<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_463"
                     title="AAPM: Online Program Helps Manage Pain (CME/CE)"
                     score="0.014"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAPM/tb/18393?impressionId=1265772700027"
                     
      &lt;p&gt;SAN ANTONIO  --  A personalized, online self-management program helped patients with pain syndromes improve coping skills and reduce stress and depression in two studies reported here.&lt;/p&gt;
&lt;p&gt;Patients randomized to the self-management program demonstrated significant improvement in multiple social, emotional, and behavioral outcomes after six months (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 to &lt;em&gt;P&lt;/em&gt;&amp;lt;0.01). Improvement in some parameters occurred within one month. A control group that was not exposed to the program showed no significant improvement.&lt;/p&gt;
&lt;p&gt;&quot;Our goal is to help people communicate better with providers, understand better how they can use social support, understand the comorbid conditions, like anxiety and depression, and develop cognitive skills to help get them through their pain episodes,&quot; said Emil Chiauzzi, PhD, of Inflexxion, the Newton, Mass. company that developed the program.&lt;/p&gt;
&lt;p&gt;Although the studies involved patients with migraine or low-back pain, programs are being developed for other types of pain condition, including several forms of neuropathic pain.&lt;/p&gt;
&lt;p&gt;The online program, demonstrated at &lt;a href=&quot;http://www.painACTION.com&quot; mce_href=&quot;http://www.painACTION.com&quot; target=&quot;_blank&quot;&gt;www.painACTION.com&lt;/a&gt;, employs patient-specific information to generate individualized self-management strategies.&lt;/p&gt;
&lt;p&gt;Patient responses to assessments are analyzed by a &quot;recommendation engine,&quot; which produces content recommendations designed to address each patient&apos;s informational and self-management needs.&lt;/p&gt;
&lt;p&gt;Elements on the Web site include multimedia education units, a pain inventory, interactive tools that provide information based on patient-provider communication, and medication risk management.&lt;/p&gt;
&lt;p&gt;&quot;The content on the Web site is focused on teaching people practical skills to manage the behavioral side of pain,&quot; Jonas Bromberg, PsyD, also of Inflexxion, said in an interview.&lt;/p&gt;
&lt;p&gt;Bromberg presented results of a randomized study involving 210 patients, all of whom met International Headache Society diagnostic criteria for migraine, with or without aura.&lt;/p&gt;
&lt;p&gt;Patients assigned to the online program completed at least eight 30-minute session during the first month of the study and at least five more 30-minute sessions during the five-month follow-up period. Patients in the control group continued to receive usual care without exposure to the Web site.&lt;/p&gt;
&lt;p&gt;Participants assigned to the online program had a minimum set of requirements for each session, which were provided at log-in. Follow-up assessments occurred at one, three, and six months.&lt;/p&gt;
&lt;p&gt;The two groups were balanced with respect to sex and headache frequency and severity, the researchers said.&lt;/p&gt;
&lt;p&gt;Bromberg reported that patients assigned to the self-management program demonstrated significant improvement in: &lt;ul&gt; &lt;li&gt;Headache self-efficacy (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01 compared with baseline)&lt;/li&gt; &lt;li&gt;Use of relaxation (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 to &lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Use of social support (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Pain catastrophizing (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Depression (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 to &lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Stress (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Chiauzzi presented results from a randomized study of 209 patients with low-back pain. The design was similar to that of the migraine study, except results were analyzed for between-group differences.&lt;/p&gt;
&lt;p&gt;The results showed significant improvement in the study group versus control group with respect to: &lt;ul&gt; &lt;li&gt;Stress (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Coping (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Social supports (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The data showed significant effects of both treatment (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01) and time (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01) favoring the Web site versus control. Chiauzzi said patients assigned to the Web site had greater mean improvement at posttest, three months, and six months.&lt;/p&gt;
&lt;p&gt;Qualitative analysis suggested that Web site participants had clinically meaningful improvement in depression, anxiety, and stress.&lt;/p&gt;
&lt;p&gt;Additionally, patients in the self-management program reported a 12.3% decrease in pain from baseline, versus 7% in the control group.&lt;/p&gt;
&lt;p&gt;Access to the Web site did not improve physical functioning.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The studies were funded by the National Institutes of Health.&lt;/p&gt;&lt;p&gt;Chiauzzi and Bromberg are employees of Inflexxion, developer of the online program.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_434"
                     title="AAPM: Capsaicin Patch Unaffected by Anesthestics (CME/CE)"
                     score="0.014"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAPM/tb/18351?impressionId=1265772700027"
                     
      &lt;p&gt;SAN ANTONIO  --  The analgesic properties of a capsaicin patch (NGX-4010, Qutenza) remained intact when used in combination with three different topical anesthetics to reduce initial skin discomfort, researchers reported here.&lt;/p&gt;
&lt;p&gt;Pain reduction among patients with neuropathic pain conditions averaged about 30% during weeks two through 12 compared with baseline levels and did not differ by the the type of lidocaine-based pretreatment.&lt;/p&gt;
&lt;p&gt;Between 45% and 50% of patients in each group had at least a 30% decrease in pain.&lt;/p&gt;
&lt;p&gt;&quot;No significant differences in tolerability were noted among the three topical anesthetics evaluated,&quot; Lynn R. Webster, MD, of Lifetree Clinical Research in Salt Lake City, and colleagues concluded in a poster presentation at the American Academy of Pain Medicine meeting.&lt;/p&gt;
&lt;p&gt;&quot;Preliminary efficacy of NGX-4010 was similar, irrespective of the topical anesthetic and comparable to results in previous phase III studies using NGX-4010 in patients with postherpetic neuralgia.&quot;&lt;/p&gt;
&lt;p&gt;The 8% capsaicin patch has FDA approval for management of postherpetic neuralgia. Prior to applying the patch, the skin is treated with a topical anesthetic to reduce discomfort. In previous studies of NGX-4010, a 4% lidocaine cream (LMX4) had been applied prior to the patch.&lt;/p&gt;
&lt;p&gt;Whether the type of anesthetic pretreatment affected the safety and efficacy of NGX-4010 was unclear. To address the issue, investigators conducted a randomized, multicenter, open-label clinical study involving 117 patients with moderate-to-severe postherpetic neuralgia, HIV-distal sensor polyneuropathy, or peripheral diabetic neuropathy.&lt;/p&gt;
&lt;p&gt;The patients were randomized to a 60-minute pretreatment period with one of three 4% lidocaine-based topical anesthetics (LMX4, Topicaine, or Betacaine). Within each anesthetic group, patients were further randomized to a 60- or 90-minute application of NGX-4010.&lt;/p&gt;
&lt;p&gt;Safety and tolerability assessments included adverse events, skin assessments by a 7-point scoring system, pain score on the day of treatment, and use of medication for treatment-related discomfort.&lt;/p&gt;
&lt;p&gt;The principal efficacy outcome was the percentage change in mean pain scores (reflecting average pain for the past 24 hours) from baseline to weeks two through 12.&lt;/p&gt;
&lt;p&gt;Men accounted for about 60% of the study population, and three-fourths of the patients had peripheral diabetic neuropathy. Duration of pain averaged four to five years. The baseline pain level averaged 5 to 6 (moderate) on the 0-10 pain scale.&lt;/p&gt;
&lt;p&gt;In all three groups, the pain level increased slightly or not at all, following application of the capsaicin patch. In general, patients treated for 90 minutes reported more pain than those treated for 60 minutes, but the difference was not statistically significant.&lt;/p&gt;
&lt;p&gt;Within the first 48 hours, 70% to 75% of patients in each group reported &amp;#8805;33% increase in pain.&lt;/p&gt;
&lt;p&gt;More than half the patients in each group required oral analgesics for treatment-related pain, and patients treated for 90 minutes with transdermal capsaicin were more likely to require oral analgesics than were the patients who were treated for 60 minutes.&lt;/p&gt;
&lt;p&gt;The most common adverse event in all three groups was mild to moderate burning or pain at the application site.&lt;/p&gt;
&lt;p&gt;From weeks two through 12, the average pain reduction compared with baseline ranged from 27.2% to 34.3% and did not differ significantly among the groups. About half the patients had at least a 30% reduction in pain compared with baseline.&lt;/p&gt;
&lt;p&gt;At week 12, 35% to 42% of patients in each group reported that their pain was &quot;much improved,&quot; and about 60% to 70% said their pain was &quot;improved.&quot;&lt;/p&gt;
&lt;p&gt;None of the between-group differences was statistically significant.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by NeurogesX.&lt;/p&gt;&lt;p&gt;Webster&apos;s disclosures include Ameritox, Cephalon, King Pharmaceuticals, Medtronic, Arcion Therapeutics, Advanced Bionics, CoMentis, F. Hoffman-La Roche, Forest Laboratories, Hisamitsu Pharmaceuticals, Merck, Myriad Pharmaceuticals, Nektar Therapeutics, NeurogesX, Pfizer, Wyeth, XenoPort, Nervo, Neuromed Pharmaceuticals, and Purdue Pharma.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_415"
                     title="AAPM: Drug for Fibromyalgia Boosts Multiple Outcomes (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAPM/tb/18327?impressionId=1265772700027"
                     
      &lt;p&gt;SAN ANTONIO  --  The fibromyalgia drug milnacipran (Savella) achieved clinically meaningful reductions in pain throughout almost four months of randomized therapy, a post-hoc analysis of daily pain control showed.&lt;/p&gt;
&lt;p&gt;Half of patients treated with the serotonin/norepinephrine reuptake inhibitor had at least a 30% improvement in pain scores at 15 weeks, and 35% to 40% had at least a 50% improvement, according to analyses reported here at the American Academy of Pain Medicine meeting.&lt;/p&gt;
&lt;p&gt;Two different doses of milnacipran led to at least 30% improvement in pain on almost half of the days during the randomized trial. Patients treated with milnacipran had at least 50% improvement during 30% of the days.&lt;/p&gt;
&lt;p&gt;&quot;A 30% improvement in pain is clinically significant, and half the patients treated with milnacipran attained that level of pain relief,&quot; Aroon Datta, MD, of Forest Laboratories in Jersey City, N.J., said in an interview. &quot;Even when the more stringent criteria of 50% improvement were applied, significantly more patients in the milnacipran groups achieved that threshold compared with placebo.&quot;&lt;/p&gt;
&lt;p&gt;&quot;By any measure, it is fair to say that patients treated with milnacipran had significantly better pain control,&quot; he added.&lt;/p&gt;
&lt;p&gt;Milnacipran is chemically similar to the antidepressant venlafaxine (Effexor). However, milnacipran has three times the power to inhibit norepinephrine reuptake. The drug was approved in 2009 for treatment of fibromyalgia.&lt;/p&gt;
&lt;p&gt;Datta reported results of a post-hoc analysis of data from two randomized, placebo-controlled clinical trials. One lasted 27 weeks, and the other had a 15-week follow-up.&lt;/p&gt;
&lt;p&gt;In the 27-week trial, approximately 900 patients were randomized 1:1:2 to placebo, milnacipran 100 mg/d (50 mg BID), or milnacipran 200 mg/d (100 mg BID). In the 15-week trial, 1,200 patients were randomized in equal proportion to placebo and the two doses of milnacipran.&lt;/p&gt;
&lt;p&gt;Patients recorded their pain level several times a day by means of an electronic diary. They rated their pain according to a visual analog scale (VAS) with a range of 0 to 100.&lt;/p&gt;
&lt;p&gt;The post-hoc analysis centered on outcomes at 15 weeks in both trials. The primary outcomes were change from baseline in weekly 24-hour VAS pain score, the proportion of patients who achieved &amp;#8805;30% and &amp;#8805;50% improvement in the VAS pain score, and the proportion of days with &amp;#8805;30% and &amp;#8805;50% improvement in pain.&lt;/p&gt;
&lt;p&gt;In the longer trial, the change in the weekly average of 24-hour recall of VAS scores differed significantly in both milnacipran groups within two weeks, and the difference was maintained through 15 weeks (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 to &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Significant differences emerged within the first week in the second trial and persisted through week 15 (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 to &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;In both trials, 52% of patients assigned to 100 mg of milnacipran and 56% of those assigned to 200 mg had &amp;#8805;30% improvement in pain scores, compared with 40% to 42% of placebo-treated patients (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 to &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;When the more stringent criterion of &amp;#8805;50% improvement was used, 31% to 35% of the 100-mg milnacipran patients achieved that goal, as did 36% to 37% of patients treated with 200 mg.&lt;/p&gt;
&lt;p&gt;About 25% of placebo patients had &amp;#8805;50% improvement. Only the 200-mg dose differed significantly from placebo (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 to &lt;em&gt;P&lt;/em&gt;&amp;lt;0.01).&lt;/p&gt;
&lt;p&gt;A similar pattern emerged in evaluation of the proportion of days with threshold pain reductions. Milnacipran-treated patients had &amp;#8805;30% improvement on 44% to 47% of days in the trial and &amp;#8805;50% improvement on 25% to 30% of days.&lt;/p&gt;
&lt;p&gt;For both thresholds, milnacipran was significantly better than placebo, whose patients had &amp;#8805;30% pain improvement on about a third of days and &amp;#8805;50% improvement on fewer than 20% of days (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01 to &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Datta also reported findings from a randomized, placebo-controlled clinical trial evaluating the pain relief afforded by the 100-mg daily dose of milnacipran. The study involved 1,025 patients with fibromyalgia randomized to placebo or active therapy.&lt;/p&gt;
&lt;p&gt;The trial had two principal 12-week efficacy outcomes: the composite of &amp;#8805;30% improvement in pain and the Patient Global Impression of Change (PGIC), and the composite of the same two outcomes plus improvement &amp;#8805;6 points on the physical function component of the SF-36 health assessment survey.&lt;/p&gt;
&lt;p&gt;The principal efficacy analysis used baseline observation carried forward (BOCF) for patients with missing data. By that statistical method, 29% of milnacipran patients were responders compared with 18% of the placebo group (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;An analysis that employed last observation carried forward (LOCF) showed response rates of 33% with milnacipran and 19&lt;strong&gt;%&lt;/strong&gt; with placebo (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;An analysis of observed cases resulted in response rates of 42% versus 26% (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;Similar results emerged from analyses of the three-measure outcome. Milnacipran led to significantly higher (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) response rates by BOCF (20% versus 11%), by LOCF (28% versus 12%), and by observed cases (30% versus 16%).&lt;/p&gt;
&lt;p&gt;Milnacipran therapy also led to significantly higher (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) response rates for each component of the composite outcomes: &amp;#8805;30% improvement in pain (45% versus 31%), PGIC (42% versus 26%), and &amp;#8805;6-point improvement in physical function (40% versus 31%).&lt;/p&gt;
&lt;p&gt;The results indicate that milnacipran 100 mg (50 mg BID) could offer an alternative for patients who cannot tolerate the FDA-approved 200-mg dose, said Datta. If physicians choose to start patients on 100 mg and then titrate up to the approved dose, that also would appear feasible, he said.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The studies were supported by Forest Laboratories and Cypress Bioscience.&lt;/p&gt;&lt;p&gt;All but two of the authors are employees of the study sponsors.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_406"
                     title="AAPM: Opioid Gains Long-Term Control of Neuropathic Cancer Pain (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAPM/tb/18316?impressionId=1265772700027"
                     
      &lt;p&gt;SAN ANTONIO  --  Patients with neuropathic cancer pain obtained consistent, long-term pain control with extended-release oxymorphone (Opana), according to results of a one-year, open-label extension study.&lt;/p&gt;
&lt;p&gt;Patients reported pain in the mild range throughout most of the follow-up, and only 11% discontinued because of lack of efficacy, Errol Gould, PhD, of Endo Pharmaceuticals in Chadds Ford, Pa., reported here at the American Academy of Pain Medicine meeting. The company manufactures Opana.&lt;/p&gt;
&lt;p&gt;No unexpected adverse events occurred.&lt;/p&gt;
&lt;p&gt;&quot;Current clinical guidelines recommend opioids as second- or third-line treatment for chronic neuropathic pain,&quot; Gould said in an interview. &quot;These results suggest that oxymorphone extended release may be a viable long-term option for patients with neuropathic pain.&quot;&lt;/p&gt;
&lt;p&gt;The findings came from a one-year extension of a multicenter, open-label, noncontrolled short-term study of patients with cancer-related chronic pain.&lt;/p&gt;
&lt;p&gt;Of 44 patients who entered the extension phase, 27 had pain that was primarily neuropathic in origin. The diagnosis of neuropathic pain was based on clinician judgment, with no prespecified diagnostic criteria for guidance.&lt;/p&gt;
&lt;p&gt;Patients began treatment in the extension phase with their ending dose from the short-term study. Dose adjustments to improve pain control or tolerability were allowed throughout the 52-week extension phase.&lt;/p&gt;
&lt;p&gt;Ten of the 27 patients completed the extension study. Principal reasons for withdrawal were adverse events, patient request, loss of effectiveness, and nonadherence.&lt;/p&gt;
&lt;p&gt;The median duration from initiation of long-term maintenance to final visit was 22 weeks. Baseline pain intensity averaged 32.9 on a 100-point scale and 32.6 at final visit. Mean least pain intensity was 13.8 at baseline and 16.2 at final visit, and worst pain intensity averaged 76.3 at baseline and 66.5 at final visit.&lt;/p&gt;
&lt;p&gt;&quot;Regression analysis showed that pain intensity changed very little throughout follow-up,&quot; Gould said.&lt;/p&gt;
&lt;p&gt;The median oxymorphone dose increased from 80 mg at baseline to 160 mg at 52 weeks.&lt;/p&gt;
&lt;p&gt;Eleven (41%) patients reported at least one treatment-related adverse event. The most common events were dry mouth, constipation, and fatigue. The only serious adverse event was an episode of depressed consciousness.&lt;/p&gt;
&lt;p&gt;&quot;Patients required some gradual increases in dosage over time, but that&apos;s consistent with the nature of the disease,&quot; said Gould.&lt;/p&gt;
&lt;p&gt;Not long ago opioids were considered ineffective for neuropathic pain, he added. This study provided additional evidence in support of opioids&apos; effectiveness in controlling neuropathic pain.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by Endo Pharmaceuticals, which manufactures Opana.&lt;/p&gt;&lt;p&gt;Gould and another co-author are employees of Endo Pharmaceuticals.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_266"
                     title="Domestic Abuse May Affect Reproductive Freedom (CME/CE)"
                     score="0.003"
                     href="http://www.medpagetoday.com/PrimaryCare/DomesticViolence/tb/18120?impressionId=1265772700027"
                     
      &lt;p&gt;In some abusive relationships, men may use strategies to force women to become pregnant, including sabotaging their birth control, researchers reported.&lt;/p&gt;
&lt;p&gt;In a cross-sectional study of women treated at five family clinics across northern California, about 20% of women said that their partner tried to coerce them into having a child, Elizabeth Miller, MD, of the University of California Davis, and colleagues reported online in the journal &lt;em&gt;Contraception&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Beyond outright coercion, abusive partners also engaged in birth control sabotage, for example, poking holes in condoms and flushing birth control pills down the toilet.&lt;/p&gt;
&lt;p&gt;&quot;It was stunning to have this many women seeking reproductive health services saying, &apos;this has happened to me,&apos;&quot; Miller said.&lt;/p&gt;
&lt;p&gt;To investigate a possible link between domestic violence and forced pregnancy, the researchers conducted a survey of 1,278 women ages 16 to 29 who sought care at the five family planning clinics in northern California.&lt;/p&gt;
&lt;p&gt;More than half of the women surveyed  --  53%  --  reported physical or sexual partner violence.&lt;/p&gt;
&lt;p&gt;Approximately a third of the women who reported partner violence also reported pregnancy coercion or birth control sabotage.&lt;/p&gt;
&lt;p&gt;Altogether, the effect of both partner violence and reproductive control nearly doubled a woman&apos;s odds of unintended pregnancy (OR 1.99, 95% CI 1.11 to 3.58).&lt;/p&gt;
&lt;p&gt;Both pregnancy coercion and birth control sabotage were separately associated with unintended pregnancy as well (OR 1.83, 95% CI 1.36 to 2.46 and OR 1.58, 95% CI 1.14 to 2.20, respectively).&lt;/p&gt;
&lt;p&gt;&quot;The findings suggest that pregnancy coercion and birth control sabotage may be an aspect of partner violence that, given its relevance to reproductive health, should be identified by providers in clinical settings,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;Among the reasons men would want their partners to bear children: &quot;It ranges from things like wanting to leave a legacy, to a straightforward desire for attachment, to having absolute control over her body,&quot; Miller said. &quot;There are all of these elements to it.&quot;&lt;/p&gt;
&lt;p&gt;Aisha Mays, MD, director of the Teen and Young Adult Clinic at San Francisco General Hospital who was not involved in the study, said pregnancy coercion is a growing problem that has been around for &quot;quite some time&quot; but is just now being recognized as a major health issue.&lt;/p&gt;
&lt;p&gt;&quot;It&apos;s about power and control,&quot; Mays said. &quot;It&apos;s another way of saying, &apos;this girl&apos;s taken, this girl&apos;s mine.&apos;&quot;&lt;/p&gt;
&lt;p&gt;Mays said she has seen cases in which a young mother who has a child with another partner will be forced by her new boyfriend to have another baby with him.&lt;/p&gt;
&lt;p&gt;It&apos;s also a way for males to make their partners more dependent on them, according to Amy Bonomi, PhD, MPH, of Ohio State University.&lt;/p&gt;
&lt;p&gt;&quot;Women in abusive relationships are sometimes forced to bear children as a means to keep them dependent on their partner and sometimes as a means to justify additional  --  and sometimes more severe  --  abuse,&quot; Bonomi said.&lt;/p&gt;
&lt;p&gt;Miller said the findings emphasize the need for family planning clinics to provide intervention programs to combat both reproductive control and partner violence.&lt;/p&gt;
&lt;p&gt;Key strategies include advising women about &quot;invisible&quot; forms of birth control such as injectable and intrauterine contraceptives, as well as easy access to emergency contraception.&lt;/p&gt;
&lt;p&gt;&quot;If we can identify that reproductive control is going on,&quot; Miller said, &quot;we can offer the woman methods for birth control that the partner can&apos;t mess with.&quot;&lt;/p&gt;
&lt;p&gt;Mays added that physicians and counselors should talk about women&apos;s empowerment with regard to reproduction during reproductive health visits.&lt;/p&gt;
&lt;p&gt;&quot;It tends to be left out,&quot; Mays said. &quot;We talk about getting the prescription [for birth control] and its side effects. But we really need to have a discussion around whether the girl is feeling ready for sex.&quot;&lt;/p&gt;
&lt;p&gt;The study was limited by its cross-sectional design, which &quot;precludes conclusions concerning temporality regarding associations observed among pregnancy coercion, birth control sabotage, and intimate partner violence with unintended pregnancy.&quot; Miller et al said additional studies are needed to clarify the chronology of reproductive control and partner violence, and how those factors might combine to affect risk for unintended pregnancy.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by grants from the National Institute of Child Health and Human Development, a UC Davis Health System Research Award, and a Building Interdisciplinary Research Centers in Women&apos;s Health award.&lt;/p&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
    </recommendedItem>
</recommendedContent>