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In episode 188, James and Mike go all PREMIUM for the holidays and discuss a few studies that have the potential to change practice. These include info on the impact or lack thereof of fasting on cholesterol measurements, the impact of A1c on functional decline and a head-to-head comparison of metformin and glipizide.

1) Variability in cholesterol measurement

JAMA 1992;267:1652-60

2) Effect of fasting on cholesterol measurements

Arch Intern Med 2012;172:1707-10

3) Impact of glycosylated hemoglobin on functional decline

J Am Geriatr Soc 2012;60:1215–21

4) SPREAD-DIMCAD

Diabetes Care 2012 Dec 10 (Epub ahead of print)

In episode 187, Mike and James – actually it was mainly Mike – finally get to the painful end of the neuropathic pain trilogy. We discuss all the second and third line options and conclude that there are a lot of options but none work really well and side effects are often limiting. At the end we recommend that clinicians get patients with neuropathic pain to listen to the TEC podcast as this gives the equivalent effect to that seen with high dose narcotics.

Show notes

1) Carbamazepine

Cochrane CD005451

2) Valproate

Cochrane CD009183

3) Opiods

Cochrane CD006146

4) Capsaicin

Cochrane CD007393

Cochrane CD010111

Clin J Pain 2012;28:101–7

Neurology 2008;70;2305-13

5) Topical lidocaine

Cochrane CD004846

6) Lacosamide

Cochrane CD009318

7) Lamotrigine

Cochrane CD006044

8) Cannabis

Pain Medicine 2009;10:1353-68

CADTH: 13 July 2010, Cannabinoids for the Management of Neuropathic Pain

9) Therapeutic touch

Cochrane CD006535

10) Systemic local anesthetics

Cochrane CD003345

11) TENS machines

Cochrane CD003222

12) Psychology (mainly CBT)

Cochrane CD007407

13) Antipsychotics

Cochrane CD004844

14) Vitamin B

Cochrane CD004573

15) Other

Cochrane CD003904

Cochrane CD007796

16) Drug combinations

Cochrane CD008943

In episode 186, Mike and James continue on the path of the treatment of neuropathic pain and we explore the whole murky world of gabapentin and pregabalin. We come to the conclusion that while these drugs produce an effect and also produce side effects it’s all about the overall magnitude of that effect. Go figure.

Show notes

1) Gabapentin

Cochrane review

CD007938

N Engl J Med 2009;361:1963-71 

Therapeutics Letter #75 – 2009 

2) Pregabalin

Cochrane review

CD007076

CDR Sept 23, 2009, pregabalin review