***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: Background : Pain following spinal cord injury ( SCI ) is a therapeutic challenge . Only a few treatments have been assessed in r and omized , controlled trials . The primary objective of the present study was to examine the analgesic effect of ketamine and lidocaine in a group of patients with neuropathic pain below the level of spinal cord injury . We also wanted to assess sensory abnormalities to see if this could help us to identify responders and if treatments result ed in changes of sensibility Study design : A r and omized , double-blind , placebo-controlled , crossover , multicenter trial . A 1-week baseline period was followed by two treatment periods of 5 weeks duration with levetiracetam increased from 500 mg b.i.d . to a maximum of 1500 mg b.i.d . separated by a 1-week washout period . Objectives : The objective of the study was primarily to evaluate the efficacy of the anticonvulsant levetiracetam in patients with spinal cord injury ( SCI ) at- and below-level pain and secondarily to evaluate the effect on spasm severity . Setting : Out patients at two spinal cord units and a pain center . Methods : Patients were allowed to continue their usual pain treatment at a constant dose . The primary outcome measure was the change in median daily pain score ( on a 0–10 point numeric rating scale ) from 1-week baseline period to the last week of each treatment period . Secondary outcome measures included pain relief of at- and below-level pain , allodynia , spasms and spasticity . Results : A total of 36 patients with SCI at- and or below-level pain were enrolled . Of these , 24 patients completed the trial . We found no effect of levetiracetam on the primary ( P=0.46 ) or any of the secondary outcome measures . Only two patients continued levetiracetam treatment following the trial , and one patient was still in levetiracetam treatment at the 6-month follow-up . Levetiracetam was generally well tolerated with no serious adverse events . Conclusions : Levetiracetam does not relieve neuropathic pain or spasm severity following spinal cord injury Abstract Objective To investigate the analgesic effect of repetitive transcranial magnetic stimulation ( rTMS ) on intractable neuropathic pain in patients with spinal cord injury ( SCI ) . Design A single center , prospect i ve , r and omized , double-blinded , controlled study . Setting SCI rehabilitation unit of university rehabilitation center . Participants Seventeen patients with SCI and chronic neuropathic pain who met the inclusion criteria recruited between April 2010 and January 2012 . Interventions Ten daily treatment sessions of real or sham rTMS ( 30 trains of 10-Hz stimuli for a duration of 5 seconds ; a total of 1500 pulses at intensity equal to 110 % of the resting motor threshold ) was applied over vertex using a ﬁgure-of-8-shaped coil . Outcome measures Pain was assessed with visual analog scale ( VAS ) at baseline and 10 days , 6 weeks and 6 months after the treatment . Patients ’ satisfactions obtained using a 5-point Likert scale at 6 months . Results Both real and sham rTMS provided a significant reduction in the VAS scores  ( real rTMS group , P = 0.004 ; sham rTMS group , P = 0.020 ) . Post hoc analysis revealed the significant difference was at 10 days and 6 weeks compared to baseline in the real rTMS group and only at 10 days compared to baseline in the sham rTMS  group . Comparison of VAS scores and patient satisfaction did not show any significant difference at each assessment point ( P > 0.05 ) . Conclusion Our results demonstrated analgesic effect of rTMS on intractable neuropathic pain in SCI was not superior to placebo . However , middle-term ( over 6 weeks ) pain relief by rTMS is encouraging and suggests the need for future studies with a larger sample size & NA ; Dysesthetic pain following traumatic myelopathy is characterized by diffuse burning and tingling sensations distal to the level of spinal injury . The dysesthetic pain syndrome ( DPS ) can compromise performance of functional abilities and inhibit participation in rehabilitation programs . Recent laboratory evidence suggests that antidepressant medications with selective inhibition of serotonin reuptake in the brain may be associated with superior analgesic effect compared to such non‐selective agents as amitriptyline . Trazodone hydrochloride is a potent presynaptic serotonin reuptake blocker with few anticholinergic and cardiovascular side effects . This study was a r and omized , double‐blind , placebocontrolled trial of trazodone hydrochloride for the treatment of DPS . Following a 2‐week placebo lead‐in period , patients were r and omized to a 6‐week course of 150 mg trazodone hydrochloride/day or placebo .  Evaluations of pain quality and intensity were performed at 2‐week intervals , utilizing the McGill Pain Question naire , Sternbach Pain Intensity Scale , and Zung Pain and Distress Index . Neurologic examination and assessment of side effects were performed at each evaluation session . No significant changes were noted in reported pain measures between patients allocated to the active drug group and those given placebo during the course of the protocol . However , significantly more patients r and omized  to trazodone complained of side effects and prematurely terminated their participation in the study . The results of this investigation are consistent with those of other earlier trials which indicate that such antidepressant medications as trazodone hydrochloride which selectively inhibit presynaptic reuptake of serotonin , may not be effective in the control of certain pain syndromes . These results do not preclude the possible utility of these agents in the treatment of other pain syndromes or at higher doses than previously studied Summary A multidisciplinary cognitive behavioral program might have beneficial effects on people with chronic neuropathic spinal cord injury pain . ABSTRACT Many people with spinal cord injury ( SCI ) rate chronic neuropathic pain as one of the most difficult problems to manage . The aim of the CONECSI ( COping with NEuropathiC Spinal cord Injury pain ) trial was to evaluate a multidisciplinary cognitive behavioral treatment program for persons with chronic neuropathic pain after SCI . The intervention consisted of educational , cognitive , and behavioral elements .  A total of 61 people were r and omized to either the intervention group or the waiting list control group in 4 Dutch rehabilitation centers . Primary outcomes were pain intensity and pain‐related disability ( Chronic Pain Grade question naire ) , and secondary outcomes were mood ( Hospital Anxiety and Depression Scale ) , participation in activities ( Utrecht Activities List ) , and life satisfaction ( Life Satisfaction Question naire ) . Measurements were performed at baseline , and at 3 , and 6 months follow‐up . The primary statistical technique was r and om coefficient analysis . The analyses showed significant changes over time on both primary ( t1–t2 ) , and 2 out of 4 secondary outcomes ( both t1–t2 and t1–t3 ) . Significant intervention effects ( Time * Group interactions ) were found for anxiety and participation in activities , but not for the primary outcomes . Subsequent paired t tests showed significant changes in the intervention group that were not seen in the control group : decrease of pain intensity , pain‐related disability , anxiety , and increase of participation in activities . This study implies that a multidisciplinary cognitive behavioral program might have beneficial effects on people with chronic neuropathic SCI pain Background : Central pain in multiple sclerosis ( MS ) is common and often refractory to treatment . Methods : We conducted a single-center , 5-week ( 1-week run-in , 4-week treatment ) , r and omized , double-blind , placebo-controlled , parallel-group trial in 66 patients with MS and central pain states ( 59 dysesthetic , seven painful spasms ) of a whole-plant cannabis-based medicine ( CBM ) , containing delta-9-tetrahydrocannabinol : cannabidiol ( THC : CBD ) delivered via an oromucosal spray , as adjunctive analgesic treatment . Each spray delivered 2.7 mg of THC and 2.5 of CBD , and patients could gradually self-titrate to a maximum of 48 sprays in 24 hours . Results : Sixty-four patients ( 97 % ) completed the trial , 34 received CBM . In week 4 , the mean number of daily sprays taken of CBM ( n = 32 ) was 9.6 ( range 2 to 25 , SD = 6.0 ) and of placebo ( n = 31 ) was 19.1 ( range 1 to 47 , SD = 12.9 ) . Pain and sleep disturbance were recorded daily on an 11-point numerical rating scale . CBM was superior to placebo in reducing the mean intensity of pain ( CBM mean change −2.7 , 95 % CI : −3.4 to −2.0 , placebo –1.4 95 % CI : −2.0 to −0.8 , comparison between groups , p = 0.005 ) and sleep disturbance ( CBM mean change –2.5 , 95 % CI : −3.4 to −1.7 , placebo –0.8 , 95 % CI : −1.5 to −0.1 , comparison between groups , p = 0.003 ) . CBM was generally well tolerated , although more patients on CBM than placebo  reported dizziness , dry mouth , and somnolence . Cognitive side effects were limited to long-term memory storage . Conclusions : Cannabis-based medicine is effective in reducing pain and sleep disturbance in patients with multiple sclerosis related central neuropathic pain and is mostly well tolerated UNLABELLED Central poststroke pain ( CPSP ) is caused by an encephalic vascular lesion of the somatosensory pathways and is commonly refractory to current pharmacologic treatments . Repetitive transcranial magnetic stimulation ( rTMS ) of the premotor cortex/dorsolateral prefrontal cortex ( PMC/DLPFC ) can change thermal pain threshold toward analgesia in healthy subjects and has analgesic effects in acute postoperative pain as well as in fibromyalgia patients . However , its effect on neuropathic pain and in CPSP , in particular , has not been assessed . The aim of this prospect i ve , double-blind , placebo-controlled study was to evaluate the analgesic effect of PMC/DLPFC rTMS in CPSP patients . Patients were r and omized into 2 groups , active ( a- ) rTMS and sham ( s- ) rTMS , and were treated with 10 daily sessions of rTMS over the left PMC/DLPFC ( 10 Hz , 1,250 pulses/d ) . Outcomes were assessed at baseline , during the stimulation phase , and at 1 , 2 , and 4 weeks after the last stimulation . The main outcome was pain intensity changes measured by the visual analog scale on the last stimulation day compared to baseline . Interim analysis was scheduled when the first half of the patients completed the study . The study was terminated because of a significant lack of efficacy of the active arm after 21 patients completed the whole treatment and follow-up phases . rTMS of the left PMC/DLPFC did not improve pain in CPSP . PERSPECTIVE The aim of this double-blind , placebo-controlled study was to evaluate the analgesic effects of rTMS to the PMC/DLPFC in CPSP patients . An interim analysis showed a consistent lack of analgesic effect , and the study was terminated . rTMS of the PMC/DLPFC is not effective in relieving CPSP Summary In a r and omized sham‐controlled crossover study , transcranial direct current stimulation over the primary motor cortex did not provide relief for long‐st and ing neuropathic spinal cord injury pain . Abstract Neuropathic pain remains one of the most difficult consequences of spinal cord injury ( SCI ) to manage . It is a major cause of suffering and adds to the physical , emotional , and societal impact of the injury . Despite the use of the best available treatments , two thirds of people experiencing neuropathic pain after SCI do not achieve satisfactory pain relief . This study was undertaken in response to a recent clinical trial reporting short‐term , clinical ly significant reductions in neuropathic SCI pain with primary motor cortex transcranial direct current stimulation ( tDCS ) . In this investigation , we aim ed to build on this previous clinical trial by extending the assessment period to determine the short‐ , medium‐ , and long‐term efficacy of tDCS for the treatment of neuropathic pain after SCI . We found that , contrary to previous reports , after 5 tDCS treatment periods , mean pain intensity and unpleasantness rating were not significantly different from initial assessment . That is , in this trial tDCS did not provide any pain relief in subjects with neuropathic SCI pain ( n = 10 ) . A similar lack of effect was also seen after sham treatment . Because the injury duration in this study was significantly greater than that of previous investigations , it is possible that tDCS is an effective analgesic only in individuals with relatively recent injuries and pain . Future investigations comparing a range of injury duration s are required if we are to determine whether this is indeed the case Abstract Background Chronic pain is a significant problem for many individuals following spinal cord injury ( SCI ) . Unfortunately , SCI-related neuropathic pain has proven to be largely refractory to analgesic medications and other available treatments . Cranial electrotherapy stimulation ( CES ) has been effective in managing some types of pain . It involves the application of a small amount of current through the head via ear clip electrodes . Objective Explore the effectiveness of CES for neuropathic pain in persons with SCI and chronic pain . Study design Multi-site , double-blind , sham-controlled study . Participants Adults with SCI and chronic neuropathic pain at or below the level of injury were r and omized to receive active or sham CES . Intervention Application 
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In a planned sub analysis , the severity of damage in the spinal cord also had no significant effect on the placebo response .