Compounded pain relief creams not effective finds study

first_imgImage Credit: Africa Studio / Shutterstock By Dr. Ananya Mandal, MDFeb 6 2019A new study has shown that pain relief creams are no better than dummy or placebo creams when it comes to relieving pain. The study titled, “Compounded Topical Pain Creams to Treat Localized Chronic Pain: A Randomized Controlled Trial,” was published in the latest issue of the journal Annals of Internal Medicine. These pain relief creams are prescribed to be applied locally over localized pain sites for pain relief explain the researchers. They come at a relatively high cost but are not better than placebo creams they add. The experts add that there have been concerns regarding the safety of pain relievers and also side effects and abuse potential of opioid pain relievers. This has raised the prescriptions for these compounded pain relievers with no real data regarding their superior efficacy or safety. They have appealed to prescribers as well as users due to the perception of their low rates of side effects due to topical use.This study is a randomized controlled trial from the researchers at the Walter Reed National Military Medical Center. The team included 399 patients with either localized pain that was diagnosed to be due to nerve damage or neuropathic (total of 133 patients) or nociceptive pain or pain due to tissue injury (not nerves) (total of 133 patients) or mixed type of pain (133 patients). The groups were further divided into two and one half was given pain cream compounded specifically for their type of pain or a placebo or dummy cream. The drugs used in the compounded creams were FDA approved and routinely used for pain relief. This included agents such as non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants (such as “ketoprofen, baclofen, cyclobenzaprine, and lidocaine”) for nociceptive pain and anticonvulsants and others (“ketamine, gabapentin, clonidine, and lidocaine”) for nerve pain. For the mixed pain treatment group compounds with “ketamine, gabapentin, diclofenac, baclofen, cyclobenzaprine, and lidocaine” were used.Related StoriesResearchers survey orthopedic providers to understand factors that drive opioid prescribing practicesStudy shows potential culprit behind LupusEngineered stem cells offer new treatment for metastatic bone cancerPain sensation was evaluated, a month after prescription of the creams. Results showed that there was no significant difference in improvement in pain symptoms with use of compounded pain creams compared to placebo creams. Around 28 percent participants in the placebo group and 36 percent participants in the pain cream group reported pain alleviation. This difference was not deemed to be significant enough for use of pain creams, write the researchers. Further, the compounded pain creams were most expensive compared to other creams, the authors add. Small benefits seen with these creams, they add, are due to the effects on the peripheral nervous system and not due to effects on the central nervous system.Senior study author Dr. Steven Cohen, a pain researcher at Walter Reed National Military Medical Center in Bethesda, Maryland, and Johns Hopkins Medicine in Baltimore in a statement said, “We know from other studies that some of the agents (lidocaine, non-steroidal anti-inflammatory drugs) may be effective for certain types of acute and chronic pain, so it is surprising that the difference here did not reach statistical significance in any of the pain types…This matters because compounded pain creams are much more expensive than prescribed (lidocaine, diclofenac) or over-the-counter (capsaicin) pain creams, but they didn’t provide meaningful benefit compared to placebo cream.” Authors conclude that these compounded pain relieving creams should not be prescribed routinely for treatment of pain.The study was funded and supported by the Centers for Rehabilitation Sciences Research, Defense Health Agency, U.S. Department of Defense.center_img Source:https://annals.org/aim/article-abstract/2724041/compounded-topical-pain-creams-treat-localized-chronic-pain-randomized-controlledlast_img read more

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Risk factors and noninvasive diagnostic assessment of NOCAD in women

first_img Source:http://cvia-journal.org/ Reviewed by James Ives, M.Psych. (Editor)Mar 1 2019In the current issue of Cardiovascular Innovations and Applications (Special Issue on Women’s Cardiovascular Health, Volume 3, Number 4, 2019, Guest Editor Gladys P. Velarde) pp. 349-361(13); DOI: https://doi.org/10.15212/CVIA.2017.0077 Keith C. Ferdinand, MD and Rohan Samson, MD from the Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA consider nonobstructive coronary artery disease in women: risk factors and noninvasive diagnostic assessment.The authors review differences in coronary anatomy, microcirculation, vascular tone and differences in the atherosclerosis process while stressing the importance of key risk factors in women such as hypertension, obesity and inflammation and its association not only with sex but ethnicity. Sex-specific differences in the epidemiology and pathophysiology of coronary artery disease and ischemic heart disease are now well recognized. Women with angina more often have nonobstructive coronary artery disease ( NOCAD) compared with men. This patient population carries a significant risk of future cardiovascular events that is not commonly appreciated, often leading to delayed diagnosis and treatment. While coronary microvascular dysfunction plays a central role in the athophysiology of NOCAD in women, other mechanisms of myocardial ischemia are now recognized. Risk factors such as hypertension and obesity disparately affect women and are likely to account for a significant proportion of NOCAD in the coming years. Vascular inflammation is an important pathophysiologic pathway in NOCAD and is a potential therapeutic target. Coronary CT angiography provides a comprehensive assessment of coronary anatomy and plaque morphology and is a reasonable screening test of choice for NOCAD.This article forms part of a special issue on Women’s Cardiovascular Health, guest edited by Gladys P. Velarde. Recent decades have witnessed great progress in the treatment of cardiovascular disease (CVD). Due to improved therapies, preventive strategies and increased public awareness, CVD (stroke, heart failure, ischemic heart disease, peripheral arterial disease and congenital heart disease) mortality has been on the decline over this span of time for both genders. Unfortunately, the decline has been less prominent for women, especially women of color. Once viewed as a man’s disease, CVD remains the leading cause of mortality for women in the United States and is responsible for a third of all deaths of women worldwide and half of all deaths of women over 50 years of age in developing countries. In the United States, CVD far outpaces all other causes of death, including all forms of cancer combined. The statistics are sobering with about one female death in the United States every 80 seconds from CVD. That represents close to 400,000 deaths per year according to the more recent statistics. Of these, more than one quarter of a million women will die this year from ischemic heart disease (IHD) which includes obstructive and non-obstructive coronary disease, and about 64% of women who die suddenly of IHD have no prior symptoms. Despite a significant number of females with known CVD and increased awareness among women of heart disease as their major health threat, a substantial proportion of women (46% as per the most recent American Heart Association survey) remain unaware of their cardiovascular risk and continue to fail to recognize its significance.Related StoriesStudy provides new insight into the heritability of coronary artery diseaseImaging beyond routine angiography may be helpful in women with suspected MI and no obstructive CADEU-funded researchers develop new therapeutic strategy for atherosclerosisThis lack of awareness is more profound (over 60% unaware) among women in higher-risk groups, racial and ethnic minorities, and has changed little in decades.Poorly understood sex/gender differences in pathobiologic mechanisms, clinical presentation, management and application of diagnostic and therapeutic and preventive strategies have contributed to this gap. A critically important factor has been the underrepresentation of women in CVD research to date. In fact, only one-third of CVD clinical trials report sex-specific results despite The Food and Drug Administration regulations requiring sex stratification data, as well as the National Institute of Health recommendations of increased inclusion of women in clinical trials. This makes it difficult for researchers and clinicians to draw accurate conclusions about sex differences in mechanisms of disease, accuracy of specific diagnostic modalities and risks or benefits of a particular drug or device for the treatment of women with CVD. Furthermore, physicians and other healthcare providers continue to underestimate women’s cardiovascular risk, in part because of utilization of traditional approaches which can lead to over-testing or inappropriate risk assessment without accurate differentiating who is truly at risk and inadequate use of preventive therapies for women.The goal of this special edition Cardiovascular Innovations and Applications is to shed some light on specific topics that dominate the spectrum of CVD in women.last_img read more

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Marijuana use has dropped among most teens after legalization

first_img Source:https://news.wsu.edu/2019/03/15/teens-report-using-marijuana-less-often-legalization/ Reviewed by Alina Shrourou, B.Sc. (Editor)Mar 18 2019Only one group of teenagers used marijuana more often after retail sales were legalized in Washington than they did before – high school seniors who work 11 or more hours per week, according to new research led by a WSU College of Nursing professor.Marijuana use went down significantly among 8th and 10th graders after legalization, and among 12th graders who didn’t work. It stayed nearly even for high school seniors who work less than 11 hours per week.The research on marijuana use and employment, led by WSU College of Nursing Assistant Professor Janessa Graves, appears in the Journal of Adolescent Health.Washington was one of the first states to approve legalization of marijuana for retail sale, with recreational cannabis stores opening in mid-2014.Related StoriesResearch sheds light on sun-induced DNA damage and repairTAU’s new Translational Medical Research Center acquires MILabs’ VECTor PET/SPECT/CTIn secret, seniors discuss ‘rational suicide’The authors were interested in knowing whether legalization in Washington made a difference in marijuana use among 8th, 10th, and 12th graders who work in jobs that don’t include household chores, yard work or babysitting. They used data from the state’s biennial Healthy Youth Survey from 2010 and 2016 in their study.No matter what grade the students were in, those who worked 11 or more hours per week reported using marijuana more often than their non-working peers.Post-legalization, 4.8 percent of non-working 8th graders reported using pot within the last 30 days, while 20.8 percent of their working peers did. Among 10th graders, 13.9 percent reported using marijuana within the last 30 days in 2016, versus 33.2 percent of 10th graders who worked 11 or more hours per week. The difference for 12th graders was 20.5 percent non-working, versus 36.7 percent working.”Kids who work more often use substances, that’s not a shock,” Graves said, noting other studies have shown the same result. Teenagers who work usually come into contact with adults who aren’t their coaches, teachers and parents, and they are often exposed to adult substance use. In addition, working teens have more disposable income than their non-working peers, the study notes.So what’s a parent of an older teen to do?”Kids learn a lot by working, in terms of responsibility,” Graves said. “But there are also pretty good data showing that kids who work engage in adult-like behaviors earlier. I would say this for any parent of working kids: It’s important to know the quality of management and supervision at your child’s job. Be thoughtful about the quality of a particular workplace.”The study also suggests that employers could take action by advertising and enforcing zero-tolerance policies of adult employees providing substances or endorsing substance use to their adolescent co-workers.last_img read more

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Not drinking water may increase childrens consumption of sugary drinks

first_imgReviewed by Alina Shrourou, B.Sc. (Editor)Apr 22 2019Kids and young adults who drink no water throughout the day may consume twice the amount of calories from sugary drinks than those who drink water, according to Penn State researchers.Asher Rosinger, assistant professor of biobehavioral health and director of the Water, Health, and Nutrition Lab, said the results — published today (Apr. 22) in the Journal of the American Medical Association Pediatrics– underscore the importance of children having free access to clean water.”Kids should consume water every single day, and the first beverage option for kids should be water,” Rosinger said. “Because if they’re not drinking water, they’re probably going to replace it with other beverages, like sugar sweetened beverages, that are less healthy and have more calories.”According to Rosinger, sugar-sweetened beverages includes soda, sweetened fruit juices, sports drinks, energy drinks, and sweetened tea and coffee drinks. They do not include 100 percent fruit juices, drinks sweetened with zero-calorie sweeteners, or drinks that are sweetened by the consumer, like coffee or tea brewed at home.Rosinger added that while other research has shown an overall decline in the consumption of sugar-sweetened beverages, there are still subpopulations of kids in the U.S. who are more likely to consume sugary drinks. He and his collaborators wanted to better understand how many kids drink water on a given day, how many do not, and how their caloric intake from sugar-sweetened beverages differ.The researchers used data from the National Health and Nutrition Examination Survey, a nationally representative data set that includes information on 8,400 children between the ages of two and 19. Data included information about the children’s water and sugar-sweetened beverage consumption, as well as calories from sugary drinks and the percent of total calories coming from sugary drinks.Related StoriesGuidelines to help children develop healthy habits early in lifeResearch reveals genetic cause of deadly digestive disease in childrenRepurposing a heart drug could increase survival rate of children with ependymomaAfter analyzing the data, the researchers found that on a given day, about 20 percent of children reported drinking no water. Additionally, those children consumed almost twice as many calories from sugar-sweetened beverages — about 200 calories total — than children who did drink water.Rosinger said that while an extra 200 calories may not seem like a lot, it can add up quickly if someone is drinking sugar-sweetened beverages on a regular basis.”What you have to remember is that an extra 3,500 calories equals one pound of weight gain,” Rosinger said. “So if you’re not compensating for those extra calories, then over a month, you can potentially gain a pound. Over several months, that could add up.”Additionally, the researchers found that while the United States Department of Agriculture recommends that no more than 10 percent of a person’s daily calories should come from added sugars, the children who did not drink any water on a given day tended to exceed this limit from sugary drinks.Rosinger said that while urging people to drink water is important, there are many reasons why kids may not drink any or enough water during the day.”It’s important to note that in parts of the U.S., some people may not trust their water due to lead or other contamination,” Rosinger said. “Water insecurity is a growing problem in the U.S., so we need to keep that in mind as important context, especially when it comes to parents who may be giving their kids soda or juice because they distrust the water.”In the future, Rosinger wants to explore possible interventions to help boost water intake in children.Hilary Bethancourt, a postdoctoral scholar in the Water, Health, and Nutrition Lab in biobehavioral health, and Lori A. Francis, associate professor of biobehavioral health, collaborated on this research. Source:https://news.psu.edu/story/569568/2019/04/22/research/not-drinking-water-may-boost-kids-consumption-sugary-beverageslast_img read more

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Trumps Labour Secretary Acosta resigns amid Epstein case

first_img Related News World 09 Jul 2019 Trump defends cabinet member Acosta embroiled in Epstein sex-abuse case World 10 Jul 2019 U.S. Labor Secretary Acosta says Epstein crimes ‘horrific’ “Alex called me this morning and wanted to see me,” Trump told reporters. “I just want to let you know this is him, not me.”Acosta’s resignation is effective in seven days. Trump named Deputy Labour Secretary Patrick Pizzella as the acting secretary of Labour.Acosta has served in Trump’s cabinet since April 2017 and from 2005 through 2009 was the U.S. attorney for the Southern District of Florida. It was there that he handled Epstein’s first case involving sex with girls, which resulted in a punishment that critics say was far too lenient.”Mr. Acosta now joins the sprawling parade of President Trump’s chosen advisors who have left the administration under clouds of scandal and corruption, leaving rudderless and discouraged agencies in their wake. Taxpayers deserve better,” Democratic U.S. Senator Sheldon Whitehouse said in a statement.Epstein, a billionaire hedge fund manager, pleaded not guilty to new federal charges in New York this week. Epstein had a social circle that over the years has included Trump, former President Bill Clinton and Britain’s Prince Andrew.Nancy Pelosi, the Democratic speaker of the House of Representatives, and Democratic Senate Majority Leader Chuck Schumer had called on Tuesday for Acosta to resign.DEFENDING HIS CASEAcosta responded to the criticism on Tuesday with tweets saying Epstein’s crimes were “horrific” and that he was glad prosecutors were moving forward based on new evidence and testimony that could “more fully bring him to justice.”On Wednesday Acosta held a news conference to defend his handling of the deal, which allowed Epstein to plead guilty to a state charge and not face federal prosecution. Acosta said Epstein would have had an even lighter sentence if not for the deal.Acosta would not say if he would make the same decision regarding Epstein now, considering the power of the #MeToo movement that led to the downfall of several powerful men publicly accused of sex crimes by women. U.S. prosecutors in New York on Monday accused Epstein, 66, of sex trafficking, luring dozens of girls, some as young as 14, to his luxury homes and coercing them into sex acts.Democratic U.S. Representative Elijah Cummings, chair of the House Oversight and Reform Committee who has called on Acosta to testify on the Epstein matter, said in a statement: “Secretary Acosta’s role in approving the extremely favourable deal for Jeffrey Epstein raises significant concerns about his failure to respect the rights of the victims, many of whom were children when they were assaulted.”The federal prosecutors in New York said they were not bound by the deal arranged by Acosta, which allowed Epstein to plead to a lesser offence and serve 13 months in jail with leave during the day while registering as a sex offender. In February, a federal judge in West Palm Beach, Florida, ruled that the 2007 agreement violated the victims’ rights. Epstein’s case and Acosta’s role in the plea deal had come under scrutiny earlier this year after an investigation by the Miami Herald.The Epstein case came up during Acosta’s Senate confirmation hearing but the Republican-majority Senate approved him in a 60-38 vote. He is the latest top Trump administration official to depart under a cloud. The heads of the Interior, Justice, State and Health departments have also either been fired or resigned, among other top staff during Trump tenure so far.Acosta, the son of Cuban refugees and the first Hispanic member of Trump’s Cabinet, previously served on the National Labour Relations Board and in the U.S. Department of Justice under Republican President George W. Bush. (Reporting by Nandiat Bose; additional reporting by Susan Heavey; Writing by David Alexander and Jeff Mason; Editing by Bill Trott) Related Newscenter_img WASHINGTON (Reuters) – U.S. Labour Secretary Alexander Acosta resigned on Friday amid fresh scrutiny of his handling of the sex abuse case against financier Jeffrey Epstein, becoming President Donald Trump’s latest adviser to leave the administration in controversy.Acosta, joining Trump at the White House before the president left for a trip to Wisconsin, said he did not want to be a distraction to the administration’s work because of his leadership of the Epstein case more than a decade ago.”As I look forward, I do not think it is right and fair for this administration’s Labour Department to have Epstein as a focus rather than the incredible economy we have today,” Acosta said.Trump, who has fired numerous cabinet and other administration officials during his 2 1/2 years in the White House, said it was Acosta’s idea to step down. {{category}} {{time}} {{title}} World 10 Jul 2019 Trump backs U.S. Labor chief Acosta, says will look into matter amid Epstein caselast_img read more

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