: Hour-long phone interviews with 6 individuals with TNBC and web-assisted phone interviews with 6 payers and 6 medical oncologists in the US were conducted. Respondents were asked how they differentiate QoL and FS, and how, relative to survival, each impacts their view of TNBC treatment. Results: For payers, QoL and FS are commonly confused and viewed as both supplementary and less important than survival metrics; however, they do desire to understand how each predicts survival. Oncologists prioritized survival, other clinical endpoints, and safety, but believed QoL and FS were very important. Moreover, they assess QoL by the adverse events experienced while on treatment, and view FS as being more objective. For patients, QoL and FS are intermingled, falling under a broad category of QoL. FS was poorly understood, and survival was viewed as critical to meaningful QoL. The threshold at which QoL overrides survival was the point at which patients consider themselves a burden to others. Conclusions: The definitions of QoL and FS used by health services researchers who define “value” is out of sync with patients, payers, and sometimes physicians, making communication of this important information to the individuals interviewed difficult. While the perceived value of QoL and FS varies, and considering the limited treatment options available for TNBC, survival supersedes both measures such that QoL and FS are nearly disregarded. [Table: see text]

scholarly journals Effects of Metreleptin on Patient Outcomes and Quality of Life in Generalized and Partial Lipodystrophy

2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Keziah Cook ◽  
Kelly Adamski ◽  
Aparna Gomes ◽  
Edward Tuttle ◽  
Henner Kalden ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Treatment Options ◽  
Quality Adjusted Life Year ◽  
Reproductive Age ◽  
Partial Lipodystrophy ◽  
The Us ◽  
Before And After ◽  
Subcutaneous Adipose ◽  
Quality Adjusted Life

Abstract Generalized and partial lipodystrophy are rare and complex diseases with progressive clinical and humanistic burdens stemming from selective absence of subcutaneous adipose tissue, which causes reduced energy storage capacity and a deficiency of adipokines such as leptin. Treatment options were limited before leptin replacement therapy (metreleptin) became available. This retrospective study evaluates both clinical and humanistic consequences of the disease and treatment. Chart data were abstracted from a cohort of metreleptin-treated patients with generalized and partial lipodystrophy (n = 112) treated at the US National Institutes of Health. To quantify the quality-of-life consequences of the lipodystrophy disease attributes recorded in chart data, a discrete choice experiment was completed in 6 countries (US, n = 250; EU, n = 750). Resulting utility decrements were used to estimate the quality-adjusted life-year consequences of changes in lipodystrophy attribute prevalence before and after metreleptin. In addition to metabolic impairment, patients with generalized and partial lipodystrophy experienced a range of lipodystrophy consequences, including liver abnormality (94%), hyperphagia (79%), impaired physical appearance (77%), kidney abnormality (63%), reproductive dysfunction (80% of females of reproductive age), and pancreatitis (39%). Improvement was observed in these attributes following initiation of metreleptin. Quality-adjusted life-year gains associated with 12 months of treatment with metreleptin were estimated at 0.313 for generalized and 0.117 for partial lipodystrophy, reducing the gap in quality of life between untreated lipodystrophy and perfect health by approximately 59% and 31%, respectively. This study demonstrates that metreleptin is associated with meaningful clinical and quality-of-life improvements.

scholarly journals Management of clozapine-induced sialorrhoea

2019 ◽  
Vol 26 (2) ◽  
pp. 106-108
Author(s):  
Sumeet Gupta ◽  
Udayan Khastgir ◽  
Matthew Croft ◽  
Sefat Roshny
Keyword(s):  
Quality Of Life ◽  
Adverse Effect ◽  
Treatment Options ◽  
Common Adverse Effect ◽  
Management Options ◽  
Limited Effect ◽  
Pharmacological Management ◽  
Off Label ◽  
Anticholinergic Medications

SUMMARYSialorrhoea (hypersalivation) is a common adverse effect of clozapine. If severe, it can affect patients' quality of life and adherence to the treatment. Clinicians therefore need to proactively manage this effect. At present, no drugs are licensed to manage clozapine-induced sialorrhoea, although there are many off-label treatment options, with variable effectiveness. Anticholinergic medications are commonly prescribed for it, but they have limited effect and can worsen constipation. This article gives a brief overview of other practical and pharmacological management options.

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