Journal Article Annotations
2016, 3rd Quarter
Annotations by Elie Isenberg-Grzeda, MD and Sean Heffernan, MD
The finding: The authors completed a review of 105 US-based RCTs and found that some complementary health approaches are effective tools for helping to manage common pain conditions. According to the authors, the safest and most effective approaches include acupuncture and yoga for back pain, acupuncture and tai chi for knee osteoarthritis, relaxation techniques for severe headaches, and migraine massage therapy for short-term neck pain relief.
Strength and weaknesses: The major limitations are frequent sample size of less than 100 subjects and the variety of outcome measures used among the studies. Also, there was a rather homogenous sample group among the various studies (most commonly older white women with few ethnic minority participants).
Relevance: Complimentary and alternative treatments are utilized more than ever before. A well-rounded physician should know and understand the safety and efficacy of these approaches to further help the patient.
The finding: Pain intensity scores were significantly reduced when the pregabalin–duloxetine combination approach was used when compared to pregabalin alone or placebo. The combination approach had a favorable outcome compared to duloxetine monotherapy, but failed to demonstrate statistical significance. The study also validated duloxetine monotherapy as a superior treatment to pregabalin monotherapy when compared directly.
Strength and weaknesses: This RCT was well designed with multiple standardized outcome measures and a rigorous crossover design, allowing comparisons of each treatment approach with each individual subject. The main limitation of a crossover trial is the potential carryover effects of between serial treatment round, which was minimized by the extended taper and a drug-free day.
Relevance: Combination therapy for fibromyalgia is common. This is the first RCT comparing a combination of an antidepressant and anticonvulant with monotherapy of each for the treatment of fibromyalgia.