Conclusions:
When the possible side-effects of standard treatment (hypnotics) are considered, there is an argument to be made for clinical use of cognitive-behavioural treatments. Research is needed to establish the likely predictors of success with such treatments. As it may well be the case that the treatment efficacy of cognitive-behavioural therapy itself is not durable, the provision of "top-up" ("refresher" sessions of CBT training to improve durability of effect are worthy of investigation.

Is acupuncture useful in the treatment of rheumatoid arthritis?

Acupuncture for rheumatoid arthritis: an analysis of the literature by Bhatt-Sanders D.

Despite the claims that acupuncture is beneficial in the treatment of stages I and II rheumatoid arthritis (RA), few satisfactory double-blind controlled studies exist. A review of the world literature showed eight studies examining the efficacy of acupuncture in RA. Five studies claim that acupuncture treatments give significant pain relief. Two studies claim that there is no significant difference between real and placebo acupuncture in RA. One study claims that acupuncture has antiinflammatory effects. Analysis of problems related to study design demonstrates that methodological flaws invalidate in varying degrees the broad spectrum of conclusions. The need for a more effective therapeutic armamentarium in the treatment of RA makes it imperative that satisfactory trials of acupuncture for RA be conducted in the future.

Definition summaries:

• Dyssomnia: a disturbance of normal sleep or rhythm pattern. May include the following:
• Inability to sleep
• Insomnia
• Sleeplessness
• Wakefulness
• Parasomnia: a disfunction relating to sleep. May include the following:
• Sleepwalking
• Night terrors
• Bedwetting
• Narcolepsy
• Nocturnal seizures