insomnia

Popping a pill may not be the best remedy for sleeplessness.

* THE QUESTION Chronic difficulty falling asleep prompts many people to take sleeping pills. Might therapy that combines relaxation techniques with behavior changes offer an effective alternative?

* THIS STUDY randomly assigned 63 adults with insomnia to receive one of four treatments for eight weeks: a nighttime dose of Ambien (zolpidem), cognitive behavior therapy, a combination of the drug and therapy, or a placebo. Therapy focused on muscle relaxation, breathing and mental focusing techniques as well as behavior changes such as getting up at the same time each day and using the bedroom only for sleep and sex. Halfway through the treatment, the therapy and combination groups had reduced episodes of insomnia by 44 percent, compared with a 29 percent reduction for those taking medication and 10 percent for the placebo group. After treatment ended, reports of insomnia were 14 percent less frequent than at the start for those who took Ambien, 17 percent less for the placebo group and 52 percent less for the therapy and combination groups.

* WHO MAY BE AFFECTED BY THESE FINDINGS? People with insomnia. More than half of participants in a U.S. survey reported insomnia at least a few nights each week.

* CAVEATS Insomniacs' sleep diaries tend to overestimate the time it takes to get to sleep and underestimate the time spent asleep. Results may have been affected by participants' knowledge of whether they received behavior therapy.

* BOTTOM LINE People with insomnia may want to ask their doctor about cognitive behavior therapy.

* FIND THIS STUDY Sept. 27 issue of Archives of Internal Medicine; abstract available online at www.archinternmed.com.

* LEARN MORE ABOUT sleep disorders such as insomnia at www.familydoctor.org and www.sleepfoundation.org.

BACK PAIN

Physical therapy may be no better than simple advice.

* THE QUESTION Many people with low-back pain visit a physical therapist. Does this treatment actually help?

* THIS STUDY randomly assigned 286 adults with mild to moderate low-back painto receive standard physical therapy or simply be advised to stay active. People in the advice group were examined and counseled once by a physical therapist and given a book on back pain. The others got the book but also received an average of five therapy sessions, with treatment ranging from stretching and strengthening exercises to joint manipulation. Therapy recipients were more likely than the others to report improvements in their condition, but standard disability measurements showed no actual differences in physical functioning between the groups.

* WHO MAY BE AFFECTED BY THESE FINDINGS? People with moderate but chronic low-back pain.

* CAVEATS Participants received varied types of therapy. Both groups reported small improvements; whether this would have occurred in a group that receive no care at all was not tested.

* BOTTOM LINE People with moderate low-back pain who are considering physical therapy should be aware that long-term treatment may be no more beneficial than a single visit.

* FIND THIS STUDY Sept. 25 issue of the British Medical Journal; abstract available online at www.bmj.com.

* LEARN MORE ABOUT low-back pain at www.mayoclinic.com and www.neurosurgerytoday.org.

PROSTATE CANCER

Surgery may spur age-related changes in bodily functions.

* THE QUESTION Does aggressive treatment for prostate cancer affect sexual or urinary functioning beyond changes attributable to normal aging?

* THIS STUDY questioned 293 men with localized prostate cancer and compared them with 618 men of comparable age who did not have prostate cancer. Before the men in the cancer group underwent treatment -- radical prostatectomy in most cases -- 45 percent said they had no erectile problems. Five years later, that number had declined to 8 percent. By comparison, 40 percent of those without prostate cancer reported no erectile problems when they entered the study; that number was 32 percent after five years. In the cancer group, 41 percent reported having total urinary control after five years, down from 84 percent initially. By comparison, 69 percent of the others had urinary control at the end of the study, down from 72 percent.

* WHO MAY BE AFFECTED BY THESE FINDINGS? Men with localized prostate cancer.

* CAVEATS The researchers did not consider other medical problems or drugs that might affect sexual and urinary functioning.

* BOTTOM LINE Men with prostate cancer may want to be aware that surgery can cause major side effects.

* FIND THIS STUDY in the Nov. 1 issue of Cancer; abstract available online at http://journals.wiley.com/cancer (click on "Early View" and search for "Hoffman").

* LEARN MORE ABOUT prostate cancer at www.cancer.org and www.cancer.gov.

-- Linda Searing