VTE, fibromyalgia and breast pain

No time to read the journals? Let Dr Bryan Palmer guide you through the latest research.

Pulmonary embolism

Research of the week

Pedometers in fashion - JAMA 2007; 298: 2,296-304

Pedometers have become trendy and accessible to the masses; they are even giving them away with breakfast cereal. But are they really useful or just a fad?

This study included data for 2,700-plus patients from 26 studies: eight randomised controlled trials and 18 observational studies.

The good news was that those using pedometers increased their activity by about 25 per cent, although mainly in the presence of a step goal. This led to significant weight loss and BP reductions. The only unanswered question was whether this is sustainable over the long term, because the average duration of follow-up was 18 months. 

Venous thromboembolic event and stroke - Lancet 2007; 370:1,773-9

This paper from Denmark made its way into the Lancet. The question being asked was: does having a venous thromboembolic event predispose you to an acute arterial event?

Researchers assessed the risk of MI and stroke in 25,199 patients with DVT, 16,925 patients with pulmonary embolism and 163,566 population controls.

The risk increased after the first year and continued to rise during the following 20 years, giving those who had had a DVT or pulmonary embolism a 20-40 per cent increased risk of MI and stroke.

Perhaps a review topic for your next registrar's audit?

Phantom limb pain trials - N Engl J Med 2007; 357: 2,206-7

Phantom limb pain occurs in at least 90 per cent of limb amputees. Mirror therapy has been used with some success in patients who have had a hand or arm amputated.

The critical component of mirror therapy may be the induction of limb imagery, so the authors conducted a randomised, sham-controlled trial of mirror therapy versus imagery therapy involving patients with phantom limb pain after the amputation of a leg or foot.

Twenty-two patients were randomly assigned to a mirror group that saw the reflected normal limb, a group that saw a covered mirror or a group trained in mental visualisation. Four weeks into the study the two latter groups were switched to mirror therapy. There was 100 per cent success at four weeks in pain reduction in the mirror group and almost 100 per cent in those who had switched at four weeks.

In comparison, in the covered-mirror group before the switch in therapy, only 17 per cent of patients reported a decrease in pain, and in the mental visualisation group, just 33 per cent.

Simple ways to help fibromyalgia patients - Arch Intern Med 2007; 167: 2,192-200

Fibromyalgia is poorly understood with few treatment options. This research from the US set out to assess four self-treatments. They enrolled 207 women with confirmed fibromyalgia and randomly assigned them to 16 weeks of: aerobic and flexibility exercise; strength training, with aerobic and flexibility exercise; the Fibromyalgia Self-Help Course (FSHC); or a combination of strength training and FSHC.

The result was change in physical function from baseline to completion of the intervention. Other outcomes included social and emotional function, symptoms and self-efficacy.

The fourth group came out the best on the scoring system. The conclusion was that the benefits of exercise are enhanced when combined with targeted self-management education.

Breast pain and exercise - Br J Sports Med 2007;41: 879-83

This research comes from my neck of the woods and must have received ethical approval at some stage. The aim of the study was to establish whether exercise-induced vertical breast displacement and discomfort in women with large breasts were reduced during running in deep water compared with treadmill running.

Researchers managed to find 16 volunteers of C cup or larger. They studied the vertical breast motion as they ran at a self-selected stride rate on a treadmill and in 2.4m deep water.

The results suggested it was more comfortable running in deep water compared with the treadmill, although more strenuous.

I think they would have come to the same conclusion watching a few episodes of Baywatch.

Dr Palmer is a former Hampshire GP currently working in Australia, and a member of our team who reviews the journals

The quick study

DVT and pulmonary embolism predispose patients to MI and stroke.

Phantom limb pain is reduced by mirror therapy.

Fibromyalgia patients' physical, emotional and social function could be improved by an exercise and stretching programme combined with self-management education.

Breast pain during exercise in women with large breasts is reduced by running in deep water.

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