Combining Cognitive-Behavioral Therapy and Milnacipran for Fibromyalgia: A Feasibility Randomized-Controlled Trial.

Combining Cognitive-Behavioral Therapy and Milnacipran for Fibromyalgia: A Feasibility Randomized-controlled Trial.

Clin J Pain. 2013 Feb 26;
Ang DC, Jensen MP, Steiner JL, Hilligoss J, Gracely RH, Saha C

OBJECTIVES:: To evaluate the feasibility of a randomized-controlled trial and to obtain estimates of the effects of combined cognitive-behavioral therapy (CBT) and milnacipran for the treatment of fibromyalgia. METHODS:: Fifty-eight patients with fibromyalgia were randomized to 1 of the 3 treatment arms: (1) combination therapy (n=20); (2) milnacipran+education (n=19); and (3) placebo+CBT (n=19). Patients received either milnacipran (100 mg/d) or placebo. Patients also received 8 sessions of phone-delivered CBT or educational instructions, but only from baseline to week 9. Assessments were conducted at baseline, week 9, and 21. The primary endpoints were baseline to week 21 changes in weekly average pain intensity and physical function (SF-36 physical function scale). RESULTS:: Compared with milnacipran, combination therapy demonstrated a moderate effect on improving SF-36 physical function [SE=9.42 (5.48), P=0.09, effect size=0.60] and in reducing weekly average pain intensity [mean difference (SE)=-1.18 (0.62), P=0.07, effect size=0.67]. Compared with milnacipran, CBT had a moderate to large effect in improving SF-36 physical function [mean difference (SE)=11.0 (5.66), P=0.06, effect size=0.70]. Despite the presence of concomitant centrally acting therapies, dropout rate was lower than anticipated (15% at week 21). Importantly, at least 6 out of the 8 phone-based therapy sessions were successfully completed by 89% of the patients; and adherence to the treatment protocols was >95%. CONCLUSIONS:: In this pilot study, a therapeutic approach that combines phone-based CBT and milnacipran was feasible and acceptable. Moreover, the preliminary data supports conducting a fully powered randomized-controlled trial.Clinical Trial Registration: NCT01038323. HubMed – rehab

Changes in bone density and geometry of the radius in chronic stroke and related factors: A one-year prospective study.

J Musculoskelet Neuronal Interact. 2013 Mar; 13(1): 77-88
Pang MY, Zhang M, Li LS, Jones AY

Objectives: To describe the changes in bone density and geometry of the radius after chronic stroke and the associated clinical factors. Methods: Twenty stroke patients (12 men and 8 women, age=42-78 years, time post-stroke=12-166 months) and 23 control participants (14 men and 9 women, age=53-77 years) were assessed at the time of enrolment and one year later. Peripheral quantitative computed tomography was used to scan the radius epiphysis (4% site) and diaphysis (33% site). Grip strength, spasticity, paretic arm disuse, physical activity, and vascular health were also evaluated. Results: During the follow-up period, only the cortical thickness and cortical bone mineral content (BMC) in the paretic radius diaphysis showed a decline that exceeded the least significant change value (p=0.002). Paretic arm disuse, lower vascular elasticity and physical activity level at initial assessment were significantly related to more decline in cortical thickness at this site (p<0.01). Conclusions: The paretic radius diaphysis sustained significant reduction in cortical thickness and cortical BMC over time in chronic stroke, but these changes were less pronounced than those previously reported in sub-acute stroke. Strategies to modify vascular health, disuse, and physical activity may be important in improving upper limb bone health but will need further investigations. HubMed – rehab

Can local muscles augment stability in the hip? A narrative literature review.

J Musculoskelet Neuronal Interact. 2013 Mar; 13(1): 1-12
Retchford TH, Crossley KM, Grimaldi A, Kemp JL, Cowan SM

Hip pain and dysfunction are increasingly recognised as important causes of morbidity in younger and older adults. Pathology compromising the passive stability of the hip joint, including acetabular labral injury, may lead to increased femoral head translation, greater joint contact pressures and ultimately degenerative hip disease. Activation of hip muscles may play an important role in augmenting the stability in the normal and the passively unstable hip. Research at other joints suggests that the local, rather than global, muscles are well suited to provide subtle joint compression, limiting translation, with minimal metabolic cost. Based on the known characteristics of local muscles and the limited research available on hip muscles, it is proposed that the local hip muscles; quadratus femoris, gluteus minimus, gemelli, obturator internus and externus, iliocapsularis and the deep fibres of iliopsoas, may be primary stabilisers of the hip joint. Interventions aimed at restoring isolated neuromuscular function of the primary hip stabilisers may be considered when treating people with passive hip instability prior to commencing global muscle rehabilitation. Finally, further research is needed to investigate the potential association between function of the hip muscles (including muscles likely to have a role in stabilising the hip) and hip pathology affecting hip stability such as acetabular labral lesions. HubMed – rehab