sodium-oxybate and Chronic-Disease

Cluster headache (CH) manifests with periodic attacks of severe unilateral pain and autonomic symptoms. Nocturnal attacks may cause severe sleep disruption. In about 10%of cases, patients present with a chronic form (CCH), which is often medically intractable. Few attempts have been made to improve headache via pharmacologic modulation of sleep.. In an open-label study, 4 patients with CCH and disturbed sleep received increasing dosages of sodium oxybate (SO), a compound known to consolidate sleep and to increase slow-wave sleep. Response to SO was monitored by serial polysomnography, and actimetry, along with pain and sleep diaries.. SO was effective in all 4 patients as shown by an immediate reduction in frequency (up to 90%) and intensity (>50%) of nocturnal pain attacks and improved sleep quality. These effects were long-lasting in 3 patients (mean 19 months, range 12-29 months) and transient (for 8 months) in one patient. Long-lasting improvement of daytime headaches was achieved with a latency of weeks in 2 patients. SO was safe, with mild to moderate adverse effects (dizziness, vomiting, amnesia, weight loss).. SO may represent a new treatment option to reduce nocturnal and diurnal pain attacks and improve sleep quality in CCH. These data also suggest the interest of treating primary headache syndromes by sleep-manipulating substances.. This study provides Class IV evidence that oral SO at night improves sleep and reduces the intensity and frequency of headaches in patients with CCH.

Topics: Adjuvants, Anesthesia; Adult; Chronic Disease; Cluster Headache; Female; Humans; Longitudinal Studies; Male; Middle Aged; Pain Measurement; Polysomnography; Sleep Wake Disorders; Sodium Oxybate; Young Adult

Topics: Adjuvants, Anesthesia; Chronic Disease; Cluster Headache; Humans; Sleep Wake Disorders; Sodium Oxybate

Chronic pain and sleep disorder can put the patient in a vicious circle (bidirectional relation between those two morbid entities). Clinical management must be global. The physiopathology includes chronic sleep deficit, mainly in deep sleep (the "restoring" sleep) generated principally by the prefrontal regions. These areas are also implicated in the modulation of pain. To break this "loops", we advocate an approach based on three main components: hygiene principles, cognitive and behavioral therapy, medications with analgesic and hypnotic proprieties.

Topics: Analgesics; Analgesics, Non-Narcotic; Analgesics, Opioid; Animals; Anticonvulsants; Behavior Therapy; Brain; Chronic Disease; Cognitive Behavioral Therapy; Drug Therapy, Combination; Evidence-Based Medicine; Humans; Hypnotics and Sedatives; Life Style; Melatonin; Pain; Pain Management; Placebos; Sleep Initiation and Maintenance Disorders; Sodium Oxybate; Treatment Outcome

Topics: Adolescent; Adult; Bronchitis; Chronic Disease; Humans; Hypoxia; Middle Aged; Oxygen Consumption; Sodium Oxybate

The investigation of gas exchange, central hemodynamics and real oxygen transport has shown expediency of using ether and fluothane as main anesthetic drugs in operations on the lungs in patients with a compensated form of chronic pulmonary respiratory insufficiency. Neuroleptoanalgesia decreased the operative risk as compared with ether and fluothane. A combined anesthesia with sodium hydroxybutyrate in association with drugs for NLA and tranquilizers is thought to be the method of choice in patients with a pronounced respiratory insufficiency.

Topics: Anesthesia, General; Chronic Disease; Ether; Fentanyl; Halothane; Hemodynamics; Humans; Lung Diseases; Neuroleptanalgesia; Nitrous Oxide; Pulmonary Circulation; Pulmonary Gas Exchange; Respiratory Insufficiency; Sodium Oxybate

Topics: Cerebrovascular Circulation; Chronic Disease; Diazepam; Humans; Hydroxybutyrates; Intracranial Arteriosclerosis; Sodium Oxybate