Int. Journal of Clinical Pharmacology and Therapeutics, 2003
To assess efficacy and safety of diclofenac-K 12.5 mg tablets in the treatment of acute low back ... more To assess efficacy and safety of diclofenac-K 12.5 mg tablets in the treatment of acute low back pain (low back pain). A multiple dose, double-blind, double-dummy, randomized, placebo-controlled, parallel group trial compared diclofenac-K (12.5 mg; n = 124) with ibuprofen (200 mg; n = 122) and placebo (n = 126) in patients with moderate-to-severe acute low back pain. The treatment consisted of an initial dose of 2 tablets followed by 1 or 2 tablets every 4-6 hours as needed (maximum 6 tablets/day) for 7 days. The primary efficacy outcome for the initial dose was TOTPAR-3, the summed total pain relief over the first 3 hours. Secondary initial dose outcomes included TOTPAR-6, summed pain intensity differences SPID-3 and SPID-6, time to rescue medication or remedicate, and the End of First Dose global efficacy assessment. The primary efficacy outcome for the flexible multiple dosing regimen was the End of Study global efficacy assessment. Secondary outcomes for multiple dosing included time to rescue medication over the entire study, the End of Day global efficacy assessments (daily over Days 1-7), pain intensity differences on the VAS measured at Visit 2 and 3, and change in Eifel algofunctional index. Safety/tolerability was assessed by recording adverse events. Diclofenac-K 12.5 mg demonstrated superiority vs placebo on the primary efficacy parameter and almost all secondary initial dose outcomes. With respect to the initial dose, diclofenac-K 12.5 mg was also significantly superior to ibuprofen 200 mg on SPID-3. Ibuprofen 200 mg was superior to placebo only on the End of First Dose global efficacy assessment. The flexible multiple dosing regimens of diclofenac-K and ibuprofen were both significantly superior to placebo on the End of Study global efficacy assessment, time to rescue medication over the entire study period, the End of Day global efficacy assessment on Days 1-2, pain intensity difference on the VAS at Visit 3 and the Eifel algofunctional index at Visit 3 (also at Visit 2 in diclofenac-K 12.5 mg group). Both active treatments were as well tolerated as placebo. The flexible multiple dosing regimen of diclofenac-K 12.5 mg (initial dose of 2 tablets followed by 1-2 tablets every 4-6 hours, max. 75 mg/day) is an effective and safe treatment of acute low back pain.
Annales de réadaptation et de médecine physique, Mar 1, 2007
Objectifs.-La Haute autorité de santé demande des radiographies systématiques avant manipulation ... more Objectifs.-La Haute autorité de santé demande des radiographies systématiques avant manipulation vertébrale lombaire. La recherche actuelle montre au contraire que l'imagerie systématique a plus d'inconvénients que d'avantages. Pour le rachis cervical, la jurisprudence fait apparaître qu'en cas de complication après manipulation cervicale, l'absence de clichés préalable est une faute, même si ces derniers n'auraient pu contre-indiquer la manipulation. Pour établir des recommandations claires sur ce thème, nous avons recherché dans la littérature qu'elles étaient les complications des manipulations qui pouvaient être évitées par la pratique d'une imagerie préalable. Puis nous avons cherché à savoir si ces complications étaient prévues ou non par les recommandations internationales (« guidelines »). Matériel et méthode.-Recherche de la littérature. Résultats.-Pour le rachis lombaire et thoracique, les recommandations internationales sont suffisantes, sauf en cas de kyste anévrismal osseux, qui peut se révéler jusqu'à l'âge de 25 ans alors que l'imagerie n'est systématiquement recommandée que jusqu'à l'âge de 20 ans. Pour le rachis cervical, malgré l'absence de données de la littérature, la prudence et les risques médico-légaux justifient la pratique d'une imagerie systématique. Conclusion.-La SOFMMOO recommande une imagerie systématique avant manipulation cervicale d'une part et en cas de douleur de dos ou de cou chez le sujet de moins de 25 ans d'autre part. Dans les autres cas, les recommandations internationales suffisent.
Animal experiments and studies in humans clearly show that the relation between pain (acute and c... more Animal experiments and studies in humans clearly show that the relation between pain (acute and chronic) and sleep quality is two-way: sleep disorders can increase pain, which in turn may cause sleep disorders. Sleep disorders and chronic low back pain are frequent health problems and it is unsurprising that the two can co-exist. This study was conducted to evaluate if sleep disorders and chronic pain associated are more frequently than one would expect. The objective of the study was to compare sleep quality in a population of patients with chronic low back pain and a control population. Sleep quality was assessed in 101 patients with chronic low back pain (CLBP) and in 97 sex-and age-matched healthy control subjects using the Pittsburgh Sleep Quality Index [PSQI; score from 0 (no disorder) to 21]. The French version of the Dallas Pain Questionnaire (DPQ) was used to assess the impact of low back pain on patients' quality of life. This impact was taken as nil in the healthy controls. The patients with CLBP and the controls were comparable in age, sex, and height, but mean bodyweight was higher in the CLBP group (70.3 ± 14.5 vs. 61.8 ± 11.4 kg; P \ 0.05). The patients with CLBP were also more frequently on sick leave than the controls (32.3%; n = 31 vs. 0.0% n = 0; P \ 0.001). Coffee, tea, and cola intakes were comparable in the two groups. Patients with CLBP had statistically higher scores in all items of the PSQI than the healthy controls. The mean PSQI was 4.7 ± 3.2 for the healthy controls and 10.9 ± 7.9 for the patients with CLBP (P \ 0.0001). Sleep disorders were greater when the impact of CLBP on daily life (the four aspects of the DPQ) was greater [P \ 0.0001]). The sleep of the patients with CLBP was significantly altered compared with that of the healthy controls, in proportion to the impact of low back pain on daily life. Our findings do not indicate whether sleep disorders are a cause or a consequence of CLBP. Keywords Chronic low back pain Á Sleep disorders Á Dallas Pain Questionnaire Á Pittsburgh Sleep Quality Index Á Case control study The exoirements comply with the current laws of the country in which it was performed.
Y at -il des lombalgies d'origine sacro-iliaque ? Revue critique Is there low back pain coming fr... more Y at -il des lombalgies d'origine sacro-iliaque ? Revue critique Is there low back pain coming from sacroiliac joint? Critical review
Objective: Specialised pressure-relieving supports reduce or relieve the interface pressure betwe... more Objective: Specialised pressure-relieving supports reduce or relieve the interface pressure between the skin and the support surface. The comparative effectiveness of dynamic support surfaces is debated. The aim of this study is to examine the impact of using an alternating pressure air mattress (APAM) on pressure ulcer (PU) incidence in patients receiving home-based care. A second aim was to determine the level of patient/family satisfaction with comfort and gain the views of the care team that used the APAM. Method: The PARESTRY study was a prospective observational study conducted in patients with a high risk of PUs (Braden score <15), discharged to hospital-care at home. The primary prevention groups consisted of patients with no PU at baseline who were in bed for at least 20 hours a day. Patients at baseline with a category 3 or 4 PU or a category 1 or 2 PU in association with poor general health or end-of-life status were included in the secondary prevention group. All patients were laid on an APAM. The primary end point was the % of patients with a worsening skin condition in the pressure area (heel, sacrum, ischium) at day 90 or at the end of the study. The primary analysis was done on the full analysis set (patients included with at least a second assessment), using the last observation carried forward technique to handle missing data, at day 90. A 95% confidence interval was calculated. Results: Analysis was performed on 92 patients (30 in primary prevention and 62 in secondary prevention). The average time spent in bed was 22.7 (SD 2.7) hours a day and 22.6 (SD 2.2) hours in the primary and secondary prevention groups, respectively. At baseline, in the secondary group, 77% of patients had a sacral PU, 63% a heel PU, 8% an ischial tuberosity PU and 45% a PU in another area, a number of patients having multiple PUs. In the primary prevention group, 63% (19/30) of patients dropped out of the study (5 were hospitalised, 9 died, 5 other causes). In the secondary prevention group, 61% (38/62) dropped out (7 were hospitalised, 23 died, 8 others causes). In the primary prevention group, only one patient had worsening skin condition. In the secondary prevention group, 17.7% (11/62: 95% CI: 8.3–27.2) of patients had worsening skin condition. The number of PUs decreased regardless of location. At the end of follow-up, 49% (45/92) of patients had a PU versus 67% (62/92) at baseline Conclusion: This work provides data on the incidence of PUs in patients at high risk, who are using APAMs, and, following inpatient hospitalisation, are taken into home health-care centres. The results of the study highlight the importance of continuity of care across transitions between care settings.
Le mensuel pratique et technique du kinésithérapeute, Jun 10, 2006
... MITRA D., CASSAR-PULLICINO VN, McCALL IW Longitudinal study of vertebral type I end plate cha... more ... MITRA D., CASSAR-PULLICINO VN, McCALL IW Longitudinal study of vertebral type I end plate changes on MR of the lumbar ... sports violents, les sports imposant des mouvements forcés en hyperextension et/ou rotation, les sports nécessitant des charges lourdes, les sports ...
La lombalgie chronique n'a pas encore livré tous ses mystères et pièges, et principalement parce ... more La lombalgie chronique n'a pas encore livré tous ses mystères et pièges, et principalement parce que sa physiopathologie dépasse pour de nombreux aspects le classique modèle anatomoclinique (une douleur rapportée à une lésion anatomique). Sa prise en charge doit faire intervenir de nombreux acteurs et pas uniquement les médecins. Cependant, la part de prise en charge du médecin est importante. Il doit intervenir à tous les stades : au moment de la lombalgie aiguë (moins de 1 mois) et de la lombalgie subaiguë (entre 1 mois et 3 mois d'évolution) pour prévenir le passage à la chronicité puis quand la lombalgie devient chronique (entre 6 et 12 mois) pour tenter d'en modifier la morbidité. Les traitements sont pharmacologiques et non pharmacologiques. Ils ont pour but de diminuer la douleur, d'améliorer la fonction du rachis, le vécu des douleurs. Les principaux traitements sont rappelés et des éléments fondés sur l'état actuel des connaissances permettent au lecteur de limiter le sentiment d'incompréhension et d'impuissance éprouvé devant la réalité de la lombalgie chronique. Cet article traite des lombalgies chroniques sans radiculalgie.
Objective: The primary objective was to determine the clinical benefit of using a specific altern... more Objective: The primary objective was to determine the clinical benefit of using a specific alternating-pressure mattress overlay (APMO) in the prevention of pressure ulcer (PU) in patients at medium to high risk. Method: This prospective study was conducted in five rehabilitation centres and three nursing homes. Patients at medium to high risk of PU, but without PU at baseline, and lying between 15 and 20 hours per day on a specific APMO were included. The primary endpoint was the percentage of patients who developed a sacral, spine, heel or trochanteric PU (supine support areas) of at least category II, at day 35. All patients were included in the analysis. Results: A total of 89 patients were included; of whom six patients (6.7%) dropped out of the study (average (±standard deviation) follow-up 32±5.4 days). No sacral, spine, heel or trochanteric PU of at least category II was reported (i.e., an incidence of 0% [95% Confidence Interval: 0–4.1%] according to the exact Clopper–Pearson method]. Patients were ‘satisfied’ or ‘very satisfied’ with the comfort and stability of the APMO. The caregivers assessed as ‘very easy’ or ‘easy’ the implementation, maintenance and use of the APMO (turning over, moving to a sitting position). Conclusion: In combination with the usual measures to prevent PU, the results of our study showed a low incidence of PU in high-risk patients lying for between 15 and 20 hours a day on an APMO, use of which is therefore recommended in these patients.
Efficacy and safety of duloxetine for treatment of fibromyalgia in patients with or without major... more Efficacy and safety of duloxetine for treatment of fibromyalgia in patients with or without major depressive disorder: results from a 6-month, randomized, double-blind, placebo-controlled, fixed-dose trial. Pain 2008; 136:432-44. 7 Pedersen L, Nielsen A, Blackburn-Munro G. Anti-nociception is selectively enhanced by parallel inhibition of multiple subtypes of monoamine transporters in rat models of persistent and neuropathic pain. Psychopharmacology 2005;182: 551-61. 8 Munro G. Dopamine d(1) and d(2) receptor agonism enhances antinociception mediated by the serotonin and noradrenaline reuptake inhibitor duloxetine in the rat formalin test. Eur J Pharmacol 2007;575:66-74. 9 Barbui C, Furukawa T, Cipriani A. Effectiveness of paroxetine in the treatment of acute major depression in adults: a systematic re-examination of published and unpublished data from randomized trials.
Acute low back pain is evolving for less than 4 or 6 weeks. The diagnostic stake in front of an a... more Acute low back pain is evolving for less than 4 or 6 weeks. The diagnostic stake in front of an acute low back pain is not to ignore a condition requiring a specific treatment (vertebral fracture, tumours, infections, inflammatory diseases...). Signs of alerts from patient history are to be looked for to enable it. Once the diagnosis of non specific low back pain has been confirmed and in absence of neurological complications, the therapeutic stake is to avoid chronicity by a treatment adapted to every patient. Numerous scientific quality data questioned the interest of the bed rest for non specific acute low back pain and the beneficial role of the preservation of the activities to avoid chronicity. The interest to inform and to reassure the patient on his future is also an important condition of the care.
... re de pr vention et de prise en charge de la lombalgie non sp cifi que. Rev Rheum 2006;73:S35... more ... re de pr vention et de prise en charge de la lombalgie non sp cifi que. Rev Rheum 2006;73:S35-52. [4] Henschke N, Maher CG, Refshauge KM, et al. Prevalence of and screening for serious spinal pathology in patients presenting to primary care sittings with acute low back ...
Despite progress in the prevention of pressure injuries (PIs), they remain a challenging public h... more Despite progress in the prevention of pressure injuries (PIs), they remain a challenging public health problem because of their frequency and morbidity. Protection of the skin by multilayer silicone foam dressings may be an adjuvant measure to prevent PIs in high-risk patients. Despite the available clinical data and published recommendations on this measure, caregivers face difficulties in identifying patients who would benefit from this adjuvant measure. The objective of this work was to define the profiles of high-risk patients who would benefit optimally from this measure in combination with basic preventive procedures. This consensual expert opinion was drawn up using two methods: the Nominal Group Technique with eight medical and paramedical experts, and the Delphi process with 16 experts. The bases for this expert consensual opinion were a formal search and analysis of the published literature regarding evidence on the prevention of PIs using multilayer silicone foam dressings. The consensual expert opinion reported here addresses five proposals mostly intended to define patients who would benefit from the use of a multilayer silicone foam dressing (≥4 layers) to prevent PIs (sacrum and heels).
Int. Journal of Clinical Pharmacology and Therapeutics, 2003
To assess efficacy and safety of diclofenac-K 12.5 mg tablets in the treatment of acute low back ... more To assess efficacy and safety of diclofenac-K 12.5 mg tablets in the treatment of acute low back pain (low back pain). A multiple dose, double-blind, double-dummy, randomized, placebo-controlled, parallel group trial compared diclofenac-K (12.5 mg; n = 124) with ibuprofen (200 mg; n = 122) and placebo (n = 126) in patients with moderate-to-severe acute low back pain. The treatment consisted of an initial dose of 2 tablets followed by 1 or 2 tablets every 4-6 hours as needed (maximum 6 tablets/day) for 7 days. The primary efficacy outcome for the initial dose was TOTPAR-3, the summed total pain relief over the first 3 hours. Secondary initial dose outcomes included TOTPAR-6, summed pain intensity differences SPID-3 and SPID-6, time to rescue medication or remedicate, and the End of First Dose global efficacy assessment. The primary efficacy outcome for the flexible multiple dosing regimen was the End of Study global efficacy assessment. Secondary outcomes for multiple dosing included time to rescue medication over the entire study, the End of Day global efficacy assessments (daily over Days 1-7), pain intensity differences on the VAS measured at Visit 2 and 3, and change in Eifel algofunctional index. Safety/tolerability was assessed by recording adverse events. Diclofenac-K 12.5 mg demonstrated superiority vs placebo on the primary efficacy parameter and almost all secondary initial dose outcomes. With respect to the initial dose, diclofenac-K 12.5 mg was also significantly superior to ibuprofen 200 mg on SPID-3. Ibuprofen 200 mg was superior to placebo only on the End of First Dose global efficacy assessment. The flexible multiple dosing regimens of diclofenac-K and ibuprofen were both significantly superior to placebo on the End of Study global efficacy assessment, time to rescue medication over the entire study period, the End of Day global efficacy assessment on Days 1-2, pain intensity difference on the VAS at Visit 3 and the Eifel algofunctional index at Visit 3 (also at Visit 2 in diclofenac-K 12.5 mg group). Both active treatments were as well tolerated as placebo. The flexible multiple dosing regimen of diclofenac-K 12.5 mg (initial dose of 2 tablets followed by 1-2 tablets every 4-6 hours, max. 75 mg/day) is an effective and safe treatment of acute low back pain.
Annales de réadaptation et de médecine physique, Mar 1, 2007
Objectifs.-La Haute autorité de santé demande des radiographies systématiques avant manipulation ... more Objectifs.-La Haute autorité de santé demande des radiographies systématiques avant manipulation vertébrale lombaire. La recherche actuelle montre au contraire que l'imagerie systématique a plus d'inconvénients que d'avantages. Pour le rachis cervical, la jurisprudence fait apparaître qu'en cas de complication après manipulation cervicale, l'absence de clichés préalable est une faute, même si ces derniers n'auraient pu contre-indiquer la manipulation. Pour établir des recommandations claires sur ce thème, nous avons recherché dans la littérature qu'elles étaient les complications des manipulations qui pouvaient être évitées par la pratique d'une imagerie préalable. Puis nous avons cherché à savoir si ces complications étaient prévues ou non par les recommandations internationales (« guidelines »). Matériel et méthode.-Recherche de la littérature. Résultats.-Pour le rachis lombaire et thoracique, les recommandations internationales sont suffisantes, sauf en cas de kyste anévrismal osseux, qui peut se révéler jusqu'à l'âge de 25 ans alors que l'imagerie n'est systématiquement recommandée que jusqu'à l'âge de 20 ans. Pour le rachis cervical, malgré l'absence de données de la littérature, la prudence et les risques médico-légaux justifient la pratique d'une imagerie systématique. Conclusion.-La SOFMMOO recommande une imagerie systématique avant manipulation cervicale d'une part et en cas de douleur de dos ou de cou chez le sujet de moins de 25 ans d'autre part. Dans les autres cas, les recommandations internationales suffisent.
Animal experiments and studies in humans clearly show that the relation between pain (acute and c... more Animal experiments and studies in humans clearly show that the relation between pain (acute and chronic) and sleep quality is two-way: sleep disorders can increase pain, which in turn may cause sleep disorders. Sleep disorders and chronic low back pain are frequent health problems and it is unsurprising that the two can co-exist. This study was conducted to evaluate if sleep disorders and chronic pain associated are more frequently than one would expect. The objective of the study was to compare sleep quality in a population of patients with chronic low back pain and a control population. Sleep quality was assessed in 101 patients with chronic low back pain (CLBP) and in 97 sex-and age-matched healthy control subjects using the Pittsburgh Sleep Quality Index [PSQI; score from 0 (no disorder) to 21]. The French version of the Dallas Pain Questionnaire (DPQ) was used to assess the impact of low back pain on patients' quality of life. This impact was taken as nil in the healthy controls. The patients with CLBP and the controls were comparable in age, sex, and height, but mean bodyweight was higher in the CLBP group (70.3 ± 14.5 vs. 61.8 ± 11.4 kg; P \ 0.05). The patients with CLBP were also more frequently on sick leave than the controls (32.3%; n = 31 vs. 0.0% n = 0; P \ 0.001). Coffee, tea, and cola intakes were comparable in the two groups. Patients with CLBP had statistically higher scores in all items of the PSQI than the healthy controls. The mean PSQI was 4.7 ± 3.2 for the healthy controls and 10.9 ± 7.9 for the patients with CLBP (P \ 0.0001). Sleep disorders were greater when the impact of CLBP on daily life (the four aspects of the DPQ) was greater [P \ 0.0001]). The sleep of the patients with CLBP was significantly altered compared with that of the healthy controls, in proportion to the impact of low back pain on daily life. Our findings do not indicate whether sleep disorders are a cause or a consequence of CLBP. Keywords Chronic low back pain Á Sleep disorders Á Dallas Pain Questionnaire Á Pittsburgh Sleep Quality Index Á Case control study The exoirements comply with the current laws of the country in which it was performed.
Y at -il des lombalgies d'origine sacro-iliaque ? Revue critique Is there low back pain coming fr... more Y at -il des lombalgies d'origine sacro-iliaque ? Revue critique Is there low back pain coming from sacroiliac joint? Critical review
Objective: Specialised pressure-relieving supports reduce or relieve the interface pressure betwe... more Objective: Specialised pressure-relieving supports reduce or relieve the interface pressure between the skin and the support surface. The comparative effectiveness of dynamic support surfaces is debated. The aim of this study is to examine the impact of using an alternating pressure air mattress (APAM) on pressure ulcer (PU) incidence in patients receiving home-based care. A second aim was to determine the level of patient/family satisfaction with comfort and gain the views of the care team that used the APAM. Method: The PARESTRY study was a prospective observational study conducted in patients with a high risk of PUs (Braden score <15), discharged to hospital-care at home. The primary prevention groups consisted of patients with no PU at baseline who were in bed for at least 20 hours a day. Patients at baseline with a category 3 or 4 PU or a category 1 or 2 PU in association with poor general health or end-of-life status were included in the secondary prevention group. All patients were laid on an APAM. The primary end point was the % of patients with a worsening skin condition in the pressure area (heel, sacrum, ischium) at day 90 or at the end of the study. The primary analysis was done on the full analysis set (patients included with at least a second assessment), using the last observation carried forward technique to handle missing data, at day 90. A 95% confidence interval was calculated. Results: Analysis was performed on 92 patients (30 in primary prevention and 62 in secondary prevention). The average time spent in bed was 22.7 (SD 2.7) hours a day and 22.6 (SD 2.2) hours in the primary and secondary prevention groups, respectively. At baseline, in the secondary group, 77% of patients had a sacral PU, 63% a heel PU, 8% an ischial tuberosity PU and 45% a PU in another area, a number of patients having multiple PUs. In the primary prevention group, 63% (19/30) of patients dropped out of the study (5 were hospitalised, 9 died, 5 other causes). In the secondary prevention group, 61% (38/62) dropped out (7 were hospitalised, 23 died, 8 others causes). In the primary prevention group, only one patient had worsening skin condition. In the secondary prevention group, 17.7% (11/62: 95% CI: 8.3–27.2) of patients had worsening skin condition. The number of PUs decreased regardless of location. At the end of follow-up, 49% (45/92) of patients had a PU versus 67% (62/92) at baseline Conclusion: This work provides data on the incidence of PUs in patients at high risk, who are using APAMs, and, following inpatient hospitalisation, are taken into home health-care centres. The results of the study highlight the importance of continuity of care across transitions between care settings.
Le mensuel pratique et technique du kinésithérapeute, Jun 10, 2006
... MITRA D., CASSAR-PULLICINO VN, McCALL IW Longitudinal study of vertebral type I end plate cha... more ... MITRA D., CASSAR-PULLICINO VN, McCALL IW Longitudinal study of vertebral type I end plate changes on MR of the lumbar ... sports violents, les sports imposant des mouvements forcés en hyperextension et/ou rotation, les sports nécessitant des charges lourdes, les sports ...
La lombalgie chronique n'a pas encore livré tous ses mystères et pièges, et principalement parce ... more La lombalgie chronique n'a pas encore livré tous ses mystères et pièges, et principalement parce que sa physiopathologie dépasse pour de nombreux aspects le classique modèle anatomoclinique (une douleur rapportée à une lésion anatomique). Sa prise en charge doit faire intervenir de nombreux acteurs et pas uniquement les médecins. Cependant, la part de prise en charge du médecin est importante. Il doit intervenir à tous les stades : au moment de la lombalgie aiguë (moins de 1 mois) et de la lombalgie subaiguë (entre 1 mois et 3 mois d'évolution) pour prévenir le passage à la chronicité puis quand la lombalgie devient chronique (entre 6 et 12 mois) pour tenter d'en modifier la morbidité. Les traitements sont pharmacologiques et non pharmacologiques. Ils ont pour but de diminuer la douleur, d'améliorer la fonction du rachis, le vécu des douleurs. Les principaux traitements sont rappelés et des éléments fondés sur l'état actuel des connaissances permettent au lecteur de limiter le sentiment d'incompréhension et d'impuissance éprouvé devant la réalité de la lombalgie chronique. Cet article traite des lombalgies chroniques sans radiculalgie.
Objective: The primary objective was to determine the clinical benefit of using a specific altern... more Objective: The primary objective was to determine the clinical benefit of using a specific alternating-pressure mattress overlay (APMO) in the prevention of pressure ulcer (PU) in patients at medium to high risk. Method: This prospective study was conducted in five rehabilitation centres and three nursing homes. Patients at medium to high risk of PU, but without PU at baseline, and lying between 15 and 20 hours per day on a specific APMO were included. The primary endpoint was the percentage of patients who developed a sacral, spine, heel or trochanteric PU (supine support areas) of at least category II, at day 35. All patients were included in the analysis. Results: A total of 89 patients were included; of whom six patients (6.7%) dropped out of the study (average (±standard deviation) follow-up 32±5.4 days). No sacral, spine, heel or trochanteric PU of at least category II was reported (i.e., an incidence of 0% [95% Confidence Interval: 0–4.1%] according to the exact Clopper–Pearson method]. Patients were ‘satisfied’ or ‘very satisfied’ with the comfort and stability of the APMO. The caregivers assessed as ‘very easy’ or ‘easy’ the implementation, maintenance and use of the APMO (turning over, moving to a sitting position). Conclusion: In combination with the usual measures to prevent PU, the results of our study showed a low incidence of PU in high-risk patients lying for between 15 and 20 hours a day on an APMO, use of which is therefore recommended in these patients.
Efficacy and safety of duloxetine for treatment of fibromyalgia in patients with or without major... more Efficacy and safety of duloxetine for treatment of fibromyalgia in patients with or without major depressive disorder: results from a 6-month, randomized, double-blind, placebo-controlled, fixed-dose trial. Pain 2008; 136:432-44. 7 Pedersen L, Nielsen A, Blackburn-Munro G. Anti-nociception is selectively enhanced by parallel inhibition of multiple subtypes of monoamine transporters in rat models of persistent and neuropathic pain. Psychopharmacology 2005;182: 551-61. 8 Munro G. Dopamine d(1) and d(2) receptor agonism enhances antinociception mediated by the serotonin and noradrenaline reuptake inhibitor duloxetine in the rat formalin test. Eur J Pharmacol 2007;575:66-74. 9 Barbui C, Furukawa T, Cipriani A. Effectiveness of paroxetine in the treatment of acute major depression in adults: a systematic re-examination of published and unpublished data from randomized trials.
Acute low back pain is evolving for less than 4 or 6 weeks. The diagnostic stake in front of an a... more Acute low back pain is evolving for less than 4 or 6 weeks. The diagnostic stake in front of an acute low back pain is not to ignore a condition requiring a specific treatment (vertebral fracture, tumours, infections, inflammatory diseases...). Signs of alerts from patient history are to be looked for to enable it. Once the diagnosis of non specific low back pain has been confirmed and in absence of neurological complications, the therapeutic stake is to avoid chronicity by a treatment adapted to every patient. Numerous scientific quality data questioned the interest of the bed rest for non specific acute low back pain and the beneficial role of the preservation of the activities to avoid chronicity. The interest to inform and to reassure the patient on his future is also an important condition of the care.
... re de pr vention et de prise en charge de la lombalgie non sp cifi que. Rev Rheum 2006;73:S35... more ... re de pr vention et de prise en charge de la lombalgie non sp cifi que. Rev Rheum 2006;73:S35-52. [4] Henschke N, Maher CG, Refshauge KM, et al. Prevalence of and screening for serious spinal pathology in patients presenting to primary care sittings with acute low back ...
Despite progress in the prevention of pressure injuries (PIs), they remain a challenging public h... more Despite progress in the prevention of pressure injuries (PIs), they remain a challenging public health problem because of their frequency and morbidity. Protection of the skin by multilayer silicone foam dressings may be an adjuvant measure to prevent PIs in high-risk patients. Despite the available clinical data and published recommendations on this measure, caregivers face difficulties in identifying patients who would benefit from this adjuvant measure. The objective of this work was to define the profiles of high-risk patients who would benefit optimally from this measure in combination with basic preventive procedures. This consensual expert opinion was drawn up using two methods: the Nominal Group Technique with eight medical and paramedical experts, and the Delphi process with 16 experts. The bases for this expert consensual opinion were a formal search and analysis of the published literature regarding evidence on the prevention of PIs using multilayer silicone foam dressings. The consensual expert opinion reported here addresses five proposals mostly intended to define patients who would benefit from the use of a multilayer silicone foam dressing (≥4 layers) to prevent PIs (sacrum and heels).
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