BACKGROUND: A number of different therapies have been used for postherpetic neuralgia. We decided to conduct a systematic review of existing randomized controlled trials. OBJECTIVE: To determine the efficacy of available therapies for relieving the pain of established postherpetic neuralgia. METHODS: We performed a systematic review, including meta-analysis, of existing randomized controlled trials. Eleven published trials and one unpublished trial were identified which met the inclusion criteria and were included in the current review. RESULTS: Pooled analysis of the effect of tricyclic antidepressants demonstrate statistically significant pain relief (OR 0.15, CI 0.08-0.27). Pooling of the results of the three trials comparing the effects of capsaicin and placebo could not be done due to heterogeneity. This heterogeneity was mainly attributable to an unpublished trial which differed in terms of the dose and duration of treatment. When this study was omitted, no heterogeneity was found and the pooled analysis revealed a statistically significant benefit (OR 0.29, 95% CI 0.16-0.54). However, problems with blinding in patients using capsaicin may have accounted for the positive effect. One small study of vincristine iontophoresis compared to placebo also yielded a favourable result (OR 0.05, 95% CI 0.01-0.26). Other treatment evaluated include lorazepam, acyclovir, topical benzydamine, and acupuncture. We found no evidence that these are effective in relieving pain associated with postherpetic neuralgia. CONCLUSION: Based on evidence from randomized trials, tricyclic anti-depressants appear to be the only agents of proven benefit for established postherpetic neuralgia.

Analgesics↗

PubMed1996

SASPREN -- a new development in family practice research in South Africa.

Research in the family practice setting can make unique contributions to our understanding of health, illness, and disease at the level of the individual patient as well as the population. In November 1990 a family practice research network (SASPREN) was established in South Africa. The network consists of sentinel practitioners who have volunteered to provide information on patients seen in their practices. This article describes the development of the network, focusing particularly on its accomplishments in the first 3 years. It is hoped that SASPREN will help overcome some of the obstacles to research encountered by family doctors and ultimately improve the care of patients in the community.

Family Practice↗

PubMed1996

The SASPREN primary care survey -- who consults the family doctor?

OBJECTIVE: To describe selected characteristics of patients consulting general/family practitioners in the Western Cape. DESIGN: A cross-sectional survey design was employed in which doctors completed a structured questionnaire during or immediately after each consultation. SETTING: Data were collected by family practitioners in private practice who were affiliated to the South African Sentinel Practitioner Research Network (SASPREN). PARTICIPANTS: All patients who had a face-to-face encounter with the doctor at his/her surgery. A total of 2 473 such encounters was included. MAIN OUTCOME MEASURES: Age, sex, race, method of payment and smoking status. RESULTS: Females outnumbered males in all race groups except blacks, where they comprised 48% of patients. Most patients were under the age of 14 years (23.3%) or between 25 and 44 years (33.3%). However, after the demography of the catchment population was taken into account, the highest utilisation of general practitioner services was found to be at extremes of age. This utilisation pattern was demonstrated in both sexes and all races. In relation to their distribution in the population, whites and Indians are over-represented in private practice while blacks and coloureds are under-represented. The bulk of patients (67%) pay for general practitioner services via some form of insurance (medical aid or benefit fund), but significant differences exist across race groups. In the case of blacks and Indians, the majority (72% and 64% respectively) of consultations are funded 'out of pocket'. An alarmingly high smoking prevalence was found in black and coloured men. In all race/sex groups smoking rates peak between 25 and 44 years. In this age group, 68.6% of black men and 73.3% of coloured men were current smokers. CONCLUSIONS: This study provides essential information on patients seen in family practice. Access to family doctor services in the Western Cape should be improved for blacks and coloureds. There is an urgent need for smoking cessation interventions in the region.

Age Factors↗

PubMed1995

Systematic review: 'state of the science' health care decision-making.

Explore the source record for details and available documents.

Clinical Medicine↗

PubMed1992

Atenolol and visual loss.

Explore the source record for details and available documents.

Aged↗

PubMedDate not supplied

Depression and anxiety as predictors of outcome after myocardial infarction.

OBJECTIVE: The objective of this study was to investigate the significance of emotional distress immediately after a myocardial infarction as a predictor of physical, psychological, and social outcomes and resource use. METHODS: In an epidemiological survey, demographic and cardiological data were obtained for all patients from a defined geographical area who had had a myocardial infarction (according to diagnostic criteria of the Monitoring Trends and Determinants in Cardiovascular Disease [MONICA] trial). Hospital survivors were interviewed and were asked to complete self-report assessments on mental state and quality of life. Full replies were available at baseline for 347 subjects. Self-report follow-up questionnaire information was collected 3 months and 1 year later. RESULTS: Fifteen percent of patients scored as probable cases of anxiety or depression. They were more likely than noncases to report preinfarct distress and poor adjustment (as indicated on the 36-item Medical Outcome Study short form). There was an improvement at 3 months, but there was little overall or individual change after that time. Anxiety and depression did not predict subsequent mortality but did significantly predict poor outcome at 1 year on all dimensions of the 36-item short form quality-of-life measure and on specific measures of everyday activity and reports of chest pain, use of primary care resources, and secondary prevention lifestyle changes. CONCLUSIONS: Subjects who are distressed in the hospital are at high risk of adverse psychological and quality-of-life outcomes during the ensuing year. Our findings strengthen the argument for in-hospital identification and treatment of patients with depression and anxiety after myocardial infarction.

Adult↗