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Epidural morphine injection followed by a steroid has been reported to be effective for the post-laminectomy pain ('failed back') syndrome. This double-blind, parallel study was undertaken to evaluate that mode of therapy. Twenty-two patients who had undergone at least one prior laminectomy, who were still symptomatic, were randomized to receive 50 mg of lidocaine epidurally with: (a) 75 mg triamcinolone diacetate (TR); or (b) 8 mg of preservative-free morphine (MP); or (c) both (TR and MP), at 1 month intervals for 3 consecutive months. The spinal interspace identified with the patients' pain complaint was the site of injection. For each treatment, patients were admitted to the Clinical Research Center for 24 h and their condition continuously monitored with a pulse oximeter and apnea monitor. Five to 7 patients in each group had pain relief for less than 1 month. No patient given morphine had pain relief for more than 1 month. Life-threatening ventilatory depression occurred in the group given triamcinolone and morphine. The use of morphine alone or combined with slow release triamcinolone does not appear to be appropriate for the treatment of the post-laminectomy pain syndrome.

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Many containers for intravenous solutions are made with plasticized polyvinyl chloride, the common form of which is di-2-ethylhexylphthalate (DEHP). Extraction of DEHP into blood and plasma stored in such plastic containers can occur, and harmful effects of DEHP in the human body consequently have been suggested. Reports on toxicity of DEHP in animals during pregnancy and the developmental period are critically reviewed.

We tested an inexpensive controlled-release nicotinic acid product (Bronson Pharmaceuticals, LaCanada, CA) and compared it with the standard, more expensive, controlled release product, Nicobid (Rorer Pharmaceuticals), by measuring the 24 hour urinary recovery of nicotinic and nicotinuric acids from ten subjects following 500 mg oral ingestion of each product. Nicotinuric acid is the major detoxification product of nicotinic acid and may serve as a simple quantitative index of hepatic biotransformation of nicotinic acid. Although both products demonstrated controlled release profiles, the rate of appearance of nicotinic and nicotinuric acid in the urine as well as the rate of in vitro drug dissolution of the Bronson product were more rapid compared with Nicobid. Moreover, the total amounts of nicotinic acid and nicotinuric acid recovered in the urine after 24 hours were greater for the Bronson product (P less than .05). Since sustained presentation of nicotinic acid to the liver may correlate with clinical antihyperlipidemic effects, our results suggest that the Bronson product may prove to be a clinically useful preparation.

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The goals of this program were to evaluate the effectiveness of migraine disease management techniques in improving patient satisfaction with migraine care, decreasing the frequency and severity of headaches and migraine-associated disability, increasing the effectiveness of migraine treatment and work productivity, improving physician diagnosis and treatment of migraine, and ultimately determining the program's impact on healthcare resource utilization. A prospective observational study was undertaken. This prospective Migraine Management Program (MMP) used active patient and healthcare physician-based disease management resources, tools, and techniques. Members were identified using administrative and medical claims databases indicating an ICD-9 diagnosis code (346.XX) for migraine during the previous twelve months. All identified patients received the Migraine Therapy Assessment Questionnaire (MTAQ) to assess their level of migraine control for pre/post measurement. Of the 2,134 patients responding to the initial MTAQ, 789 completed both a baseline and follow-up and 1,345 completed only a baseline questionnaire. For those patients completing both, there was a statistically significant reduction in all identified management issues: poor symptom control, high attack frequency, knowledge/behavior barriers, economic burden, and dissatisfaction with treatment. Comparing the former group to those completing only the baseline MTAQ, the latter were significantly more likely to report problems with three migraine management issues; poorer symptom control, greater economic burden, and dissatisfaction with their treatment. The use of appropriate patient and physician educational interventions, such as Aetna's MMP incorporating disease management principles and the MTAQ questionnaire, can have a significant impact on patient-centered outcomes and satisfaction with their migraine treatment.