Clinical Inquiries, 2012
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Item Do venlafaxine and gabapentin control hot flashes in women with a history of breast cancer?(Family Physicians Inquiries Network, 2012) Sarkissian, Angela; Neher, Jon O.; Singh, Ravipal; St. Anna, LeilaniVenlafaxine reduces hot flashes more than placebo in women with a history of breast cancer; adverse effects include dry mouth and constipation (strength of recommendation [SOR]: B, randomized clinical trials [RCTs] with heterogeneous outcomes). Gabapentin also reduces hot flashes more than placebo (SOR: B, a single RCT); adverse effects include dizziness and somnolence (SOR: C, standard reference). After having tried both medications, women tend to prefer venlafaxine (SOR: C, open-label crossover trial). Treating hot flashes is an off-label use for both drugs.Item Do any topical agents help prevent or reduce stretch marks?(Family Physicians Inquiries Network, 2012) Moore, Jeanne; Kelsberg, Gary; Safranek, SarahNo topical agent has been proven to prevent or reduce stretch marks. Randomized controlled trials (RCTs) show that cocoa butter doesn't prevent stretch marks (strength of recommendation [SOR]: A, 2 RCTs); neither does olive oil (SOR: B, 1 small RCT). A cream containing Centella asiatica extract, vitamin E, and collagen hydrolysates doesn't prevent new stretch marks but might avoid additional stretch marks in women who had already developed them during puberty. Massage with vitamin E ointment alone may reduce the number of stretch marks (SOR: C, 2 small RCTs with methodologic flaws).Item Cardiovascular risks of combined oral contraceptive use(Family Physicians Inquiries Network, 2012) Fehr, Adrienne D.; Mounsey, Anne L.; Yates, Jennifer E.; Flake, DonnaBecause of an increased risk of cardiovascular disease, the use of combined oral contraceptives (OCs) should be considered carefully in women who smoke and in those with hypertension or hyperlipidemia. (Strength of Recommendation: B, based on systematic reviews of case-control and cohort studies.) Combined OC use in patients with hypertension may increase the risk of peripheral arterial disease.Item Which treatments relieve painful muscle spasms from a black widow spider bite?(Family Physicians Inquiries Network, 2012) Prongay, Rob; Kelsberg, Gary; Safranek, SarahOpioids relieve pain and benzodiazepines ease muscle spasms in most patients with latrodectism--widespread, sustained spasms--resulting from envenomation by a black widow spider (strength of recommendation [SOR]: C, case series). Black widow-specific antivenin appears to shorten duration of symptoms and reduce hospitalization more than symptomatic treatment, but can cause allergic reactions, including anaphylaxis and death from acute and delayed serum reactions (SOR: C, case series). A similar antivenin against the redback spider, a close relative of the black widow, produces clinical effects that are equivalent whether they're given intravenously (producing measurable serum levels) or intramuscularly (producing no measurable serum levels) (SOR: B, randomized controlled trial [RCT]), raising the possibility that the antivenin might not be effective at all. Calcium gluconate appears ineffective for symptom relief (SOR: C, case series).Item What medications are best for diabetic neuropathic pain?(Family Physicians Inquiries Network, 2012) Page, Neil; DeLuca, Jesse P.; Crowell, KarenTricyclic antidepressants, duloxetine, pregabalin, oxycodone, and tramadol are all effective for the symptomatic treatment of painful diabetic neuropathy (strength of recommendation [SOR]: A, systematic reviews of randomized controlled trials [RCTs] and single RCTs). Gabapentin is also effective (SOR: B, systematic review of RCTs with methodologic flaws). Studies directly comparing tricyclic antidepressants with gabapentin or duloxetine show equivalent efficacy (SOR: A, systematic reviews of RCTs and single RCTs). The outcome evaluated in all of these studies was pain.