Interventions for treating persistent and intractable hiccups in adults

ArticleinCochrane database of systematic reviews (Online) 1(1):CD008768 · January 2013with26 Reads
DOI: 10.1002/14651858.CD008768.pub2 · Source: PubMed
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.
    • "Baclofen (GABA-agonist ) is among the substances that act through the nervous system and has by far the best ability to treat chronic hiccups (Guelaud et al. 1995; Oshima et al. 1998; Petroianu et al. 1997; Steger et al. 2015). However, a Cochrane systemic review found insufficient evidence as to which pharmacological agent is best for hiccups (Moretto et al. 2013). Hiccups are the manifestation of diaphragmatic myoclonus and are considered to be a form of physiologic myoclonus. "
    [Show abstract] [Hide abstract] ABSTRACT: Hiccups are the sudden involuntary contractions of the diaphragm and intercostal muscles. They are generally benign and self-limited, however, in some cases they are chronic and debilitating. There are approximately 4000 admissions for hiccups each year in the United States. The hiccup reflex arc is composed of three components: (1) an afferent limb including the phrenic, vagus, and sympathetic nerves, (2) the central processing unit in the midbrain, and (3) the efferent limb carrying motor fibers to the diaphragm and intercostal muscles. Hiccups may be idiopathic, organic, psychogenic, or medication-induced. Data obtained largely from case studies of hiccups either induced by or treated with medications have led to hypotheses on the neurotransmitters involved. The central neurotransmitters implicated in hiccups include GABA, dopamine, and serotonin, while the peripheral neurotransmitters are epinephrine, norepinephrine, acetylcholine, and histamine. Further studies are needed to characterize the nature of neurotransmitters at each anatomical level of the reflex arc to better target hiccups pharmacologically.
    Full-text · Article · Dec 2016
    • "Several clinical studies have reported that baclofen may help treat persistent hiccups occurring after a stroke131415 . Although a Cochrane systematic review found no sufficient evidence for the treatment of persistent or intractable hiccups with either pharmacologic or nonpharmacologic interventions, all four studies included in the review had focused on acupuncture, and not baclofen, or even other pharmacologic interventions [20]. To the best of our knowledge, only a few randomized controlled trials with small sample sizes have evaluated the efficacy of baclofen for persistent hiccups after stroke. "
    [Show abstract] [Hide abstract] ABSTRACT: The results of preclinical studies suggest that baclofen may be useful in the treatment of stroke patients with persistent hiccups. This study was aimed to assess the possible efficacy of baclofen for the treatment of persistent hiccups after stroke. In total, 30 stroke patients with persistent hiccups were randomly assigned to receive baclofen (n = 15) or a placebo (n = 15) in a double-blind, parallel-group trial. Participants in the baclofen group received 10 mg baclofen 3 times daily for 5 days. Participants assigned to the placebo group received 10 mg placebo 3 times daily for 5 days. The primary outcome measure was cessation of hiccups. Secondary outcome measures included efficacy in the two groups and adverse events. All 30 patients completed the study. The number of patients in whom the hiccups completely stopped was higher in the baclofen group than in the placebo group (relative risk, 7.00; 95% confidence interval, 1.91–25.62; P = 0.003). Furthermore, efficacy was higher in the baclofen group than in the placebo group (P < 0.01). No serious adverse events were documented in either group. One case each of mild transient drowsiness and dizziness was present in the baclofen group. Baclofen was more effective than a placebo for the treatment of persistent hiccups in stroke patients. Trial registration Chinese Clinical Trials Register: ChiCTR-TRC-13004554
    Full-text · Article · Jul 2014
  • [Show abstract] [Hide abstract] 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.
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