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Neuropathic pain represents a diagnostic challenge and is difficult to treat. In recent years, clinical trials have led to the development of a number of new treatment guidelines. The guidelines recommend drugs for the most important types of neuropathic pain and suggest alternatives in the event of lack of effect or intolerable adverse effects. Patients with this condition often suffer from anxiety, depression and insomnia, which influences the choice of drug. This article presents the most important drugs on which these guidelines concur.

Reactions to drug withdrawal may lead to unnecessary reintroduction and inappropriate prescribing. This problem is often encountered after long-term therapy with drugs acting on the cardiovascular and central nervous systems. The adverse effects include rebound effects, withdrawal syndrome, termination of drug-drug interaction, increased risk of disease and recurrence of disease. Lack of scientific evidence limits development of guidelines on how to terminate drug therapy. Slow and gradual tapering schedules for substances with long half-lives is usually recommended to avoid withdrawal syndrome and rebound effects. However, the most important measure is to avoid prescribing drugs that are difficult to withdraw. Appropriate information and involvement of the patient are also important.

Horse- chestnut seed extract is widely used throughout Europe, and has been used to treat a variety of medical conditions. The most common indication is currently chronic venous insufficiency, for which conventional therapy includes use of compression stockings. Horse chestnut seed extract is generally well tolerated; the most common side effects are gastrointestinal disturbances, dizziness and calf-muscle spasms. Clinical trials have shown that horse- chestnut seed extract and placebo are associated with similar side effects Horse- chestnut may interact with anticoagulants and antidiabetics, and caution is advised in patients taking these drugs. A number of clinical trials have shown that horse- chestnut seed extract may be beneficial to patients with mild to moderate chronic venous insufficiency. However, inadequate randomization, short duration and use of different end-points in these trials makes it difficult to conclude regarding effectiveness and safety, especially in long-term use. Horse- chestnut seed extract appears to be a short-term treatment option in patients with mild to moderate chronic venous insufficiency, but more rigorous trials are required to confirm the efficacy of this treatment.

The aim of this paper is to assess the substance pregabaline's potential for abuse. Little information is available on the subject and that retrieved is in part conflicting. Pregabaline is likely to be abused for its positive psychological effects, e.g. euphoria. However, these effects are weak and not sustained during long-term use. Pregabaline is therefore likely to have a lower potential for abuse than benzodiazepines. In clinical studies, symptoms suggestive of physical dependence (e.g. insomnia, nausea, headache, diarrhoea) have been observed in some patients after abrupt discontinuation of pregabaline. However, available documentation indicates that pregabaline is associated with less physical and psychological dependence than benzodiazepines.

Background: Bus drivers as a group have elevated health risks that are related to their working conditions. The present study measured the perception of working conditions among workers in a bus company and the results of job adjustments for health problems., Material and Methods: Perception of working conditions was measured by a questionnaire in a cross-sectional design in which bus drivers were compared to workers in other departments of the same company. In a longitudinal design, effects of intervention were studied when a small group of workers experiencing health problems were offered job adjustments for shorter or longer periods., Results: Duration of employment was associated with a negative perception of working conditions, particularly among bus drivers with more than 10 years' experience. Between one and three years after intervention (job adjustment), 80% of the workers recruited to the intervention were still in their jobs; 60% of the workers needed only a mean period of six months of job adjustment., Interpretation: A wear-and-tear effect could be associated with number of years of driving. Preventive measures to reduce further health problems among these drivers could involve job adjustments.