Since the last version of this review, we identified another study that added another form of medical therapy, BoNTs, specifically BoNT/A, to the list of pharmacologic interventions being reviewed for clinical efficacy in phantom limb pain. However, the results of this study did not substantially change the main conclusions. The short- and long-term effectiveness of BoNT/A, opioids, NMDA receptor antagonists, anticonvulsants, antidepressants, calcitonins, and local anaesthetics for clinically relevant outcomes including pain, function, mood, sleep, quality of life, treatment satisfaction, and adverse events remain unclear. Based on a small study, BoNT/A (versus lidocaine/methylprednisolone) does not decrease phantom limb pain. Morphine, gabapentin, and ketamine demonstrate favourable short-term analgesic efficacy compared with placebo. Memantine and amitriptyline may not be effective for PLP. However, results must be interpreted with caution, as they were based mostly on a small number of studies with limited sample sizes that varied considerably and also lacked long-term efficacy and safety outcomes. The direction of efficacy of calcitonin, local anaesthetics, and dextromethorphan needs further clarification. Overall, the efficacy evidence for the reviewed medications is thus far inconclusive. Larger and more rigorous randomised controlled trials are needed for us to reach more definitive conclusions about which medications would be useful for clinical practice.
The short- and long-term effectiveness of opioids, NMDA receptor antagonists, anticonvulsants, antidepressants, calcitonins, and anaesthetics for clinically relevant outcomes that include pain, function, mood, sleep, quality of life, satisfaction and adverse effects remains unclear. Morphine, gabapentin and ketamine demonstrate trends towards short-term analgesic efficacy. Memantine and amitriptyline were ineffective for PLP. Results, however, are to be interpreted with caution as these were based mostly on a small number of studies with limited sample sizes that varied considerably and also lacked long-term efficacy and safety outcomes. The direction of efficacy of calcitonin, anaesthetics and dextromethorphan need further clarification. Larger and more rigorous randomised controlled trials are needed to make stronger recommendations about which medications would be useful for clinical practice.
B ackground and purpose: Adherence to medication is fundamental to optimal health recovery yet compliance to medication rates are lower than 50% in most studies. This study aimed to investigate the correlates of adherence in stroke patients. Method: Twenty-six stroke patients and 29 amputee patients who had completed a rehabilitation program at Melbourne Rehabilitation Centre were investigated. Medical adherence was determined from computed adherence metrics based on pill counts and subjective reports of patient knowledge of medication use. Model components that were believed to contribute to poor adherence, included emotional and cognitive dysfunction, beliefs about medication, and social support. These factors were assessed by patient and partner self-rating questionnaires. Results: Stroke patients showed a lower level of adherence compared to amputee patients. Cognitive and emotional dysfunction, beliefs about medication, and the level of care were significantly associated with low adherence to medicine regimes in stroke patients. Level of cognitive impairment and emotional impairment were significantly associated with low adherence to medicines in amputee patients. Emotional dysfunction was the best predictor of poor adherence in both patient groups. Conclusion: The findings are in keeping with past adherence studies with other patient groups and support the position that emotional, cognitive, and social factors are important factors in adherence. The specific nonadherence profile for this brain-damaged group is modeled and the application for outpatients following rehabilitation is discussed.
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