In episode 185, Mike does a stellar job of reviewing the painfully complex literature around the treatment of neuropathic pain – diabetic neuropathy, post-herpetic neuralgia, trigeminal neuralgia. James as usual just adds to the painful nature of the whole process. In this particular episode we discuss the use of antidepressants and at the end we realize we shouldn’t call these agents antidepressants and decide to call them Kevin.

Show notes

1) Antidepressants for neuropathic pain

Cochrane CD005454

2) Duloxetine for neuropathic pain

Cochrane CD007115

In episode 184, James and Mike don their PREMIUM critical appraisal hats yet again to report the results of important recent studies that examine the impact two “new” drugs, aliskiren and dalcetrapib, have on clinically important outcomes. Unfortunately, these well-designed studies show yet again there is no guarantee that if you change cholesterol or blood pressure that clinically important outcomes will decrease.

Show notes

1) Aliskiren

N Engl J Med 2012.
DOI: 10.1056/NEJMoa1208799 

2) Dalcetrapib

N Engl J Med 2012.
DOI: 10.1056/NEJMoa1206797

In episode 183, the Mikes and James shine a bright light on the evidence around the use of proton pump inhibitors. We look at the good and bad outcomes and realize it is all about the numbers and the quality of the evidence. After 45 minutes the bright light and our knowledge starts to dim until we get to the end of the podcast when we shut the light off completely.

Show notes

1) Benefit of PPIs versus H2RA and placebo

Acute 

Cochrane Library CD003244

Chronic http://www.cks.nhs.uk/dyspepsia_proven_gord/evidence/supporting_evidence/no_response_to_initial_therapy/extending_treatment_duration#-330424

2) Prevention of NSAID –induced endoscopic ulcers

Cochrane Library CD002296

3) Stress ulcers

Crit Care Med 2010;38:1-7

4) Rebound

Gastroenterology 2009;137:80-7

5) Withdrawal

Gastroenterology 2001;121:1095–1100

Aliment Pharmacol Ther 2007;25:709–714

6) On demand use

Am J Gastroenterol 2007;102:642–653

7) Esomeprazole

Clin Gastro Hepat 2006;4:1452–8

8) Interactions

BMJ 2012;345:e4388 doi: 10.1136/bmj.e4388

9) Fractures

Drugs 2012;72:437-45

10) Pneumonia

Cleveland Clinic J Med 2011;78:39-49

11) C. difficile

Dig Dis Sci 2011;56:931–50

12) Iron and B12, and cancer

Dig Dis Sci 2011;56:931–50

In episode 182, the Mikes and James talk about the evidence behind the zoster vaccine. We give all the numbers you could possibly want to discuss this with your patients so that they can help you make up your mind what is best for them. As always, the greater the risk the greater the potential benefit. At the end of the podcast the Mikes wrap James in barbwire in an attempt to demonstrate to the listening audience the concept of post-herpetic neuralgia.

Show notes

1. Zoster vaccine evidence

N Engl J Med 2005;352:2271-84

Clinical Infectious Diseases 2012 (in press)

Clinical Infectious Diseases 2012;54:922–8

Ann Intern Med 2010;152:545-54

2. Zoster incidence etc

Can J Infect Dis Med Microbiol 2010;21:45-52 

CMAJ 2010. DOI:10.1503/cmaj.091711

BMJ 2000;321:1–4

Journal of Infectious Diseases 2012;206:190–6

Mayo Clin Proc 2011;86:88-93

National Advisory Committee on Immunization (NACI) 2010; 36: 1-19. Accessed October 15, 2012. http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/10vol36/acs-1/index-eng.php

MMWR 2008; 57(5):1-30. Accessed October 15, 2012. http://www.cdc.gov/MMWR/preview/mmwrhtml/rr5705a1.htm