[Retrospective analysis of the combined therapy of terazosin with chlormezanone for chronic prostatitis/chronic pelvic pain syndrome].

OBJECTIVE: To investigate the efficacy and safety of the alpha1-receptor inhibitor terazosin combined with chlormezanone in the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). METHODS: A total of 168 CPPS patients, aged 20 -50 (mean 32.9) years and with the disease course of 3 months to 7 years (mean 17 months), were equally randomized into a terazosin group (n = 58), a chlormezanone group (n = 38) and a terazosin + chlormezanone (T + C) group (n = 72), and treated accordingly for 4 weeks. All the patients were scored on NIH-CPSI (National Institute of Health-Chronic Prostatitis Symptom Index) after the treatment and the therapeutic effects were compared among the three groups. RESULTS: Of the total number of patients, 159 completed the treatment and were evaluated, including 55 of the terazosin group, 35 of the chlormezanone group and 69 of the T + C group. After the treatment, the NIH-CPSI scores of the three groups decreased from 24.05 +/- 3.02 to 16.15 +/- 3.25 (mean 7.90), from 23.43 +/- 3.58 to 17.51 +/- 3.08 (mean 5.92), and from 23.93 +/- 3.30 to 15.01 +/- 3.08 (mean 8.92), respectively, with statistically significant differences from pretreatment (P < 0.05) as well as between the combined therapy group and the other two (P < 0.05). The adverse events included postural hypotension (17.1% in the terazosin group and 15.4% in the T + C group), dysspermatism (3.4% in the terazosin group only), lassitude, fatigue and anorexia (18.5% in the chlormezanone group and 12.6% in the T + C group). Nine of the patients failed to accomplish the treatment because of adverse events, 3 (5.2%) in the terazosin group, 3 (7.9%) in the chlormezanone group and 3 (12.6%) in the T + C group. CONCLUSION: Both terazosin and chlormezanone can relieve the symptoms in CP/CPPS patients and improve their life quality, but their combined use may produce a better efficacy than either terazosin or chlormezanone used alone.

Adjuvant laser acupuncture in the treatment of whiplash injuries: a prospective, randomized placebo-controlled trial.

UNLABELLED: Following introduction of the compulsory use of seat belts in cars, whiplash injuries of the cervical spine have become common in everyday practice. Current treatment approaches lead to resolution of the symptoms within a short time in most cases but cannot prevent a small proportion of patients developing persistent health problems. The effects of adjuvant treatment with laser acupuncture on the acute symptoms and the results one year after the injury were studied in this prospective, randomized, placebo-controlled single-blind study. One group of patients (n = 23) were treated with laser acupuncture (5 mW HeNe laser on 22 acupuncture points for 15 s each) plus cervical collar and a combination of paracetamol and chlormezanone; a second group (n = 22) received the same treatments but with the use of a placebo laser. The treatment was given three times per week until the patient was asymptomatic. No statistically significant advantage of the laser acupuncture treatment was found in the acute phase (mobility in all three planes, duration of pain and duration of use of a cervical collar) or the chronic phase (drug use and the incidences of chronic recurrent problems such as myofascial pain, headaches, vertigo and tinnitus). CONCLUSION: Adjuvant laser acupuncture with a 5 mW HeNe laser and an irradiation time of 15 s appears to be ineffective in the management of whiplash injuries.

Chlormezanone in the treatment of insomnia due to rheumatic stiffness.

An open assessment of chlormezanone in the treatment of rheumatic sleep disturbances was carried out in general practice. Sixty-one patients received 400 mg chlormezanone (2 tablets) each night for 2 weeks. Patients' nightly sleep assessment showed a steady improvement over the 2-week period, and overall effectiveness was rated as good or excellent by 75% of patients. Only 1 patient stopped treatment because of side-effects. It was concluded that chlormezanone could prove a useful alternative to current therapy for treatment sleeplessness in rheumatic patients.

A comparison of chlormezanone and temazepam in sleep disturbance.

Fifty-five patients complaining of insomnia entered a single-blind general practice study and were treated with either 400 mg chlormezanone or 20 mg temazepam at night for 2 weeks. There was a significant increase from baseline for both treatments in average duration of sleep, quality of sleep and frequency of waking refreshed. There was no significant difference between the treatments, with overall effectiveness rated similarly. It is concluded that chlormezanone is at least as useful as temazepam in treating insomnia.

Treatment of sleep disturbance in arthritis with chlormezanone.

A double-blind, crossover study was carried out in 31 patients with rheumatoid arthritis or osteoarthritis who suffered from insomnia which was considered to be caused primarily by their disease. Patients received 7-day courses of 400 mg chlormezanone, 200 mg chlormezanone and placebo in a pre-determined random order. Patients rated chlormezanone significantly (p less than 0.025) more effective than placebo in overcoming sleep disturbance and preferred the 400 mg dose. There was also a trend towards better quality of sleep with chlormezanone, although this did not attain statistical significance in this relatively small study. Daytime alertness was similar for both active and placebo treatment periods. Chlormezanone, therefore, would seem to be a useful addition to antirheumatic therapy when there is related insomnia.

Treatment of anxiety-related insomnia with chlormezanone.

Twenty-nine patients seen in general practice suffering from sleep disturbance due to mild neurotic anxiety were treated with 400 mg chlormezanone per night for 2 weeks. Patients' and doctors' assessments of quality of sleep and Hamilton anxiety rating scores were carried out initially and after 1 and 2 weeks. Patients also completed a daily record card assessing their sleep. The results suggest that chlormezanone produced prompt improvement within 2 nights of the start of treatment, and by the end of the study period only 2 (7%) patients still reported their sleep as being poor compared with 80% initially, and 19 (66%) rated their sleep as good or excellent. There was a steady reduction in anxiety rating scores throughout treatment. Only 1 patient reported a transient mild side-effect.

Successful treatment of anxiety with a single night-time dose of chlormezanone: double-blind comparison with diazepam.

A multi-centre, double-blind trial was carried out in general practice in 44 patients with symptoms of neurotic anxiety to compare the effects of treatment with either 400 mg chlormezanone at night or 5 mg diazepam 3-times daily for 4 weeks. The results indicated tht there were similar improvements in anxiety, duration and quality of sleep, and frequency of waking refreshed with both drugs. There was no significant difference in overall effectiveness of the treatments, as rated by both the patients and physicians. It is suggested, therefore, that chlormezanone could serve as a substitute for the benzodiazepine with the advantage of only once-daily dosage.

Two-dose comparison of chlormezanone in sleep disturbance due to anxiety.

A double-blind, crossover, multi-centre study was carried out in general practice on 76 patients with mild neurotic anxiety and associated sleep disturbance to compare the effectiveness of chlormezanone given as a single night-time dose of 200 mg or 400 mg, each given for a period of 1 week. There was a significant improvement in the quality and duration of sleep with both dosages, and this was significantly greater with the higher dose. Both doses produced a similarly significant improvement in the frequency of awakening refreshed, and reduction in anxiety rating. The higher dose was considered overall more effective, and significantly more patients preferred it.

Four-week tolerance study of chlormezanone for the treatment of insomnia in the elderly.

A 4-week study of chlormezanone was carried out in thirty-two patients admitted to a geriatric ward and requiring regular night sedation. Two patients required 400 mg nightly, the remainder only 200 mg nightly. The duration and quality of sleep, and frequency of awaking refreshed, all improved during chlormezanone therapy. There was no deterioration in mental agility test performance. There were no serious side-effects, no significant changes in blood urea or liver function tests, and no evidence of drug accumulation. It is concluded that chlormezanone appears to be a well tolerated drug for elderly patients with sleep disturbance meriting further controlled evaluation.

A controlled study of Trancopal in the treatment of sleep disturbances due to anxiety.

Sixty-eight patients presenting with sleep disturbances due to mild neurotic anxiety were treated for two weeks with a single night-time dose of 400 mg trancopal or matching placebo under double-blind conditions. Patients kept a daily record of the quality of their sleep and the observer carried out a weekly rating of anxiety using a modified Hamilton scale. By Day 7 patients receiving Trancopal had a significantly better rating for sleep and mean Hamilton scores for day-time anxiety than the placebo group. Side-effects were minimal. It was concluded that for patients with sleep disturbances due to neurotic anxiety Trancopal is a well tolerated and effective alternative to the hypnotics.

A controlled study of Trancopal in sleep disturbances due to rheumatic disease.

A placebo controlled, double-blind study was carried out in six centres in general practice to assess the effectiveness of Trancopal in treating sleep disturbances due to rheumatic disorders. Eighty-five patients received a usual dose of two tablets of Trancopal or matching placebo at night for two weeks. Patients were assessed weekly and kept a daily record of the quality of sleep. All ratings showed that patients slept significantly better on Trancopal than on placebo. Day-time rheumatic stiffness however was not significantly reduced. Six patients receiving Trancopal reported side-effects chiefly drowsiness (five patients) which was controlled by dose reduction. It was concluded that for rheumatic patients Trancopal offers an acceptable alternative to current hypnotics over which it may prove to have some advantages, particularly for the elderly.