Sleep complaints: Whenever possible, avoid the use of sleeping pills.

(1) Most sleep complaints involve difficulties in getting to sleep or staying asleep, or not feeling refreshed on awakening. Misconceptions and worrying over the lack of sleep and its consequences can contribute to reinforcing these disorders; (2) How can patients who complain of poor-quality sleep be helped, without resorting to treatments that can have adverse effects? To answer this question, we conducted a systematic review of the literature based on the standard Prescrire procedure; (3) One effective approach is to explain the basic physiology of sleep, to discuss misconceptions, and to adopt a strategy of "stimulus control". This method has a similar efficacy to prescribing a benzodiazepine. and the effect is longer lasting; (4) Moderate, regular physical exercise, especially in the morning, seems to help some patients, but the evidence is weak; (5) Some clinical trials of phytotherapy have shown a positive risk-benefit balance of weak aqueous or hydroalcoholic valerian extracts. Efficacy is limited, however; (6) A meta-analysis of placebo-controlled trials showed that benzodiazepines and related drugs increase the duration of sleep and help patients to fall asleep sooner. However, none of these trials provides comparative data spanning periods of more than two weeks. Efficacy is uncertain in the longer term, as patients quickly develop a tolerance to the hypnotic effects of benzodiazepines; (7) The adverse effects of benzodiazepines include frequent memory disorders, daytime drowsiness, falls, fractures and road accidents, and a withdrawal syndrome after treatment cessation. Related drugs such as zolpidem and zopiclone provoke similar adverse effects; (8) Sedative antihistamines have not been as well-evaluated as benzodiazepines in this setting. Small comparative trials of doxylamine and diphenhydramine showed no major difference in efficacy versus benzodiazepines and related drugs. The main adverse effects of sedative antihistamines are daytime drowsiness and altered vigilance, and atropinic effects; (9) Case-control studies showed a statistical link between benzodiazepine use in early pregnancy and birth defects such as cleft lip. In contrast, data on the use of doxylamine during pregnancy are reassuring; (10) Other sedative psychotropics have not been adequately tested in this setting or have been shown to have a negative risk-benefit balance; (11) In practice, patients who complain of poor-quality sleep should be given appropriate information on the mechanisms of normal sleep and related misconceptions, on the best methods for getting to sleep, and on the dangers of sedative psychotropics (dependence, withdrawal syndrome). When prescribing or dispensing a benzodiazepine to a woman of child-bearing age, the risk of birth defects, although not clearly demonstrated, must be mentioned.

[Short-term therapy of painful muscular disorders. Results of a multicenter double-blind test of 2 new suppository preparations with and without codeine]. / Kurzzeittherapie schmerzhafter muskulärer Beschwerden. Ergebnis einer multizentrischen Doppelblind-Prüfung von 2 neuen Zäpfchen-Präparaten mit und ohne Kodein.

A report is given about a multicentric double-blind test for proof of effectiveness of two new suppository preparations with and without codeine against comparable remedies. Dolo Visano Supp. sine codeino showed a slight superiority over the reference preparation. This was proved above all for the influence upon pain and muscular overstrain. The better tolerability was marked. Dolo Visano Supp. (with codeine) showed advantages against the reference preparation. It was used in cases of severe pain, and in 88% it had a very good effect, whereas for the reference preparation this applied only in 67,9%. The assessments of physician and patients were almost alike. The myotonolytic effect has been proved equally for both of the new suppository preparations.

[Treatment of painful muscular disorders of various degrees of severity. Comparison of 2 new suppository preparations]. / Behandlung schmerzhafter muskulärer Beschwerden unterschiedlicher Schwere. Zwei neue Suppositorien-Präparate im Vergleich.

In clinical rheumatology, the hazardousness of mixed preparations containing cortisone is being stressed even more, their use is only recommended in very special cases and only for short periods. Dolo Visano Supp. sine codeino and Dolo Visano Supp. are remedies which are indicated, like other mixed preparations not containing steroids, in cases of painful muscular overstrain and psychomuscular kinesalgia (symptom range of non-articular rheumatism). In our study, they were used in acute and severe pain conditions in intermediate or short-term therapy until complaints improved. Dolo Visano Supp. sine codeino and Dolo Visano Supp. (with codeine) can contribute in limiting the use of the risky preparations containing cortisone, which have hitherto been applied so frequently.

Pharmacotherapy of masticatory system dysfunction.

The decision to use drugs systemically in the management of mandibular dysfunction must be made with consideration of the information summarized in this report. It has been shown that pharmacotherapy may be effective. It has also been demonstrated that systemic pharmacotherapy frequently produces side effects which are occasionally severe. The clinician must decide on the appropriateness of therapy with the knowledge that many other conservative measures may also have excellent success rates and that pharmacotherapy is likely to be palliative rather than curative.

[Psychosomatic disorders of the gastrointestinaltract (author's transl)]. / Psychosomatische Erkrankungen des Gastrointestinaltraktes.

The difficulty of the diagnosis of psychosomatic disorders is known to be lying in the shortage of time, the inadequate training of physicians and in the similarity of psychosomatic symptoms are compared to those of solely organic diseases. The irritable stomach-even with hyperacidity--and the irritable colon with constipation or diarrhea are among the most frequent disorders caused by psychosomatic mechanisms. The duodenal ulcer and the ulcerative colitis belong to the true somatopsychic and psychosomatic diseases. Precise organic (diagnostic) clarification and differentiated drug therapy are necessary in addition to psychotherapeutic measures.

Hereditary persistent distal cramps.

A disease consisting of persistent muscle cramps involving distal muscle groups that occurred in 12 members of the same family is described. The cramps appeared on exertion and in full relaxation or during sleep. In the third generation they appeared in the second decade; in the fourth and fifth generations in childhood with higher frequency and intensity of cramps. The disease is not sex linked and seems to be dominantly inherited. Electromyography showed no myotonic response on insertion. Motor unit potentials were normal. Continual waxing and waning electrical discharges corresponding to clinically visible contractions of parts of the muscles were present. Repetitive nerve stimulation caused no change in the amplitude of evoked muscle potentials. On spinal anaesthesia or nerve block the muscle contractions continued but became painless. The movements were only stopped with local infiltration of anaesthetic into the muscle. There were no cramps on ischaemic work. Drug studies revealed no benefit on carbamazepine, slight relief with meprobamate, and complete disappearance with potassium chloride. The remission outlasted the treatment for three months and then cramps of milder degree reappeared. Repeated potassium chloride treatment was not effective. The cramps increased on hydrochlorothiazide, and 12 hours after spinal anaesthesia. In the authors' opinion the disease should be considered as not belonging to any known nosological entity.