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Thursday, September 2, 2004
NEW YORK (Reuters Health) - Patients with depression often have physical symptoms such as pain or stomach problems, and these are less likely to clear up with antidepressant treatment than is the depression itself, new study findings suggest. There has been little research on outcomes of physical symptoms in patients treated for clinical depression, Dr. Kurt Kroenke and his colleagues note in the Journal of General Internal Medicine.
Results of a study looking at antidepressant treatments show that "physical symptoms tend to improve, but not to the same degree on average as emotional symptoms," Kroenke told Reuters Health. Researchers with the study, based at the Indiana University School of Medicine in Indianapolis, followed 573 depressed patients treated by 87 physicians over nine months of therapy with Prozac, Paxil (known as Seroxat in some countries), or Zoloft.
At the outset, more than one third of the subjects reported fatigue and sleep difficulties, back pain, gastrointestinal problems, difficulty breathing, dizziness and palpitations. Depression improved rapidly over the first four weeks, followed by continued gradual improvement over the next eight months. Physical symptoms also declined substantially during the first four weeks, and then seemed to plateau. "There remained a substantial reservoir of unresolved symptoms," particularly pain symptoms, the investigators write. These physical symptoms have a considerable impact on quality of life, Kroenke noted. So by "simply starting an antidepressant and asking patients if they are less depressed, doctors will be missing part of the picture."
He suggests that "if one class of drug works for some symptoms but not all, one should consider a higher dose or switching to a different medication." For example, there is evidence that newer antidepressants that work on both serotonin and norepinephrine are more effective against pain. There are also non-medication approaches for treating persistent pain, Kroenke said, including pain self-management programs, cognitive behavioral therapy and physical therapy.
- Karla Gale
SOURCE: Journal of General Internal Medicine, August 2004.
Wednesday, September 8, 2004
NEW YORK (Reuters Health) - The anti-rheumatoid arthritis drug Enbrel may relieve symptoms of acute, severe sciatica -- pain that radiates down the leg from a pinched or inflamed nerve in the spine.
That word comes from Dr. Stephane Genevay and colleagues at the University Hospital of Geneva, Switzerland, who conducted a pilot study of the effectiveness of three subcutaneous injections of Enbrel, given 3 days apart, in ten patients admitted to hospital with severe sciatica.
Ten days after treatment and continuing for 6 weeks, all the patients showed significant improvements on a visual analogue scale for leg pain and on two measures of disability, the authors report in the Annals of the Rheumatic Diseases.
A comparison group of ten other sciatica patients who participated in an earlier study of steroid injections showed similar, but less marked, improvements after 10 days. However, by 6 weeks these patients fared significantly worse than Enbrel patients, the researchers found.
Overall, they note, 90 percent of the Enbrel group met their definition of a good clinical result versus only 30 percent of the steroid group.
"This may be a promising approach for patients suffering from sciatica," Genevay told Reuters Health, "but results are still preliminary and physicians should not start to treat patients with this kind of treatment unless it is done in a carefully planned research."
Genevay commented that a multicenter clinical trial with a similar drug, Humira, "should begin within a couple of months in Switzerland."
- Will Boggs, MD
SOURCE: Annals of the Rheumatic Diseases, September 2004.
September 21, 2004
Pain management
Undertreated chronic pain can have physical, psychological and financial consequences. The Baltimore-based American Pain Foundation recommends managing pain, not letting it manage you, by following these steps:
• Get a diagnosis. Your pain might be signaling a disease or infection.
• Tell your health-care provider you are in pain. Don't let anyone tell you it's "just in your head." You are the expert on your pain.
• Be persistent about reducing your pain and participate actively in your pain care.
• Learn all you can about your pain, health problems, pain-management options and the types of health-care providers who specialize in pain. Visit the library. Search the Internet, including the foundation's Web site at www.painfoundation.org. Talk to people who are living with pain.
• Learn to describe your pain symptoms clearly - how much it hurts, where it hurts, how often it hurts, and what it feels like - so you can contribute to the assessment of your pain.
• Ask your health-care provider if he or she is comfortable working as your partner in developing a pain-management plan.
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