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Three patients with cancer experienced severe side-effects after starting anti-neuropathic pain therapy. All patients, 1 woman and 2 men aged between 69 and 71, fell or had problems with balance. These side-effects diminished after reducing the doses or stopping the medication. It seems that side-effects in patients with cancer are more common and more severe than in other populations with neuropathic pain, such as patients with diabetic neuropathy or postherpetic neuralgia. There is little research into the treatment of neuropathic pain in patients with cancer. In this patient group it is advisable to monitor the patient at least once a week for an optimal treatment and to prevent severe side-effects, especially in the first weeks after starting the treatment.

Objective: To document the circumstances surrounding falls in patients with Parkinson's disease., Design: Prospective., Method: Parkinson patients with a check-up appointment in the period 1 May 1998-31 May 1999 at the Neurology Outpatient's Department of Leiden University Hospital, used standardized forms to record the circumstances surrounding all incidents of falling during the subsequent 6 months. For control purposes, a partner or acquaintance with comparable living conditions was asked to do the same. The researchers judged whether falls were related to physical impairment (personal, intrinsic factors) or environmental factors (extrinsic factors)., Results: 59 patients with Parkinson's disease (21 women (36%); mean age: 60.8 years; mean Hoehn and Yahr score: 2.3) and 55 controls (37 women (67%); mean age: 59.6 years) were studied. Patients reported 205 falls and controls 10 falls. Recurrent (> or = 2) falls occurred in 15 patients (25%) and two controls (4%) (relative risk (RR): 9.0: 95% confidence interval (95% CI): 2.0-41.7). Recurrent falls were more common among persons using benzodiazepines (RR: 5.0: 95% CI: 1.6-15.5). Reliable information was obtained for 160 falls in patients. Most falls (79%) had an intrinsic cause, like turning around, standing up, bending and stumbling. Abrupt movements were a particularly frequent cause of falls. Simultaneous performance of multiple tasks contributed to almost 50% of falls in patients., Conclusion: Falls are common among Parkinson patients. Most falls are related to intrinsic factors. Prevention of these intrinsic falls requires treatment of the underlying postural instability. Use of benzodiazepines must be avoided whenever possible. Interventions aimed at extrinsic factors, such as reduction of domestic hazards, are possibly less effective.