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People who have cancer which has spread to their bones and the nerves adjacent to the bones often suffer severe pain. There are several treatments to help relieve this pain: radiotherapy, analgesic drugs (pain killers) such as opioids, and bone‐modulating drugs such as bisphosphonates and calcitonin. Calcitonin has the potential to relieve pain and maintain bone strength, thus reducing the risk of broken bones. This review looked at the effectiveness of calcitonin for controlling pain from bone metastases. However, only two studies were found with very low quality evidence to support the use of calcitonin for patients suffering from bone pain. We updated the review in 2015 and did not find any more studies. There were slightly more side effects for the patients given calcitonin. Unless new studies provide additional relevant information about this treatment, other therapeutic approaches should be considered.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 19, 2006

Long‐term corticosteroids are prescribed for a number of reasons, including inflammatory bowel disease, chronic obstructive lung disease and rheumatoid arthritis. Steroids cause bone loss by a variety of complex mechanisms. Calcitonin is an anti‐resorptive therapy that has been approved for the treatment of established osteoporosis. The purpose of this review was to evaluate calcitonin as a means of preventing bone loss with corticosteroid therapy. Nine randomized controlled trials were included in the review, with 221 patients randomized to calcitonin and 220 to placebo. The results showed that calcitonin prevents bone loss at the spine and forearm by about 3% after the first year of therapy. There was no effect on bone loss at the hip. Calcitonin was not statistically different from placebo at preventing fractures of the spine and long bones, such as hip fractures. Calcitonin was associated with four times the side effects of placebo, and these were mostly nausea and facial flushing.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 24, 2000

Recipients of a kidney transplants have a pre‐existing increase in bone fragility resulting from kidney disease. Bone mineral density decreases rapidly in the first year after engraftment and there is continued bone loss through the period of transplantation. The incidence of fracture following successful transplantation is greater than 2% per annum. Bone loss and fracture risk are significantly higher than both the general and dialysis population. This study examines the benefits and risks of treatments used to reduce bone disease following kidney transplantation. Twenty‐four trials (12,99 patients) were included. No individual intervention (bisphosphonate, vitamin D sterol or calcitonin) has been shown in randomised controlled trials to reduce fracture risk after kidney transplantation. Meta analysis of all available such trials combined, however, shows that any intervention (bisphosphonate, vitamin D sterol, or calcitonin) for bone disease in kidney transplant recipients does reduce the risk of fracture in this population. These agents also provide a significant improvement in bone mineral density when given after transplantation, although the clinical significance of this is uncertain due to the lack of validation in bone densitometry in chronic kidney disease. Bisphosphonates have greater efficacy to preserve bone mineral density than vitamin D sterols in head‐to‐head trials.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 18, 2007

The central giant cell granuloma (CGCG) of the jaws is a rare benign tumour of the mandible (lower jaw) and the maxilla (upper jaw) characterized by destruction of the bone, loss of symmetry of the face and displacement of teeth and tooth germs, especially in younger patients. Aggressive types of tumours are usually expansive and rapidly grow, causing pain, bleeding, and displaced and loose teeth. The management of CGCG can include conventional surgery with or without medical adjunctive treatment or resection in‐bloc for the aggressive variant. Although the most common therapy is surgical curettage, the high recurrence rate, especially in aggressive lesions, has raised concern and led to a search for other treatment options. This review compared primary non‐surgical interventions versus primary surgical or other treatments. Although a number of therapies have been proposed for treating central giant cell granuloma of the jaws, our review did not identify evidence from randomised controlled trials to support their use. Our review only identified one study comparing calcitonin to placebo. No significant difference in the proportion of patients with increased volume of more than 10% of the tumour compared to the pretreatment measurement at 3 months of follow‐up was found between both groups.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 7, 2009

We reviewed the evidence on the effectiveness of non‐surgical treatments for people with leg pain caused by pressure on the nerves in the spine.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: August 30, 2013

People can experience pain in a missing body part, for example after limb amputation. This is known as phantom limb pain. Various medications have been tried as treatments for phantom limb pain. It is uncertain whether any of the following medications work: botulinum toxin A, opioids, N‐methyl D‐aspartate (NMDA) receptor antagonists (e.g. ketamine, memantine, dextromethorphan), anticonvulsants, antidepressants, calcitonin, and local anaesthetics. It is unclear whether these medications can help with pain, function, mood, sleep, quality of life, treatment satisfaction, and safety (e.g. adverse events) in the short and long term.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 14, 2016

Sepsis is defined as confirmed or suspected infection associated with a systemic inflammatory response syndrome (SIRS). This condition can evolve to an acute organ dysfunction, known as 'severe sepsis'; or to persistent hypotension, even after adequate fluid replacement, known as 'septic shock'. Procalcitonin (PCT) is a biological indicator in the blood that has been found to increase during blood infection. We wanted to assess whether evaluation of PCT can reduce mortality and time receiving antimicrobial therapy in adults with blood infection. To this end, we compared PCT versus nothing, versus standard care (only usual clinical judgement) and versus other blood chemical indicators. Nowadays, other chemical indicators include C‐reactive protein (CRP), interleukins and neopterin.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 18, 2017

Complex regional pain syndrome (CRPS) is characterised by persistent pain, usually in the hands or feet, that is not proportionate in severity to any underlying injury. It often involves a variety of other symptoms such as swelling, discolouration, stiffness, weakness and changes to the skin. This overview sought to summarise and report all of the available evidence arising from systematic reviews for all treatments for this condition regarding how well they work and any potential harm that they might cause.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 30, 2013

In some children with urinary tract infection (UTI), the infection is localized to the bladder (lower urinary tract). In others, bacteria ascend from the bladder to the kidney (upper urinary tract). Only children with upper urinary tract involvement are at risk for developing permanent kidney damage. If non‐invasive biomarkers could accurately differentiate children with lower urinary tract disease from children with upper urinary tract disease, treatment and follow‐up could potentially be individualized. Accordingly, we examined the usefulness of three widely available blood tests (procalcitonin, C‐reactive protein, erythrocyte sedimentation rate) in differentiating upper from lower urinary tract disease. We found 24 relevant studies of which 17 provided data for our primary outcome. Six studies (434 children) provided data for the procalcitonin test; 13 studies (1638 children) provided data for the C‐reactive protein test, and six studies (1737 children) provided data for the erythrocyte sedimentation rate test. We found all three tests to be sensitive (summary sensitivity values ranged from 86% to 95%), but not very specific (summary specificity values ranged from 38% to 71%). None of the tests were accurate enough to allow clinicians to confidently differentiate upper from lower urinary tract disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 20, 2015

In people with acute respiratory infections, unnecessary antibiotic use significantly contributes to increasing bacterial resistance, medical costs, and the risk of drug‐related adverse events. The blood marker procalcitonin increases in bacterial infections and decreases when patients recover from the infection. Procalcitonin can be measured in the blood of patients by different commercially available assays with a turnaround time of around one to two hours and support clinical decision making about initiation and discontinuation of antibiotic therapy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: October 12, 2017

The thyroid gland is a vital hormone gland: It plays a major role in the metabolism, growth and development of the human body. It helps to regulate many body functions by constantly releasing a steady amount of thyroid hormones into the bloodstream. If the body needs more energy in certain situations – for instance, if it is growing or cold, or during pregnancy – the thyroid gland produces more hormones.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: April 19, 2018

The thyroid gland is a vitally important endocrine (hormone) gland that is mainly involved in the body’s energy metabolism. It is located at the front of the neck, below the voice box, and is butterfly-shaped. The thyroid gland produces the thyroid hormones triiodothyronine (T3) and thyroxine (T4), among other things.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: April 30, 2018

The pancreas is an organ in the abdomen (tummy) that secretes several digestive enzymes (substances that break down the food that we eat) into the pancreatic ductal system, which empties into the small bowel. The pancreas also contains the islets of Langerhans, which secrete several hormones including insulin (which helps regulate blood sugar). Acute pancreatitis is a sudden inflammation of the pancreas that can lead to destruction of the pancreas (pancreatic necrosis). The treatment of people with pancreatic necrosis differs from that of people without pancreatic necrosis. Blood tests such as C‐reactive protein (CRP), procalcitonin, and lactate dehydrogenase (LDH) may be used to find out whether a person with acute pancreatitis has pancreatic necrosis. This is usually followed by CT scan to confirm that the person has pancreatic necrosis. If the person is found to have pancreatic necrosis, the intensity of care is increased and additional treatments are performed as required. At present it is unclear whether measuring the levels of CRP, procalcitonin, or LDH is useful in identifying pancreatic necrosis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 21, 2017

This overview aimed to summarise all evidence from systematic reviews on strategies directed at doctors to reduce the antibiotic prescriptions they give to patients with acute respiratory infections (ear, nose, throat or chest infections).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: September 7, 2017

We wanted to find out if using bisphosphonate treatment was better or worse than dummy treatment (placebo) to relieve bone pain in people with Paget's disease of bone and determine if treatment could prevent complications. We also wanted to discover which bisphosphonates were better.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2018

We conducted a review of the effects of Chinese herbal medicines for people with primary osteoporosis. We found 108 studies with 10,655 people.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 6, 2014

Research shows that pelvic radiotherapy can cause changes in pelvic bones, which may lead to fractures occurring from minimal trauma (called insufficiency fractures) and permanent damage to bone from interrupted blood supply (called avascular necrosis). These conditions can result in pain, problems with mobility, hospitalisation, need for surgery and death. This review looked at the literature for medicines which may be given prior to or during pelvic radiotherapy, to determine if these could reduce the incidence of insufficiency fractures and avascular necrosis, and improve bone health and quality of life.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2018

The pancreas is an organ in the abdomen (tummy) that secretes several digestive enzymes (substances that enable and speed up chemical reactions in the body) into the pancreatic ductal system before it empties into the small bowel. It also contains the Islets of Langerhans, which secrete several hormones including insulin (helps regulate blood sugar). Acute pancreatitis is life‐threatening illness characterized by sudden inflammation of the pancreas, which can lead to failure of other organs, such as the lungs and kidneys. There is a lot of research into different medical treatments for the treatment of acute pancreatitis, but it is not clear what benefits each treatment has, or indeed if any medical treatment is beneficial apart from supportive treatment. This care includes body hydration and intensive care treatment for people with organ failure (to support the failing organs). We sought to resolve this issue by searching for existing studies on the topic. We included all randomised controlled trials (clinical studies where people are randomly put into one of two or more treatment groups) whose results were reported to 7 October 2016.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: April 21, 2017

Background: EBT is a type of massive blood transfusion (where blood is taken from a healthy person and infused into the bloodstream of an ill person) which predisposes to low blood calcium as a result of the bonding (chelating) effect of anticlotting chemicals used to preserve donor's blood. Low blood calcium can cause abnormal functions of muscles (including the heart) and nerves. In this review, we investigated the benefits of administered calcium on blood calcium levels and the safety of calcium administration to newborn infants receiving EBT.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

We reviewed the evidence on the effects and safety of different treatments of osteoporosis in people with beta‐thalassaemia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: March 10, 2016

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