Effect of oral clonidine on pain reduction in patients with opioid use disorder in the emergency department: A randomized clinical trial.

AIMS: Pain can create physical and psychosocial discomfort. Pain management of patients with opioid misuse history can be challenging, in part due to their tolerance to opioids. Clonidine is an alpha-2 agonist that has been used for the reduction of anxiety and pain. The aim of this study was to investigate the effect of oral clonidine on pain outcomes in patients with a history of opioid use disorder presenting with orthopaedic fractures in the emergency room. METHODS: In this blinded clinical trial in the emergency department, 70 opioid-dependent patients with orthopaedic fractures were divided into a control group of 35 and an intervention group of 35 subjects. Initially, 0.2 mg of oral clonidine was given to the intervention group and the control group received placebo tablets. Pain levels were recorded based on the Numerical Rating Scale rating before intervention, at 30 min, 1 h after intervention and at disposition from the emergency room (3-6 h after intervention). The total morphine requirement was also recorded. RESULTS: The pain score of the clonidine group was significantly lower than that of the control group at 1 h and at disposition time. The amount of morphine required was significantly reduced in the clonidine group (P < 0.05). Oral clonidine had no significant effect on pulse rate. Oral clonidine was more effective for pain reduction in lower limb injuries. CONCLUSION: Oral clonidine significantly reduced pain and the need for morphine in opioid-dependent patients with orthopaedic fractures.

Nanocurcumin as an Add-on to Antipsychotic Drugs for Treatment of Negative Symptoms in Patients With Chronic Schizophrenia: A Randomized, Double-Blind, Placebo-Controlled Study.

PURPOSE/BACKGROUND: It is well documented that one of the pathophysiological mechanisms of negative symptoms in patients with schizophrenia is hypofunction of N-methyl-d-aspartate receptors. This double-blind, placebo-controlled clinical trial was designed to assess the efficacy and safety of nanocurcumin as an adjuvant agent on psychotic symptoms, especially negative symptoms, in patients with chronic schizophrenia. METHODS/PROCEDURES: Fifty-six inpatients with stable chronic schizophrenia and predominant negative symptoms were randomized in a 1:1 ratio to nanocurcumin soft gel capsule (160 mg/d) and control groups, along with their antipsychotic regimen for 16 weeks. The efficacy of treatment was assessed by Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, Clinical Global Impressions-Severity, and Clinical Global Impressions-Improvement scales. Extrapyramidal symptoms were evaluated by Simpson-Angus Scale and Barnes Akathisia Rating Scale. Patients were assessed at baseline and weeks 4, 8, 12, and 16 after the medication started. FINDINGS/RESULTS: No significant differences were observed in demographic or clinical variables between both groups at baseline. The nanocurcumin group showed significantly greater improvement on the negative subscale (P = 0.05), the general psychopathology subscale (P < 0.001), the positive subscale (P = 0.004), total Positive and Negative Syndrome Scale (P < 0.001), Clinical Global Impressions-Severity (P < 0.001), and Clinical Global Impressions-Improvement scores (P < 0.001) in comparison with the control group at the endpoint. Extrapyramidal symptom rating scales and Calgary Depression Scale for Schizophrenia and frequency of other adverse effects were comparable between 2 groups. IMPLICATIONS/CONCLUSIONS: The present study indicates nanocurcumin as a safe and potential adjunctive treatment strategy for treatment of primary negative symptoms of schizophrenia.

Self-monitoring of blood pressure for improving adherence to antihypertensive medicines and blood pressure control: a randomized controlled trial.

BACKGROUND: Self-monitoring is reported to have limited efficacy for hypertension management in high-income countries. In this study, we aimed to evaluate the effect of self-monitoring on blood pressure (BP) control in an Iranian population. METHODS: A randomized controlled trial was conducted on 196 mild to moderate hypertensive patients in an outpatient cardiovascular clinic. Patients in the intervention group received a wrist self-monitoring device and were educated to measure and document their BP daily during the study period (24 weeks). Patients in the control group received usual care. Three follow-up visits with the physician were scheduled for all patients (weeks 4, 12, and 24), and the investigator assessed adherence to medications after each visit (pill counting). The primary outcome (BP) was compared between groups using repeated-measure analysis of variance. RESULTS: One hundred ninety patients completed the study. Systolic BP (144.4±7.4 vs 145.9±6.4mm Hg) and diastolic BP (85.5±6.9 vs. 85.1±7.7mm Hg) were similar between groups at baseline. The trend of BP was not significantly different between groups during the study period. Systolic and diastolic BP decreased significantly in both groups at the first follow-up visit (systolic BP: 132.6 vs. 133.4mm Hg; diastolic BP: 77.4 vs. 77.2mm Hg). In the intervention group, we observed a small continued decrease in diastolic BP up to week 24 BP (P = 0.01). Both groups showed adherence rates >95% during the study period. CONCLUSIONS: Our study could not confirm that self-monitoring can improve BP control in patients with frequent medical visits.