Chronic pain: can treatment over the Internet help?

Key message: The Internet offers a means of delivering therapies to people in their homes to help them manage chronic pain and a new Cochrane review has explored the evidence on how well these work. Current evidence suggests that psychological treatments delivered in this way may help adults with non-headache pain, reducing pain, disability, depression and anxiety, but more research is needed before we can be confident about these results.

What’s the evidence on tackling fatigue in rheumatoid arthritis?

Key message: There is some evidence that physical activity and talking treatments can help people with rheumatoid arthritis manage fatigue. We don’t have enough evidence to say which elements of these types of interventions are most effective, nor whether other non-drug approaches are also helpful.

Rheumatoid arthritis (RA) is an autoimmune disease that causes inflammation of the joints. It’s the second most common type of arthritis in the UK population. Key symptoms are painful, swollen joints, but fatigue (extreme mental and/or physical tiredness) is also a problem for many people who have RA. There’s currently no cure for RA and no accepted evidence-based guidelines on how best to manage this condition. Non-pharmacological interventions, that’s alternatives to prescribed drugs such as exercise and psychotherapies or ‘talking treatments’, have been found to help people with a range of long-term conditions manage fatigue and now a new review from the Cochrane Musculoskeletal Group has looked at whether this is so for adults with RA.

Children living with pain may be helped by psychological therapies

Key message: Psychological therapies can be helpful in reducing pain in childen and adolescents with chronic and recurrent pain. 

Living with chronic pain is a miserable business. It can be a major cause of disability and distress and affects not only the person themselves but those close to them. Any parent will tell you how upsetting it is to see their child in pain and I was surprised to learn how many children live with it, around 15% to 30%, with around 8% having severe and frequent pain. So what can be done to help them?

Cognitive behavioural therapy can help people manage chronic pain

Key message: Cognitive behavioural therapy (CBT), when delivered by experienced staff, can be helpful in the management of chronic pain, though it is not known which components of CBT work best for different types of patients and for which outcomes

Talking treatments for problem drinking and gambling: two new Cochrane reviews

Chief Medical Officer, Professor Dame Sally Davies’ first annual report on the state of the nation’s health, published today, has highlighted the rising rates of liver disease, with deaths from chronic liver disease and cirrhosis in the under 65s having increased by around 20% between 2000 and 2009, yet falling by around the same amount in other European countries. The three major causes of liver disease – harmful drinking, obesity and undiagnosed infection – are preventable. With around 70% of us having two or more habits or medical risk factors that are linked with serious diseases, the report recommends that health professionals should focus on tackling these together. This was also recommended in a recent report from The King’s Fund, which looked at clustering of unhealthy behaviours and called for a shift in focus in public health initiatives, to tackling multiple unhealthy behaviours rather than single ones.

The benefits of exercise during and after cancer treatment: new Cochrane evidence

Key message:Aerobic exercise may help reduce cancer-related fatigue during and after treatment for solid tumours.

“Exercise is good for you” is a familiar mantra and now there is evidence that aerobic exercise, such as walking or cycling, may help relieve the tiredness experienced by people having treatment for cancer, particularly solid tumours. A Cochrane review published in 2008 has now been updated, with 28 additional randomized controlled trials (RCTs) bringing the total to 56 RCTs with over 4000 people. Half the trials involved people with breast cancer. Exercise interventions varied between studies.

Cochrane evidence on managing depression, schizophrenia and autism spectrum disorders

Two more mental health reviews published in Issue 10 in The Cochrane Library are the subject of excellent blogs from The Mental Elf. These new reviews, from the Cochrane Depression, Anxiety and Neurosis Group and the Cochrane Schizophrenia Group, look at the evidence on duloxetine compared with other drugs for depression, and on information and communication technology in patient education and support for people with schizophrenia. A third blog neatly summarises a new review from the Cochrane Developmental, Psychosocial and Learning Problems Group on the effectiveness of Early Intensive Behavioural Intervention for children with autism spectrum disorders, an approach which is widely used with the aim of improving functional behaviours and skills in these children. They’re well worth reading and you can find them from the links below.

Smoking: helping people stop and stopping them from starting

Smoking, with its enormous implications for health, is a high profile health topic, and the spotlight is firmly on it this month as the Department of Health’s ‘Stoptober’ smoking cessation campaign continues. Sir Richard Peto, giving the Harveian Oration, Halving premature death, at the Royal College of Physicians on Thursday, named smoking as one of the “four corpsemen of the Apocalypse”, along with alcohol, obesity and HIV.