Interventions for treating persistent and intractable hiccups in adults
Palliative Medicine, Sir Michael Sobell House, Oxford, UK. .Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 01/2013; 1(1):CD008768. DOI: 10.1002/14651858.CD008768.pub2
Hiccups involve repeated, involuntary contractions of the muscles used for breathing. They usually stop of their own accord; rarely, however, they may last for more than 48 hours. When they do persist, hiccups can cause a patient considerable upset, interfere with sleeping and eating, and can lead to other complications. Many different drugs and non-drug measures have been suggested to stop long-lasting hiccups. This review aimed to find out whether there is good evidence that any of these work. We searched for good quality studies that involved adult patients (18 or older) who had experienced hiccups for 48 hours or more. Our conclusion is that there is insufficient evidence to recommend a particular treatment for hiccups. There is a need for randomised controlled studies to identify which treatments might be effective or harmful in treating persistent hiccups.
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ABSTRACT: Many medicines have been proposed to cure various ills of biomedicine including evidence-based medicine, evolutionary medicine, narrative medicine, and complexity medicine, among others. To the extent that all models are idealizations or abstractions, all of these model medicines are imperfect in some respects. In the absence of a single unified model, if indeed unification is possible or even desirable, and despite the relative advantages of one model or another, in practice many models and methods are necessary in medicine. In this article, I consider the value of such diversity in models and methods. I briefly describe several models. Then I discuss simulations of agents who use diverse models. Advocates of models such as those discussed here typically claim that we should use their preferred model because it is the best. Evidence-based medicine, for instance, has been promoted as the single best model of medicine while other models have been cast as lesser models or in opposition to it and each other. But isolated models and methods may never be as good as groups of models and methods. Debates about various individual models may result in better outcomes, but explicitly choosing to use many models is likely to produce even better outcomes.
Article: Hiccups and Advanced Illness[Show abstract] [Hide abstract]
ABSTRACT: History Physical Examination Diagnostics Clinical Question Discussion Back to Our Case Take Away Points References
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ABSTRACT: OBJECTIVE:To determine whether gabapentin is effective in the treatment of persistent or intractable hiccups.DATA SOURCES:A search of MEDLINE (1966-March 2013) using the MeSH search terms gabapentin, hiccups, and hiccups/drug therapy was performed. Additional databases searched included Web of Science (1945-March 2013) and International Pharmaceutical Abstracts (1970-March 2013) using the text words gabapentin and hiccups. Bibliographies of relevant articles were reviewed for additional citations.STUDY SELECTION AND DATA EXTRACTION:All DATA SOURCES: Because of the low incidence of persistent or intractable hiccups, few if any controlled clinical trials are conducted on the efficacy of drug treatment. Therefore, most of the data involve case reports or case series. We evaluated 17 case reports and 2 case series involving gabapentin therapy for persistent or intractable hiccups. Therapeutic outcomes with gabapentin were positive in all cases, with temporal evidence suggesting an effect, but outcomes often were obscured by combination therapy and comorbidities in some cases. Case reports suggest that gabapentin might be useful as a second-line agent in patients undergoing stroke rehabilitation or in the palliative care setting where chlorpromazine adverse effects are undesirable. Gabapentin was very well tolerated, with only a few minor adverse effects.CONCLUSIONS:Gabapentin has a similar body of evidence as other pharmacotherapeutic agents used to treat hiccups. Gabapentin is well tolerated and should be considered as a second-line agent in selected patients.
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