Browsing by Author "Moulin, Dwight E"

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    2012 Canadian Guidelines for the Diagnosis and Management of Fibromyalgia Syndrome: Executive Summary
    (2013-01-01) Fitzcharles, Mary-Ann; Ste-Marie, Peter A; Goldenberg, Don L; Pereira, John X; Abbey, Susan; Choinière, Manon; Ko, Gordon; Moulin, Dwight E; Panopalis, Pantelis; Proulx, Johanne; Shir, Yoram; the National Fibromyalgia Guideline Advisory Panel,
    BACKGROUND: Recent neurophysiological evidence attests to the validity of fibromyalgia (FM), a chronic pain condition that affects >2% of the population.OBJECTIVES: To present the evidence-based guidelines for the diagnosis, management and patient trajectory of individuals with FM.METHODS: A needs assessment following consultation with diverse health care professionals identified questions pertinent to various aspects of FM. A literature search identified the evidence available to address these questions; evidence was graded according to the standards of the Oxford Centre for Evidence-Based Medicine. Drafted recommendations were appraised by an advisory panel to reflect meaningful clinical practice.RESULTS: The present recommendations incorporate the new clinical concepts of FM as a clinical construct without any defining physical abnormality or biological marker, characterized by fluctuating, diffuse body pain and the frequent symptoms of sleep disturbance, fatigue, mood and cognitive changes. In the absence of a defining cause or cure, treatment objectives should be patient-tailored and symptom-based, aimed at reducing global complaints and enhancing function. Healthy lifestyle practices with active patient participation in health care forms the cornerstone of care. Multimodal management may include nonpharmacological and pharmacological strategies, although it must be acknowledged that pharmacological treatments provide only modest benefit. Maintenance of function and retention in the workforce is encouraged.CONCLUSIONS: The new Canadian guidelines for the treatment of FM should provide health professionals with confidence in the complete care of these patients and improve clinical outcomes.
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    Buprenorphine Transdermal System for Opioid Therapy in Patients with Chronic Low Back Pain
    (2010-01-01) Gordon, Allan; Rashiq, Saifudin; Moulin, Dwight E; Clark, Alexander J; Beaulieu, André D; Eisenhoffer, John; Piraino, Paula S; Quigley, Patricia; Harsanyi, Zoltan; Darke, Andrew C
    OBJECTIVE: The present randomized, double-blinded, crossover study compared the efficacy and safety of a seven-day buprenorphine transdermal system (BTDS) and placebo in patients with low back pain of moderate or greater severity for at least six weeks.METHODS: Prestudy analgesics were discontinued the evening before random assignment to 5 μg/h BTDS or placebo, with acetaminophen 300 mg/codeine 30 mg, one to two tablets every 4 h to 6 h as needed, for rescue analgesia. The dose was titrated to effect weekly, if tolerated, to 10 μg/h and 20 μg/h BTDS. Each treatment phase was four weeks.RESULTS: Fifty-three patients (28 men, 25 women, mean [± SD] age 54.5±12.7 years) were evaluable for efficacy (completed two weeks or more in each phase). Baseline pain was 62.1±15.5 mm (100 mm visual analogue scale) and 2.5±0.6 (five-point ordinal scale). BTDS resulted in lower mean daily pain scores than in the placebo group (37.6±20.7 mm versus 43.6±21.2 mm on a visual analogue scale, P=0.0487; and 1.7±0.6 versus 2.0±0.7 on the ordinal scale, P=0.0358). Most patients titrated to the highest dose of BTDS (59% 20 μg/h, 31% 10 μg/h and 10% 5 μg/h). There were improvements from baseline in pain and disability (Pain Disability Index), Pain and Sleep (visual analogue scale), Quebec Back Pain Disability Scale and Short-Form 36 Health Survey scores for both BTDS and placebo groups, without significant differences between treatments. While there were more opioid-related side effects with BTDS treatment than with placebo, there were no serious adverse events. A total of 82% of patients chose to continue BTDS in a long-term open-label evaluation, in whom improvements in pain intensity, functionality and quality of life were sustained for up to six months without analgesic tolerance.CONCLUSION: BTDS (5 μg/h to 20 μg/h) represents a new treatment option for initial opioid therapy in patients with chronic low back pain.