Vitamin D3 supplementation and treatment outcomes in patients with depression (D3-vit-dep).

OBJECTIVE: To examine whether vitamin D supplementation in patients with depression would result in a reduction in Hamilton D-17 depression score (primary outcome) at 3 and 6 months compared to controls and to explore the correlations between serum vitamin D and symptoms of depression, wellbeing, systolic blood pressure, and waist circumference. In this outpatient multicentre study conducted between 2010 and 2013, patients, 18-65 years old, diagnosed with mild to severe depression were randomly assigned to receive D supplementation 70 micrograms daily or placebo on top of standard treatment. Participants, care givers and those assessing the outcomes were blinded to group assignment. RESULTS: At baseline, 23 patients had a normal 25(OH)D level, 22 had insufficiency (< 25 nmol/L), and 17 had deficiency (25-50 nmol/L). No significant reduction in depression was seen after vitamin D supplementation compared to placebo at Hamilton (18.4-18.0; p = 0.73 at 12 weeks). Vitamin D supplementation did not provide a reduction in symptom score among patients with depression. Trial registration The trial was registered in the National Board of Health (EudraCT: 2011-002585-20) and in ClinicalTrials.Gov (NCT01390662).

Perineural injection of etanercept as a treatment for postamputation pain.

BACKGROUND: The inflammatory cytokine tumor necrosis factor-alpha has been shown to play a pivotal role in the development and maintenance of a wide variety of neuropathic pain conditions. Not surprisingly, systemic treatment with drugs that block tumor necrosis factor have been demonstrated to alleviate pain and pain-related behaviors in clinical and preclinical studies, respectively. Despite evidence that local administration of this drug class may be more efficacious than systemic administration, there are no clinical studies to support or refute this assertion. OBJECTIVE: To report results on the use of perineural etanercept in 6 traumatic amputees with postamputation pain. METHODS: The authors treated 6 soldiers with residual limb and phantom pain with a series of perineural etanercept injections. RESULTS: Five of the six patients reported significant improvements in residual limb pain at rest and with activity, phantom limb pain, functional capacity, and psychologic well-being 3 months after injections. The one soldier who failed therapy was the only patient who presented with pain greater than 1 year in duration. At the reduced doses administered, no adverse effects were observed. DISCUSSION: These findings support preclinical evidence that the local administration of tumor necrosis factor inhibitors may prove to be a safe and effective treatment for challenging pain conditions.

Rucksack-induced plexopathy mimicking a lateral antebrachial cutaneous neuropathy.

A 20-yr-old active duty soldier complained of right lateral forearm numbness that began shortly after carrying 100 lbs of equipment (20-lb load-bearing equipment, 20-lb individual body armor, and 60-lb rucksack) while deployed during Operation Iraqi Freedom. Physical examination revealed normal strength but decreased sensation over the right lateral forearm, thumb, and index finger. Imaging studies were normal. Electrodiagnostic studies revealed an absent right lateral antebrachial cutaneous nerve conduction study with abnormal electromyography findings in the right deltoid and biceps brachii. He was diagnosed with an upper trunk brachial plexopathy. The patient's symptoms gradually resolved with conservative treatment. Although rucksack palsies have been previously reported, this relatively rare cause of brachial plexus injury has been generally declining with the reengineering of more ergonomically favorable rucksacks. It is possible that the additional body armor may have contributed.

A double-blind, placebo-controlled, dose-response pilot study evaluating intradiscal etanercept in patients with chronic discogenic low back pain or lumbosacral radiculopathy.

BACKGROUND: In recent years, convincing evidence has emerged implicating tumor necrosis factor alpha as a causative factor in radiculopathy and discogenic back pain. But although preliminary open-label studies demonstrated promising results for the treatment of low back pain with tumor necrosis factor-alpha inhibitors, early optimism has been tainted by a controlled study showing no significant benefit in sciatica. To determine whether outcomes might be improved by a more direct route of administration, the authors evaluated escalating doses of intradiscal etanercept in 36 patients with chronic lumbosacral radiculopathy or discogenic low back pain. METHODS: A double-blind, placebo-controlled pilot study was conducted whereby six patients received 0.1, 0.25, 0.5, 0.75, 1.0, or 1.5 mg etanercept intradiscally in each pain-generating disc. In each escalating dose group of six patients, one received placebo. A neurologic examination and postprocedure leukocyte counts were performed in all patients at 1-month follow-up visits. In patients who experienced significant improvement in pain scores and function, follow-up visits were conducted 3 and 6 months after the procedure. RESULTS: At 1-month follow-up, no differences were found for pain scores or disability scores between or within groups for any dose range or subgroup of patients. Only eight patients remained in the study after 1 month and elected to forego further treatment. No complications were reported, and no differences were noted between preprocedure and postprocedure leukocyte counts. CONCLUSIONS: Although no serious side effects were observed in this small study, a single low dose of intradiscal etanercept does not seem to be an effective treatment for chronic radicular or discogenic low back pain.