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Series A [3] Setting Subjects General practice Patients who had been taking NSAIDs regularly in the treatment of pain and disability related to osteoarthritis of the hip or knee. 1 ; Is paracetamol as effective as NSAIDs? 2 ; Is medication-use influenced by presenting the personal results to each individual patient?.
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The problem with treating pain, of course, is that no one can see it. And even though doctors are warned never to think that they know how much pain patients are experiencing, it happens all the time. "Put yourself in that position and you immediately misrepresent the patient and do them a misservice. The patient may end up undertreated, " said Allan I. Basbaum, PhD, professor and chair of the Department of Anatomy at University of California, San Francisco, and editor in chief of the journal Pain. Women are particularly likely to face this problem because they seek treatment for pain far more often than men. In fact, clinical pain conditions, except for back pain, occur at far higher rates in women, Basbaum said. For instance, 9 of 10 patients with fibromyalgia and 8 of 10 patients with temporomandibular disorder are women. Women are also 2 times more likely to have irritable bowel syndrome IBS ; , 9 times more likely to have interstitial cystitis, and 3 times more likely to have migraine. Exactly why women experience pain differently from men remains largely unclear. "However many people you talk to, that's how many explanations you will get. A variety of factors probably contributes to the sex differences in pain, " said Roger B. Fillingim, PhD, associate professor at University of Florida College of Dentistry in Gainesville. Some pain experts postulate that the differences originated during primitive times when gender roles were more clear-cut and people's response to pain was more closely linked to survival strategies. Societal, behavioral, and psychological influences still clearly play a part in sex differences in pain. For a long time, doctors tended to undertreat women's pain, chalking up their symptoms of pain to their being more emotional or lacking in toughness, but recent clinical studies, backed by abundant animal studies, have demonstrated that women have a lower threshold and tolerance for pain. Currently, researchers are beginning to identify specific biological underpinnings of sex differences in pain. These findings are providing clues about why women suffer more and, in doing so, are making women's reports of pain more difficult for physicians to dismiss. Continued research in this direction may lead to a day when doctors treat pain in both female and male patients more effectively.
In connection with this problem the government of great britain decided that it needed a new anti-drugs compaign and lexapro. We have been concerned and aware of the potential for cardiovascular effects for the last few years, steven galson, acting director of the fda's center for drug evaluation and research, said the day merck announced the withdrawal.
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Background--Valve regurgitation has been associated with dexfenfluramine, but its prevalence and severity are uncertain. Additional factors that may contribute to valve regurgitation in patients exposed to this drug are poorly understood. Methods and Results--Echocardiography was performed on subjects recruited from 26 prescribing sites in 15 states. The total sample of 412 subjects included 172 dexfenfluramine patients and 172 unexposed controls matched for age, sex, and body mass index and 68 unmatched subjects meeting the same entry criteria 51 dexfenfluramine patients and 17 controls ; . Mean treatment duration was 6.9 months; mean interval from treatment discontinuation to echocardiogram was 8.5 months. Each echocardiogram was interpreted independently by 3 echocardiographers. FDA-grade regurgitation at least mild aortic regurgitation or at least moderate mitral regurgitation ; was significantly more frequent in dexfenfluramine patients 7.6% versus 2.1% for controls; P 0.01; odds ratio, 3.82 ; . This difference was primarily due to more frequent mild aortic regurgitation in dexfenfluramine patients 6.3% versus 1.6% in controls; P 0.02; odds ratio, 4.15 ; . No differences were found in sclerosis or mobility for either the aortic or mitral valve. Factors independently related to FDA-grade regurgitation or any grade of aortic regurgitation were older age, higher diastolic blood pressure at the time of echocardiography, and shorter time from drug discontinuation to echocardiogram. Conclusions--Dexfenfluramine use is associated with an increase in the prevalence of abnormal valve regurgitation. Age and blood pressure may also affect the prevalence of regurgitation. Dexfenfluramine-related valve regurgitation may regress after drug discontinuation. Circulation. 1999; 100: 2161-2167. ; Key Words: dexfenfluramine drugs echocardiography regurgitation valves, for instance, patent for lamisil.
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