***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: & NA ; In the double‐blind placebo‐controlled study presented here , the effects were investigated of a low dose of amitriptyline ( 75 mg ) in patients with chronic pain of various origins . The active drug was superior to placebo in reducing pain intensity . The reduction was small . In the second treatment week , the  amitriptyline  treated patients slept longer . No differences between active drug and placebo were found with respect to daily activities or use of analgesics . Based on our data and those of other studies , it is concluded that amitriptyline ( and other antidepressants ) in low doses does have a positive effect on the intensity and some other aspects of chronic pain , but that the effect is modest . It must be kept in mind that chronic pain is a very treatment‐resistant condition . Therefore , even modest positive effects may be worthwhile The analgesic efficacy of amitriptyline 25 mg was compared with placebo in 41 patients with chronic ( more than 3 months ) nonmalignant pain , using a double‐blind r and omised multiple‐dose 3‐week treatment period crossover design . Amitriptyline 25 mg provided significantly greater efficacy than placebo , with significant differences evident within the first week . There was no significant difference on mood scores between amitriptyline and placebo . The results suggest that surprisingly low doses of amitriptyline may be effective without substantial adverse effects , that the effect is evident early , and that the effect is distinguishable from any effect of the amitriptyline on mood R and omized clinical trials of amitriptyline will require data from pilot studies to be used for sample size estimates , but such data are lacking . This study investigated the 6-week and 1-year effectiveness of low dose amitriptyline ( 10 - 30 mg ) for the treatment of patients with chronic temporom and ibular disorder ( TMD ) pain . Based on clinical examination , patients were divided into two groups : myofascial and mixed ( myofascial and temporom and ibular joint disorders ) .  Baseline pain was assessed by a Visual Analogue Scale ( VAS ) for pain intensity and by the McGill Pain Question naire ( MPQ ) . Depression was assessed by the Beck Depression Inventory ( BDI ) short form . Patient assessment of global treatment effectiveness was obtained after 6 weeks and 1 year of treatment by using a five-point ordinal scale : ( 1 ) worse , ( 2 ) unchanged , ( 3 ) minimally improved , ( 4 ) moderately improved , ( 5 ) markedly improved . The results showed a significant reduction for all pain scores after 6 weeks and 1 year post-treatment . The depression scores changed in depressed but not in non-depressed patients . Global treatment effectiveness showed significant improvement 6 weeks and 1 year post-treatment . However , pain and global treatment effectiveness were less improved at 1 year than at 6 weeks ABSTRACT Temporom and ibular disorder ( TMD ) is characterized by a combination of symptoms affecting the temporom and ibular joint and /or chewing muscles . The two most common clinical TMD symptoms are pain and dysfunction . Pain is usually caused by dysfunction , and emergency therapy has focused on controlling it . Recent investigations into TMD have led to the recommendation of antidepressants as a supporting treatment against constant neuralgic pain . The aim of this double-blind study was to verify the efficiency of antidepressants ( amitriptyline ) as a support in the treatment of chronic TMD pain .  Twelve female volunteers presenting chronic TMD pain were divided into two groups and treated for 14 days : Group 1 with 25 mg/day of amitriptyline and Group 2 with a placebo . The intensity of pain and discomfort was evaluated daily , using a visual analog scale ( VAS ) , over a period of seven days preceding the treatment ( baseline ) , during the 14-day treatment , and for seven days after the treatment . The results revealed a significant reduction of pain and discomfort in Group 1 ( 75 % ) compared to Group 2 ( 28 % ) during the three weeks beginning at baseline ( p < 0.01 ) . Amitriptyline proved to be an efficient alternative treatment for chronic pain in TMD patients OBJECTIVES To determine the individual and combined effects of potential risk factors in relation to the temporom and ibular disorder , Pain Dysfunction Syndrome ( PDS ) . DESIGN Case-control study . MATERIAL AND METHODS Cases were new referrals to the temporom and ibular disorder clinic of the University Dental Hospital of Manchester , diagnosed with PDS . Controls were r and omly selected from 24 dental practice s. Using a postal question naire information was collected on socio-demographic , local mechanical , psychological factors , co-morbidities and illness behaviour . The adjusted participation rate was similar in cases and controls ( 64 % ) , and 131 cases and 196 controls finally participated in the study . RESULTS Compared with the controls , the cases were more likely to report that their teeth felt as though they did not fit together properly [ odds ratio ( OR ) 8 , 95 % Confidence Interval ( CI ) 6 - 13 ] and report history of facial trauma ( OR 3 , 95 % CI 2 - 6 ) . Both diurnal and nocturnal grinding were significantly associated with PDS , and individuals who reported grinding their teeth both during the day and at night had a risk of 6 ; 95 % CI 3 - 13 for PDS compared with those who did not . A history of orthodontic treatment , having any dentures , having missing teeth , use of chewing gum or biting the fingernails did not show any relationship with PDS . People who took medication for the bowels had a higher risk of PDS ( OR 2 , 95 % CI 1 - 4 ) . Participants with frequent headaches had a threefold increase in risk of having PDS ( OR 3 , 95 % CI 2 - 5 ) while having pain in parts of the body other than the head was associated with an OR of 3 ( 95 % CI 2 - 5 ) . An increased propensity to have PDS was seen in those individuals with higher levels of psychological distress ( OR 3 ; 95 % CI 1 - 4 in the highest category , test for trend P < 0.001 ) and sleep disturbance ( OR 5 ; 95 % CI 2 - 94 in the highest category , test for trend P < 0.001 ) . Aspects of illness behaviour , such as disease conviction ( OR 4 ; 95 % CI 2 - 9 in the highest category ) and perception of illness ( 0.3 ; 95 % CI 0.2 - 0.5 ) were associated with PDS . The result for the denial scale became statistically significant after adjustment for age and gender ( 2 ; 95 % CI 1 - 3 ) . CONCLUSIONS The current case-control study provides complementary epidemiological information on oro-facial pain ( OFP ) and supports a multifactorial aetiology of PDS , with factors from many domains , including local mechanical factors , psychological and co-morbidities . People with PDS  were characterized by frequent headaches , history of facial trauma , teeth grinding , sleep problems , pain elsewhere in the body and high levels of psychological distress . From the results of current study and available evidence it seems inappropriate to consider PDS in isolation and future research should adopt a multidisciplinary approach to OFP OBJECTIVE The objective of this study was to assess the effectiveness of low-level laser therapy ( LLLT ) in the management of temporom and ibular joint ( TMJ ) pain  in a r and om and double-blind research design . STUDY DESIGN TMJ pain patients , r and omly assigned , received 2 to 3 treatments per week for 8 weeks of active LLLT ( Helium Neon , 632.8 nm , 30 mW ) ( n = 26 ) or sham LLLT ( n = 26 ) . Measures of TMJ pain during function were evaluated at baseline and weeks 2 , 4 , and 8 after the first laser therapy . RESULTS At the 8-week point , within-group improvements were present for TMJ pain during function , for both the active and sham LLLT groups ( P = .000 ) . Between-group differences were not highly evident ( P > .05 ) . CONCLUSION The study suggests that LLLT is not better than placebo at reducing TMJ pain during function 
    Output:
    
Following analysis of the articles , and in function of their scientific quality , a type B recommendation is given in favor of the use of tricyclic antidepressants for the treatment of temporom and ibular disorders