Psychometric analysis of the audiovisual taxonomy for assessing pain behavior in chronic back-pain patients

Sixty chronic back-pain patients were administered the audiovisual taxonomy of pain behavior during their first and last weeks in an inpatient multidisciplinary pain clinic. Audiovisual total score provided a useful index of pain behavior with a suitable frequency and reliability, while offering unique variance as a measure of treatment outcome. Patients' pain behaviors upon admission to the pain program were positively correlated with the following background variables: receiving worker's compensation, pounds overweight, and number of back surgeries. Patients' pain behaviors upon completion of the pain program were significantly correlated with their preferences for pain treatment modalities. High levels of pain behavior correlated with a preference for treatments of ice and heat. Low levels of pain behavior correlated with a preference for physical therapy, social work, lectures, and relaxation. It was suggested that treatment outcome in a multidisciplinary pain clinic is more immediately related to patients' coping styles and their choice of pain treatment modalities than to their demographics and personalities.     

低能量体外冲击波治疗ⅢB型慢性前列腺炎的临床疗效观察

目的 探讨低能量体外冲击波在ⅢB型慢性前列腺炎患者中的临床治疗效果。方法 选择2017年2月~2018年10月我院收治的ⅢB型慢性前列腺炎患者45例作为研究对象,采用随机数字表法分为对照组15例和观察组30例。对照组给予盐酸坦洛新缓释片口服治疗,观察组采用低能量体外冲击波治疗,比较两组国际前列腺症状评分及VAS疼痛评分。结果 观察组治疗后疼痛症状（2.36±1.23）分、排尿症状（1.36±1.24）分、生活质量（3.08±1.21）分、总分（7.03±1.85）分及VAS评分（2.67±1.12）分,均低于对照组疼痛症状（4.26±1.89）分、排尿症状（2.35±1.70）分、生活质量（4.35±1.76）分、总分（11.01±4.63）分及VAS评分（3.92±1.01）分,差异具有统计学意义（P＜0.05）。结论 低能量体外冲击波能改善ⅢB型慢性前列腺炎患者症状,有助于减轻患者疼痛,能为ⅢB型慢性前列腺炎治疗提供方法。     

Results of a self-management program added to standard physical therapy in chronic neck pain

ObjectiveTo evaluate the effectiveness of a self-management treatment added to a physical therapy program compared to a physical therapy program in patients with chronic neck pain.MethodsFifty-three patients with chronic neck pain were randomly allocated to a physical therapy intervention (control group) or an individualized self-management combined with physical therapy intervention (experimental group). Both interventions were developed over a four-week period. Outcome measures included were Disability, Fear-Avoidance Beliefs, Health-Related Quality of Life, Pain, and Anxiety and Depression. All outcomes were measured before and after the treatment and at three-month follow-up.ResultsThere were not significant differences between groups at baseline. After the intervention both groups obtained better results in the Neck Disability Index but there were not significant differences between them (p > 0.05). At follow-up, the self-management group obtained significant better results compared to the control group (95 % CI: -5.20(-6.8 to -1.5), p = 0.032).ConclusionsAn individualized self-management program added to a physical therapy program led to a greater improvement in disability at 3 months follow up compared to a physical therapy program alone. Catastrophizing, pain, and health-related quality of life improved significantly after the intervention and at follow-up compared to the standard care alone.Practical implicationsThis study indicates that physical therapy for patients with chronic neck pain preferably should include self-management education.     

脑血管意外合并抑郁症患者对神经功能康复的影响

目的:探讨脑血管意外合并抑郁症患者对神经功能康复的影响。方法:选取2014年1月—2016年1月于我院因脑血管意外合并抑郁症的患者80例,随机分为常规治疗组(A组)和抗抑郁治疗组(B组),以40例非抑郁症的脑血管意外患者作为对照(C组),分别在治疗前和治疗后6个月通过神经功能缺损(NIHSS)评分量表比较3组患者的神经功能,通过汉密尔顿抑郁量表(HAMD)评定抑郁程度,通过匹斯堡睡眠质量指数(PSQI)量表和日常生活能力量表(ADL)评价3组患者的睡眠质量和日常生活能力以评价结果。结果:3组患者治疗前的NIHSS评分、ADL评分对比差异无统计学意义(P0.05),治疗后6个月A组的NIHSS评分高于B、C组(t=8.520,13.398;P0.05),治疗后6个月A组的ADL评分低于B、C组(t=4.370,6.694;P0.05);治疗前A、B组之间HAMD评分差异无统计学意义(P0.05),治疗6个月后A、B组HAMD评分均显著下降(t=5.112,21.238;P0.05),且B组评分显著低于A组(t=14.920,P0.05);治疗前A组和B组PSQI评分比较没有统计学差异(P0.05),治疗后6月3组的PSQI评分均显著下降(t=3.909,17.923,6.642;P0.05),且B组显著低于A组(t=13.172,P0.05)。结论:脑血管意外合并抑郁症将影响神经功能的恢复,积极给予抗抑郁处理将改善患者的睡眠质量,有利于患者生活质量的提高。     

脑电生物反馈治疗对慢性精神分裂症认知功能影响

目的:探讨脑电生物反馈治疗对慢性精神分裂症患者认知功能的影响。方法:对58例慢性精神分裂症患者在利培酮药物治疗的基础上,分别给予脑电生物反馈治疗(脑电生物反馈治疗组30例)及传统娱疗(传统娱疗组28例)。采用认知评估工具连线测验、简单视觉空间记忆测验(BVMT-R)、WMS-Ⅲ空间广度测验、霍普金斯词语学习测验(HVLT-R)、定步调听觉连续加法测验(PASAT)和威斯康星卡片分类测验(WCST-64)对治疗前及治疗8周后进行神经心理测试。采用阳性和阴性症状量表(PANSS)评定临床症状。结果:治疗前与治疗后PANSS评分两组间无显著差异(P0.05),两组在治疗前神经心理测验成绩无显著差异(P0.05)。治疗8周后,两组间各项神经心理测试比较:空间广度测验的顺行得分、持续错误数、完成分类数无显著差异(P0.05)。连线测验(t=2.10,2.07;P0.05),逆行得分(t=-2.52,P0.05),HVLT-R(t=-2.86,P0.01;t=-3.63,-10.35,P0.001),BVMT-R(t=-5.01,P0.001;t=-3.04,P0.01;t=-4.23,P0.001),PASAT(t=-20.65;P0.001),两组比较均有显著差异。结论:脑电生物反馈治疗对慢性精神分裂症的认知功能改善作用较传统娱疗组明显。     

Topical antifungal treatment of chronic rhinosinusitis with nasal polyps: a randomized, double-blind clinical trial

BACKGROUND: Recently, fungal elements were suspected to be the causative agent of chronic rhinosinusitis, and benefits of topical amphotericin B therapy have been reported. OBJECTIVE: The effects of amphotericin B versus control nasal spray on chronic rhinosinusitis were compared in a double-blind, randomized clinical trial. METHODS: Patients with chronic rhinosinusitis were administered 200 microL per nostril amphotericin B (3 mg/mL) or saline nasal spray 4 times daily over a period of 8 weeks. The response rate, defined as a 50% reduction of pretreatment computed tomography score, was the primary outcome variable. Additional outcome variables included a symptom score, a quality of life score, and an endoscopy score. Before and after treatment, nasal lavages were pretreated with dithiothreitol and examined for fungal elements by PCR and standard culture techniques. RESULTS: Seventy-eight patients were included, and 60 patients finished the study per protocol. In the control group, no positive response (0 of 32) was observed, and 2 of 28 patients responded in the amphotericin B group (P>.2). The symptom scores were distinctly worse after amphotericin B therapy (P <.005). The other parameters investigated did not differ remarkably between the treatment groups. CONCLUSION: Nasal amphotericin B spray in the described dosing and time schedule is ineffective and deteriorates patient symptoms.     

Fish Oil Treatment of Interferon-Alpha-Induced Dyslipidaemia

Objective: Our study was designed to evaluate the role of omega-3 fatty acids (OFAs) in reducing serum triglyceride levels in patients with chronic hepatitis C receiving treatment with interferon-alpha (IFNalpha). Design: 52 patients (23 males, 29 females) with chronic hepatitis C were randomly assigned to nonblind treatment with IFNalpha 3 million units (MU) three times weekly alone (group A) or in combination with OFAs 3 g/day for 6 months (group B). Results: Hepatitis C virus (HCV) RNA serum levels decreased significantly in both groups compared with baseline, but there was no significant difference in HCV RNA levels between the 2 groups. At the end of treatment there was a statistically significant difference in ALT levels between patients in group A and in group B (72.15 vs 50.05 IU/L; p = 0.01). A statistically significant increase in triglyceride levels occurred in group A during treatment (p = 0.03 vs baseline). In contrast, a statistically significant decrease in triglyceride serum levels occurred in group B (p = 0.001 vs baseline). Conclusion: Concurrent administration of OFAs reversed IFNalpha-induced hypertriglyceridaemia in patients with chronic hepatitis C.     

Behavioral treatment of essential hypertension: a comparison between cognitive therapy and biofeedback of heart rate

The efficacy and the mechanisms of action of two behavioral treatments for essential hypertension were compared: cognitive group therapy for anger control and biofeedback for heart rate control. The cognitive therapy aimed at lowering the "general anger" level and helping overt expression of "anger out;" heart rate biofeedback aimed at slowing heart rate in stress situations. Ninety-seven essential hypertensive patients were randomly assigned to three groups; after 20 dropouts, 77 patients fully participated in the study: cognitive treatment (N = 30), biofeedback (N = 27), and control (no treatment, N = 20). The treatments were held in 17 weekly sessions; during treatment, blood pressure was measured once a month, and during follow-up after 1 and 6 months. The anger level and heart rate control were assessed at the beginning and the end of treatment. The main results were: 1) a significant decrease of blood pressure for both treatments as compared with control, 2) a significant decrease of blood pressure with heart rate biofeedback as compared with cognitive therapy, and 3) a better control in anger achieved with cognitive therapy and a lesser control in heart rate as compared with biofeedback.     

药物联合认知行为治疗对精神分裂症患者自我效能感的影响

目的:观察常规药物联合认知行为治疗对精神分裂症患者自我效能感的影响。方法:以2014年2月-2015年8月在我院接受治疗的精神分裂症患者为观察对象,随机分为对照组和观察组各40例。其中对照组给予常规药物治疗,观察组在常规药物治疗的基础上给予认知行为治疗。治疗前后采用阴性症状和阳性症状量表(PANSS)、智力测定工具、成人公认认知测评(MCCB)以及自我效能量表对其治疗效果进行调查。结果:治疗前两组患者的自我效能无明显差别(P0.05),治疗3个月和6个月时,观察组自我效能得分明显高于对照组(t=-3.115,-2.736;P0.01);治疗前两组患者的PANSS总分和各因子得分无明显差别,治疗后3个月和6个月时,观察组的PANSS总分和各因子得分低于对照组(t=8.286,4.745,5.030,10.018;P0.001);治疗前两组患者的瑞文智力测验结果无明显差别,治疗后3个月和6个月时,观察组瑞文智力测验结果高于对照组(t=-3.148,-4.812;P0.001);两组患者治疗前MCCB测验各项得分无明显差别,治疗后3个月和6个月时,观察组MCCB得分明显高于对照组。结论:常规药物联合认知行为治疗对精神分裂症患者有较好的治疗效果,可明显提高患者的自我效能,改善其临床症状。     

Evaluation of a cognitive behavioural programme for rehabilitating patients with chronic pain.

The aim of this prospective longitudinal study was to evaluate an inpatient cognitive behavioural pain management programme for patients with chronic pain. A physical and psychological assessment of patients was carried out before and after treatment, and at one and six months follow up. A total of 212 patients with disabling chronic pain of mean duration 10.5 years, for whom no further medical or psychiatric treatment was appropriate or available, were admitted; their mean age was 50 years and 65% were women. The four week programme was delivered by a multidisciplinary team of two psychologists, a physiotherapist, nurse, occupational therapist and anaesthetist. The main components of therapy included: education, teaching behavioural and cognitive skills, a stretch and exercise programme, medication reduction, goal setting and pacing, and relaxation training. Outcome measures assessed quality of life, physical performance (for example walking speed), pain intensity and distress, depression severity and confidence. Assessment immediately after treatment revealed significant improvements on all measures. Improvements were well maintained at six month follow up. Cognitive behavioural treatment can be of value in improving the day-to-day functioning and quality of life of patients with chronic pain for whom conventional medical treatments have apparently failed.     

Comparing physical and behavior therapy for chronic low back pain on physical abilities,psychological distress,and patients' perceptions

A treatment-outcome study was conducted to study the impact of behavior and physical therapy on components of the chronic low back pain syndrome. Eighteen patients received behavior therapy and 15 patients received physical therapy. All patients had at least a 6-month history of seeking treatment for chronic low back pain. Prior to treatment patients were assessed in four principal areas of functioning: (1) physical abilities; (2) current physical functioning; (3) psychological and psychosocial functioning; and (4) pain intensity and pain perception. Treatments were conducted in a group (five to eight patients) outpatient setting. Both behavior therapy and physical therapy groups met for 10-weekly sessions, each lasting 2 hr. Behavior therapy was designed to address the environmental, social, and emotional components of the low back pain syndrome as well as the depression and decreased activity that result from chronic low back pain. Physical therapy was based upon traditional rehabilitation theory and was designed to improve low back function. Patients were reevaluated at posttreatment, 6 months, and 1 year. The results showed a general improvement for patients in both groups and a few treatment-specific differences in outcome measures.This research was supported by the Veterans Administration Medical Research Program. Portions of this paper were read at the Annual Meeting of the American Pain Society, New York, September 1980.     

Effects of written anger expression in chronic pain patients: making meaning from pain

Based on prior research demonstrating benefits of emotional disclosure for chronically ill individuals and evidence that anger is particularly problematic in chronic pain sufferers, outpatients from a chronic pain center (N=102) were randomly assigned to express their anger constructively or to write about their goals non-emotionally in a letter-writing format on two occasions. Letters were coded for degree of expressed anger and meaning-making (speculation and insight into conditions that precipitated anger). Over a 9 week period, participants in the anger-expression group (n=51) experienced greater improvement in control over pain and depressed mood, and marginally greater improvement in pain severity than the control group (n=51). Degree of expressed anger uniquely accounted for intervention effects and meaning-making mediated effects on depressed mood. These findings suggest that expressing anger may be helpful for chronic pain sufferers, particularly if it leads to meaning-making.     

体外冲击波联合玻璃酸钠注射治疗膝关节骨关节炎的疗效观察

目的 探讨体外冲击波联合玻璃酸钠注射疗法治疗膝关节骨关节炎(KOA)的疗效。方法 前瞻性研究山东省立第三医院骨科2015年6月—2017年6月240例KOA患者,采用随机数字表法分成A、B、C三组,每组80例。A组采用玻璃酸钠注射治疗,B组采用体外冲击波治疗,C组采用体外冲击波联合玻璃酸钠注射治疗。对三组患者治疗前和治疗后第1、3、5周,采用视觉模拟评分(VAS)、Lequesne指数评分和西安大略和麦克马斯特大学(WOMAC)骨关节炎指数评分进行疗效评定,并进行组间比较。结果 治疗后第1、3、5周各组的VAS、Lequesne指数评分、WOMAC关节炎指数评分均依次降低,经配对分析显示,均低于治疗前,差异均有统计学意义(P值均＜0.05)。三组患者相同时间点的VAS、 Lequesne指数评分和WOMAC骨关节炎指数评分比较,差异均有统计学意义(P值均＜0.05);C组治疗前VAS为(8.59±0.98)分、Lequesne指数评分为(10.55±2.15)分、WOMAC骨关节炎指数评分为(35.58±10.13)分,治疗后第1、3、5周VAS分别为(5.51±0.63)分、(3.39±0.51)分、(1.57±0.12)分,Lequesne指数评分分别是(8.13±2.15)分、(7.01±2.03)分、(5.05±2.11)分,WOMAC骨关节炎指数评分分别为(28.45±9.48)分、(20.38±8.64)分、(14.85±5.45)分,疗效均优于A组及B组,差异均有统计学意义(P值均＜0.05)。结论 体外冲击波联合玻璃酸钠注射治疗KOA具有协同作用,能进一步缓解疼痛,建议临床推广和应用。     

Efficacy of long-term interferon therapy in chronic hepatitis B patients with HBV genotype C

Infection with Hepatitis B virus (HBV) genotype C predominates in Japan. We analyzed the efficacy of interferon (IFN) alpha or beta in the treatment of chronic hepatitis B patients with HBV genotype C and the clinical predictors for therapeutic response. Forty-three genotype C-infected, chronic hepatitis B e antigen (HBeAg)-positive patients (32 men and 11 women with a mean age of 35.6+/-10.1 years) who had been treated with IFN therapy were retrospectively studied. The patients were classified into two treatment groups. Short-term therapy group was administered a 5-6 MU dose three times weekly for 4 weeks, and the long-term therapy group for 24 weeks. At the end of the follow-up period, 4 (15%) of 27 short-term therapy group patients and 6 (38%) of 16 long-term therapy group patients had normalized serum ALT levels and seroconversion of HBeAg to anti-HBe (p=0.137). Multivariate analysis for parameters most important for the efficacy of IFN therapy was performed using Cox proportional hazard models in order to investigate the association between baseline characteristics of patients and the response to IFN treatment. As a result, the p-values of IFN treatment group and sex were <0.05, and both factors can be recognized as independent significant factors (relative risk, 2.93 and 2.53; p=0.027 and 0.040, respectively). Furthermore, the cumulative rates of seroconversion of HBeAg to anti-HBe analyzed by the Kaplan-Meier method was significantly higher in the female group (p=0.015) and in the long-term IFN therapy group (p=0.0046). In summary, long-term IFN therapy may be more effective than short-term IFN therapy for patients with chronic HBV genotype C infection.     

Anger expression and chronic pain

Intensity of angry feelings and styles of expressing anger were examined for their relationship to measures of the chronic pain experience. Subjects were 142 chronic pain patients. Multiple regression analyses revealed that a style of inhibiting the expression of angry feelings was the strongest predictor of reports of pain intensity and pain behavior among a group of variables including demographics, pain history, depression, anger intensity, and other styles of anger expression. In a similar manner anger intensity contributed significantly to predictions of perceived pain interference and activity level. More conservative hierarchical regression analyses supported these findings. Results are consistent with explanatory models of pain and disability that hypothesize an etiologic role of a pervasive inability to express intense negative emotions, particularly anger.This research was partially supported by a Department of Veterans Affairs Merit Review grant awarded to Robert D. Kerns.     

Serum Carnitine Levels in Chronic Hepatitis C Patients Before and After Lymphoblastoid Interferon-α Treatment

Objective: Chronic liver disease is often a hypocarnitinaemic condition. Since carnitine affects lipid metabolism, modifications of lipid pattern and energy metabolism can be expected in patients affected by chronic viral hepatitis. The aim of this study was to assess the relationship between serum carnitine levels and the grading of chronic hepatitis C, and to evaluate the effects of lymphoblastoid interferon (IFN)-αnl on carnitine levels in patients with hepatitis C. Design: We evaluated carnitine serum levels in a group of 32 patients with chronic hepatitis C before and after treatment with intramuscular IFNα 3MU 3 times/week for 6 months, comparing them with levels in 20 healthy controls. Statistical correlations between serum carnitine, histological activity index score, duration of disease and lipid pattern were also evaluated. Results: Serum carnitine levels, which were statistically lower in hepatitis C patients than in controls before therapy, increased after IFNα (p = 0.0003 vs pretreatment). There were no significant changes in total cholesterol in any patient after treatment, although serum triglyceride levels increased (p = 0.0003). Serum carnitine levels were correlated with age (r = 0.35; p = 0.02), type of response (r = ?03; p = 0.04), duration of disease (r = ?0.8; p = 0.0001) and high-density lipoprotein cholesterol levels (r = 0.43; p = 0.005) after completion of IFNα treatment. Conclusion: It is suggested that the post-treatment increase in serum carnitine observed in this study could be considered a new index of improved liver function. Also, exogenous administration of carnitine may be useful in patients with chronic hepatitis C who have reduced endogenous synthesis of this substance.     

Role of platelet surface receptor abnormalities in the bleeding and thrombotic diathesis of uremic patients on hemodialysis and peritoneal dialysis

BACKGROUND: Patients with chronic renal failure suffer from bleeding diathesis and a tendency to accelerated atherosclerosis. Altered platelet function plays a well defined role in the hemorrhagic complications of these patients and has a probable impact on atherothrombotic disease in uremia. In this study we investigated the expression of platelet surface receptors, the glycoprotein GPIb (receptor for von Willebrand Factor(vWF) and GPIIb/IIIa (receptor for fibrinogen) in patient with chronic renal failure in pre-dialysis status, under hemodialysis and peritoneal dialysis treatment, in order to assess the impact of the abnormal receptorial status of uremic platelets on the clinical manifestations of hemostatic alterations in uremic patients. METHODS: Thirty-seven normal healthy subjects (controls = Group A), 18 patients with mild chronic renal failure (creatinine = 1.8 +/- 0.5 mg% - Group B), 15 patients with advanced renal failure (creatinine = 5.4 +/- 2. 1 mg% - Group C), 18 hemodialysis patients (Group D) and 11 peritoneal dialysis patients (Group E) were included in the study. The expression of platelet surface receptors GPIb and GPIIb/IIIa was investigated with monoclonal antibodies CD42 and CD41 (Immunotech, Marseille, France) and a FACScan flowcytometer (Becton-Dickinson, USA). RESULTS: Mean values of GPIb glycoprotein (mean flow +/- SD) were: group A = 48.14 +/- 9.31; group B = 40.48 +/- 8.18 (p < 0.005); group C = 34.05 +/- 7.55 (p < 0.0005) versus group A; p = 0.025 versus group B); group D = 34.51 +/- 7.22 (p < 0.0005 versus group A; p = 0.025 group B and p = ns versus group C); group E = 26.34 +/- 4.06 (p < 0.0005 versus group A, p < 0.0005 versus group B, p < 0.005 versus groups C and D). Mean values of glycoprotein GPIIb/IIIa were: group A = 375.32 +/- 90.58; group B = 398.48 +/- 54.26 (p = ns); group C = 426.86 +/- 52.78 (p < 0.025 versus group A; p = ns versus group B); group D = 425.17 +/- 75.03 (p < 0.025 versus group A; p = ns versus groups B and C); group E = 336.39 +/- 43.26 (p = ns versus group A; p < 0.005 versus group B, p < 0.0005 versus group C and p < 0.001 versus group D). CONCLUSIONS: Our data confirm the receptorial defect of glycoprotein GPIb (the receptor for vWF) on the surface of uremic platelets: a negative correlation between serum creatinine and the expression of glycoprotein GPIb was found. The defect was not corrected by hemodialysis and/or peritoneal dialysis. Hemodialysis and peritoneal dialysis have a different impact on the expression of GPIIb/IIIa glycoprotein (the receptor for vWF): peritoneal dialysis seems to have a more favourable effect by restoring normal values of the expression of this membrane integrine. Theoretically the data could be correlated to the better biocompatibility of the peritoneal dialysis and to more favorable clinical behaviour in terms of accelerated atherosclerosis and athero-thrombotic complications in the uremic patients with end stage renal disease. Finally the abnormalities of platelet surface receptors may play a main role in the hemostatic alterations of uremic patients.     

充气式温毯预保温联合液体加温对肺叶切除术患者体温及热舒适度的影响

目的本研究拟探讨充气式温毯预保温联合液体加温对胸科全麻肺叶切除术患者体温及热舒适度的影响。方法择期行胸腔镜(VATS)肺叶切除术患者46例,随机分为预保温(充气式温毯)+液体(温箱)保温组(T)和对照组(C),每组23例,记录预保温前后、麻醉过程中、术毕及进出麻醉术后恢复室(PACU)时患者鼓膜温及术后寒战、热舒适度、恢复室停留时间。结果在麻醉后1、2、3 h和术毕时4个时间点,与对照组相比,保温组患者术中的核心体温下降幅度小,更趋于稳定(P0.01);保温组患者术后低体温发生率,寒战发生率均较低(8.7%比56.5%,4.3%比34.8%,P0.05);保温组患者热舒适度评分高于对照组(8.52±0.94比7.65±0.83,P0.01)。结论术前预保温联合液体保温可维持全麻肺叶切除术患者术中体温平稳,降低低体温及寒战发生,提高热舒适度,为患者提供有效的体温保护。     

An evaluation of a behavioral program for chronic pain

The current study evaluated a behavioral program for the management of chronic pain. One hundred twenty-one patients were treated. Primary pain complaints were predominantly in the low back or head/neck/face regions. Patients participated in a 4-week inpatient treatment package consisting of controlled medication reduction, physical therapy, behavioral group therapy, self-monitoring, contracting, and biofeedback/relaxation training. Several measures of verbal/nonverbal pain behavior and physical functioning were obtained over the baseline, treatment, and follow-up periods. Results showed significant reductions in analgesic medication use and verbal/nonverbal pain behavior and improvements in physical functioning, employment status, and pro-health behaviors which were maintained at 12-month follow-up.The authors wish to thank the following people for their assistance: D. Bugold, N. Flynn, A. Glavan, L. Graham, J. Henkel-Johnson, E. Martin, P. Panyan, B. Patric, K. Slack, J. Sommerfeld, K. Wahman, S. Wahman, B. Wilk, and M. Wipson. This research was supported in part by a grant from the Paul F. Dwan Foundation.     

Efficacy and safety of long-term treatment of asthmatic patients with pranlukast, a cysteinyl-leukotriene-receptor antagonist: four-year followup study.

BACKGROUND: There are few studies that have examined the long-term efficacy and safety of pranlukast, a leukotriene receptor antagonist, in asthmatic patients. METHODS: Sixty-three asthmatic patients were entered in this 4-year study [group 1, mild or moderate (N = 22); group 2, severe without using oral prednisolone (N = 22); group 3, severe with using oral prednisolone (N = 19)]. Pranlukast was administered at 225 mg twice daily to 14 subjects in group 1 (group 1p), 14 in group 2 (group 2p), and 11 in group 3 (group 3p), chosen for pranlukast additional therapy at random. Another group of 24 asthmatic patients was assigned to conventional therapy group (groups 1c, 2c, and 3c). Efficacy was determined by improvement in symptom score, peak expiratory flow rate (PEFR) percentage predicted, reduced daily variability of PEFR (percentage), and reduced frequency of use of rescue beta2-agonist (times per week). RESULTS: In groups 1p and 2p, PEFR percentage predicted began to improve from 2 weeks after commencement of treatment. The symptom score, daily variability of PEFR, and use of rescue beta2-agonist diminished significantly. In group 3p, pranlukast was ineffective in improving PEFR percentage predicted. All but two patients continued to receive pranlukast and no adverse effects were noted, at least during the 16-week therapy. Further, 22 patients continued to receive pranlukast for 4 years, and none experienced any adverse effects. CONCLUSIONS: We showed in this study that long-term treatment with pranlukast is effective for asthmatic patients without any adverse effects.