Debbie Rigby rounds up the latest in research news
This article discusses concerns about prescribing of gabapentinoids (gabapentin or pregabalin) in numerous pain syndromes and off-label indications. Relatively few clinical trials have assessed the use of gabapentinoids in the common pain syndromes for which they are prescribed off-label. Gabapentinoids can have nontrivial side effects and are open to misuse, abuse, or diversion.
N Engl J Med 2017; 377:411-414
A case vignette describes the evidence for management of migraine, followed by a review of formal guidelines. Therapies for acute migraine (e.g., triptans, nonsteroidal anti-inflammatory drugs, and antiemetic agents individually or in combination) should be taken as early as possible after the onset of a migraine attack. Preventive therapies (e.g., beta-blockers, candesartan, tricyclic antidepressants, and anticonvulsant agents as well as botulinum toxin for chronic migraine) should be considered on the basis of the frequency and severity of attacks, response to medications for acute migraine, and coexisting conditions.
N Engl J Med 2017; 377:553-561
Heart failure is present in 1–2% of the Australian population. Treatment includes ACE inhibitors, beta blockers, aldosterone antagonists and the new combination of sacubitril and valsartan (a neprilysin inhibitor–angiotensin receptor antagonist). Ongoing education about self-management is key to caring for patients with heart failure. Digoxin and diuretics may also have a role in treating persistent symptoms.
Aust Prescr 2017;40:128-36
Non-adherence to medicines is common in patients with chronic disease and in those prescribed preventive medication. It can be intentional, unintentional, or both. Patients should be asked about adherence at every consultation. A collaborative communication style is effective, using the patient’s own expressions and responding to their cues. Normalising non-adherence, and starting with open questions then following up with more specific probes, can also help.
Aust Prescr 2017;40:147-50