***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES To determine the immediate effects of modified Proprioceptive Neuromuscular Facilitation ( PNF ) stretching ( group I ) versus Myofascial Trigger Point ( MTrP ) therapy plus modified PNF stretching ( group II ) in comparison to a control group receiving no treatment . DESIGN R and omized , assessor-blind , ( 3 x 4 ) mixed-model repeated measures . SETTING University laboratory . PARTICIPANTS Thirty physically active males with tight hamstrings and at least one latent MTrP on muscles innervated by the lumbosacral , sciatic , tibial and common peroneal nerves . MAIN OUTCOME MEASURES Knee range of motion ( ROM ) , stretch perception , pressure pain threshold ( PPT ) and subjective pain intensity . Outcomes were evaluated at baseline , immediately after treatment , at 10 and 30 min . RESULTS Significant changes over time occurred for group II in all outcomes ( p < or = 0.001 ) . Group II also showed lower pain intensity scores than group I immediately post-treatment ( p = 0.045 ) and a strong clinical effect over group I in ROM at all follow-ups ( effect sizes = 0.9 - 1.0 , p < or = 0.05 ) . Other differences were found between both stretching groups as compared to the control group ( p < or = 0.05 ) . CONCLUSION The results indicate immediate pre- to post-treatment benefits from MTrP therapy combined with modified PNF stretching in young and physically active males with latent MTrPs OBJECTIVE To evaluate the effects of an 8-week water physical therapy program on cervical and shoulder pain , pressure sensitivity , and the presence of trigger points ( TrPs ) in breast cancer survivors . DESIGN R and omized , controlled trial . SETTING To date , no study has investigated effects of water therapy in breast cancer . PATIENTS Sixty-six breast cancer survivors were r and omly assigned into two groups : WATER group , who received a water exercise program or CONTROL group who received the usual care treatment for breast cancer . INTERVENTIONS The WATER therapy program consisted of 24 sessions ( 3 times/week over 8 weeks ) of low-intensity exercises in a warm pool ( 32 ° C ) . Each session included 10-minute warm-up period ; 35 minutes of aerobic , low-intensity endurance , and core stability training ; and a 15-minute cool-down period ( stretching and relaxation ) .  OUTCOMES Neck and shoulder pain ( visual analog scale , 0 - 100 mm ) , pressure pain thresholds ( PPTs ) over C5-C6 zygapophyseal joints , deltoid muscles , second metacarpal , and tibialis anterior muscles , and the presence of TrPs in cervical-shoulder muscles were assessed at baseline and after the 8-week program by an assessor blinded to treatment allocation . RESULTS The WATER group demonstrated a between-group improvement for neck pain of -31 mm ( 95 % confidence interval [CI]-49 to -22 , P < 0.001 ; effect size 1.1 , 0.81 - 1.75 ) and for shoulder-axillary of -19 mm ( -40 to -04 , P = 0.046 ; effect size 0.70 , 0.14 - 1.40 ) . Improvements were also noted for PPT levels over C5-C6 joints ( between-group differences , affected side : 27.7 kPa , 95 % CI 3.9 - 50.4 ; unaffected : 18.1 kPa , 95 % CI 6.1 - 52.2 ) . No between-group differences for PPT over the remaining points were observed ( P > 0.05 ) . Finally , patients in the WATER program showed a greater reduction of active TrPs as compared with the CONTROL group ( P < 0.05 ) . CONCLUSIONS An 8-week water therapy program was effective for improving neck and shoulder/axillary pain , and reducing the presence of TrPs in breast cancer survivors as compared with usual care ; however , no significant changes in widespread pressure pain hyperalgesia were found Background : High insulin and insulin-like growth factor-I ( IGF-I ) levels may be associated with an increased breast cancer risk and /or death . Given the need to identify modifiable factors that decrease insulin , IGF-I , and breast cancer risk and death , we investigated the effects of a 6-month r and omized controlled aerobic exercise intervention versus usual care on fasting insulin , IGF-I , and its binding protein ( IGFBP-3 ) in postmenopausal breast cancer survivors . Methods : Seventy-five postmenopausal breast cancer survivors were identified from the Yale-New Haven Hospital Tumor Registry and r and omly assigned to an exercise ( n = 37 ) or usual care  ( n = 38 ) group . The exercise group participated in 150 minutes per week of moderate-intensity aerobic exercise . The usual care group was instructed to maintain their current physical activity level . A fasting blood sample was collected on each study participant at baseline and 6 months . Blood levels of insulin and IGF were measured with ELISA . Results : On average , exercisers increased  aerobic exercise  by 129 minutes per week compared with 45 minutes per week among usual care participants ( P < 0.001 ) . Women r and omized to exercise experienced decreases in insulin , IGF-I , and IGFBP-3 , whereas women r and omized to usual care had increases in these hormones . Between-group differences in insulin , IGF-I , and IGFBP-3 were 20.7 % ( P = 0.089 ) , 8.9 % ( P = 0.026 ) , and 7.9 % ( P = 0.006 ) , respectively . Conclusions : Moderate-intensity aerobic exercise , such as brisk walking , decreases IGF-I and IGFBP-3 . The exercise-induced decreases in IGF may mediate the observed association between higher levels of physical activity and improved survival in women diagnosed with breast cancer . ( Cancer Epidemiol Biomarkers Prev 2009;18(1):306–13 The aim of this study was to evaluate the effects of scapular stabilization exercise ( SSE ) on pain intensity , pressure pain threshold ( PPT ) , muscle tension and anxiety in patients with scapulocostal syndrome ( SCS ) . Thirty-six patients were r and omly assigned to receive a 30-minute session of either SSE or control ( relaxed by lying supine quietly ) for 12 sessions over a period of 4 weeks . Pain intensity , PPT , muscle tension and anxiety were assessed before and after a 4-week intervention period and 2 weeks after the intervention period . The adverse effects were evaluated after completion of the intervention period . Results indicated that the SSE group showed a significant improvement in all parameters after the intervention period and at 2 weeks after the intervention period ( p < 0.05 ) . For all outcomes , similar changes were not found in the control group . The adjusted post-test mean values of each assessment time point for pain intensity , muscle tension and anxiety were significantly lower in the SSE group than those of the control group ( p < 0.05 ) . Moreover , the values for PPT were significantly higher in the SSE group ( p > 0.05 ) . There were no reports of adverse effects in either group . We therefore conclude that SSE can improve pain related parameters and could be an effective intervention for SCS OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity Summary Cold pressor pain and exercise causes multisegmental increases in pressure pain thresholds . Exercise is dominated by local manifestations of hypoalgesia , whereas cold pressor pain results generally in remote hypoalgesia . ABSTRACT Pain inhibitory mechanisms are often assessed by paradigms of exercise‐induced hypoalgesia ( EIH ) and conditioned pain modulation ( CPM ) . In this study it was hypothesized that the spatial and temporal manifestations of EIH and CPM were comparable . The participants were 80 healthy subjects ( 40 females ) , between 18 and 65 years of age in this r and omized , repeated‐ measures cross‐over trial that involved data collection on 2 different days . CPM was assessed by 2 different cold pressor tests ( h and and foot ) . EIH was assessed by 2 intensities of aerobic bicycling exercises and 2 intensities of isometric muscle contraction exercises ( arm and leg ) . Pressure pain thresholds ( PPTs ) were recorded before , during , after , and 15 minutes after conditioning/exercise at sites local to and remote from the extremity used for cold pressor stimulation and exercise . PPTs increased at local as well as at remote sites during both cold pressor tests and after all of the exercise conditions except low‐intensity bicycling . EIH after bicycling was higher in women than in men . CPM and the EIH responses after isometric exercises were comparable in men and women and were not affected by age . The EIH response was larger in the exercising body part compared with nonexercising body parts for all exercise conditions . High‐intensity exercise produced greater EIH responses than did low‐intensity exercise . The change in PPTs during cold pressor tests and the change in PPTs after exercises were not correlated . The CPM response was not dominated by local manifestations , and the effect was seen only during the stimulation , whereas exercise had larger local manifestations , and the effects were also found after exercise OBJECTIVE This prospect i ve study examined circulating cytokines in patients with fibromyalgia ( FM ) over 6 months rather than at only one timepoint , and investigated correlations between serum cytokine concentrations and pain intensity in FM patients receiving multidisciplinary pain therapy .  METHODS Serum concentrations of proinflammatory cytokines interleukin 6 ( IL-6 ) , IL-8 , and tumor necrosis factor-alpha ( TNF-alpha ) and antiinflammatory cytokines IL-4 and IL-10  were measured ( Bio-Plex system ) in 20 FM patients and 80 healthy subjects on admission and 10 , 21 , and 180 days after initiation of treatment and correlated to pain intensity . RESULTS On admission , serum levels of IL-8 ( p < 0.001 ) and TNF-alpha ( p < 0.001 ) , but not IL-6 , were elevated in patients with FM . No significant difference in IL-4 and IL-10 was found between FM patients and controls . High IL-8 levels remained consistent during the followup , but TNF-alpha was already reduced after 10 days and until 6 months after therapy . After 6 months ' treatment with multidisciplinary pain therapy , IL-8 and TNF-alpha levels were significantly lower than at the beginning ( p < 0.05 for IL-8 , p < 0.001 for TNF-alpha ) . IL-8 but not TNF-alpha serum levels were correlated with pain intensity ( r = -0.782 , p = 0.001 ) in FM patients after 6 months ' multidisciplinary pain therapy . CONCLUSION Our results suggest that proinflammatory cytokines TNF-alpha and IL-8 are involved in FM , but they do not apparently provoke the pain of FM directly . Multidisciplinary pain therapy modified the cytokine profile in patients with FM during the observation period OBJECTIVES The purpose of this study was to investigate the effects of electrotherapy and exercise on pain intensity and mobility of connective tissue in patients with myofascial pain syndrome ( MPS ) in their cervical region . METHODS 60 patients were divided into 3 groups using a r and om allocation programme method . A hotpack was applied , and ultrasound was carried out on the patients 
    Output:
    
Visual analogue scale pain intensity ratings and the number of myofascial trigger points present in the neck and shoulder/axillary area of participants significantly decreased in the exercise group compared to those in the control group .
Pain pressure thresholds significantly increased in muscle areas of the cervical spine in the water exercise group .
Aerobic exercise presents a potential treatment modality for managing myofascial pain .