News in brief - April 13, 2009

Combination therapies more effective in helping patients quit smoking

Physicians should consider smoking a chronic disease and use multiple treatments to help patients quit, according to two studies in the April 7 Annals of Internal Medicine.

In one study, a randomized clinical trial, the 750 enrollees were assigned either a nicotine patch or bupropion; or the same pharmacotherapy supplemented with up to two calls from trained counselors; or the pharmacotherapy supplemented with up to six counseling calls. During the two-year trial, patients in the highest intensity group with the greatest number of counseling calls were the most successful.

In the second study, researchers studied 127 smokers with chronic conditions such as cardiovascular disease or chronic obstructive pulmonary disease. They were randomized to receive a nicotine patch for 10 weeks or a combination of patch, a nicotine inhaler and bupropion for as long as required. At about six months, the patients in the combination therapy group had a success quit rate of about 35%. The patch group achieved a 19% success rate.

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Oxycodone relieves shingles pain

An opioid analgesic can alleviate the pain caused by reactivation of the varicella zoster virus, according to a study in the April Pain.

"For some patients, even the light touch of a Q-tip to their skin is excruciating," said Robert Dworkin, PhD, lead author and professor of anesthesiology, neurology, oncology and psychiatry at the University of Rochester Medical Center in New York.

Researchers randomized 87 shingles patients older than 50 to receive the antiviral famciclovir for a week, combined with either 28 days of controlled-release oxycodone, gabapentin or placebo. Both medications had similar safety profiles, although constipation was the most common reason for discontinuing the opioid.

Those on oxycodone experienced less pain than those taking the placebo for the first two weeks of treatment. No differences were noted between these two groups in the latter half of the treatment period. Gabapentin provided some benefit during the first week, but overall did not block pain better than placebo.

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Family history strong indicator of venous thrombosis risk

Having at least one relative with venous thrombosis is an indication of an increased chance of this disorder whether or not the patient carries any of the known genetic markers for it, according to a study in the March 23 Archives of Internal Medicine.

"Family history may be more useful for risk assessment than thrombophilia testing," wrote the authors from Leiden University Medical Center in the Netherlands.

Researchers analyzed blood samples and the family history of 1,605 patients experiencing venous thrombosis for the first time and compared them with 2,159 controls. A family history of this condition doubled the risk, irrespective of genetic makeup. The chances of this clotting problem grew fourfold if more than one relative was affected.

The risk also increased as the number of risk factors accumulated. Patients carrying a gene associated with venous thrombosis who had a family history of this disease, and had an environmental risk factor such as taking oral contraceptives or a period of extended bed rest, were 64 times more likely to experience this problem.

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