***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 Glucosamine and chondroitin sulfate are used to treat osteoarthritis . The multicenter , double-blind , placebo- and celecoxib-controlled Glucosamine/chondroitin Arthritis Intervention Trial ( GAIT ) evaluated their efficacy and safety as a treatment for knee pain from osteoarthritis . METHODS We r and omly assigned 1583 patients with symptomatic knee osteoarthritis to receive 1500 mg of glucosamine daily , 1200 mg of chondroitin sulfate daily , both glucosamine and chondroitin sulfate , 200 mg of celecoxib daily , or placebo for 24 weeks . Up to 4000 mg of acetaminophen daily was allowed as rescue analgesia . Assignment was stratified according to the severity of knee pain ( mild [ N=1229 ] vs. moderate to severe [ N=354 ] ) . The primary outcome measure was a 20 percent decrease in knee pain from baseline to week 24 . RESULTS The mean age of the patients was 59 years , and 64 percent were women . Overall , glucosamine and chondroitin sulfate were not significantly better than placebo in reducing knee pain by 20 percent . As compared with the rate of response to placebo ( 60.1 percent ) , the rate of response to glucosamine was 3.9 percentage points higher ( P=0.30 ) , the rate of response to chondroitin sulfate was 5.3 percentage points higher ( P=0.17 ) , and the rate of response to combined treatment was 6.5 percentage points higher ( P=0.09 ) . The rate of response in the celecoxib control group was 10.0 percentage points higher than that in the placebo control group ( P=0.008 ) . For patients with moderate-to-severe pain at baseline , the rate of response was significantly higher with combined therapy than with placebo ( 79.2 percent vs. 54.3 percent , P=0.002 ) . Adverse events were mild , infrequent , and evenly distributed among the groups . CONCLUSIONS Glucosamine and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with osteoarthritis of the knee . Exploratory analyses suggest that the combination of glucosamine and chondroitin sulfate may be effective in the subgroup of patients with moderate-to-severe knee pain . ( Clinical Trials.gov number , NCT00032890 . ) The aim of this study was to verify the clinical responses to Thai massage ( TM ) and Thai herbal compression ( THC ) for treating osteoarthritis ( OA ) of the knee in comparison to oral ibuprofen . This study was a r and omized , evaluator-blind , controlled trial . Sixty patients with OA of the knee were r and omly assigned to receive either a one-hour session of TM or THC ( three times weekly ) or oral ibuprofen ( three times daily ) . The duration of treatment was three weeks . The clinical assessment s included visual analog scale assessing pain and stiffness , Lequesne 's functional index , time for climbing up ten steps , and physician 's and patient 's overall opinions on improvement . In a within-group comparison , each treatment modality caused a significant improvement of all variables determined for outcome assessment s. In an among group comparison , all modalities provided nearly comparable clinical efficacy after a three-week symptomatic treatment of OA of the knee , in which a trend toward greatest improvement was likely to be found in THC group . In conclusion , TM and THC generally provided comparable clinical efficacy to oral ibuprofen after three weeks of treatment and could be considered as complementary and alternative treatments for OA of the knee Objective . Two studies evaluated efficacy and safety of tanezumab versus naproxen for treatment of knee or hip osteoarthritis ( OA ) . Methods . R and omized controlled studies [ NCT00830063 ( Study 1015 , n = 828 ) and NCT00863304 ( Study 1018 , n = 840 ) ] of subjects with hip or knee OA compared intravenous tanezumab ( 5 mg or 10 mg ) to placebo and naproxen ( 500 mg twice daily ) . Co primary outcomes were Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) Pain , WOMAC Physical Function ( 0–10 numerical rating scale ) , and patient ’s global assessment of OA at Week 16 . Results . In both studies , tanezumab  reduced pain versus placebo [ least squares mean differences , 95 % CI , tanezumab 5 mg : −1.21 ( −1.72 , −0.70 ) ; −1.13 ( −1.65 , −0.62 ) ; tanezumab 10 mg : −0.91 ( −1.42 , −0.40 ) ; −0.80 ( −1.32 , −0.29 ) ] , and improved function and global scores . Tanezumab 5 mg produced greater pain reduction [ −0.76 ( −1.28 , −0.25 ) ; −0.69 ( −1.21 , −0.17 ) ] , and favorable functional and global outcomes versus naproxen  . Pain reductions with tanezumab 10 mg versus naproxen did not reach significance , unlike functional ( both studies ) and global ( 1 study ) outcomes ; thus , tanezumab 10 mg was not superior to naproxen , and predefined statistical testing procedures were not met , allowing for conclusion of superiority of tanezumab 5 mg over naproxen despite replicated favorable co primary outcomes . Tanezumab was associated with greater incidence of peripheral sensory adverse events ( paresthesia , hyperesthesia , hypoesthesia , burning sensation ) , pain in extremity , peripheral edema , and arthralgia . Overall frequency and discontinuations as a result of adverse events were similar to placebo and naproxen . Conclusion . Tanezumab provides efficacious treatment of knee or hip OA and may have therapeutic utility in patients with OA who experience inadequate analgesia with nonsteroidal antiinflammatory drugs Purpose Osteoarthritic pain is largely considered to be inflammatory pain . Sensory nerve fibers innervating the knee have been shown to be significantly damaged in rat models of knee osteoarthritis ( OA ) in which the subchondral bone junction is destroyed , and this induces neuropathic pain ( NP ) . Pregabalin was developed as a pain killer for NP ; however , there are no reports on pregabalin use in OA patients . The purpose of this study was to investigate the efficacy of pregabalin for pain in OA patients . Material s and Methods Eighty-nine knee OA patients were evaluated in this r and omized prospect i ve study . Patients were divided into meloxicam , pregabalin , and meloxicam+pregabalin groups . Pain scores were evaluated before and 4 weeks after drug application using a visual analogue scale ( VAS ) , and Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Pain scales among groups were compared using a Kruskal-Wallis test . Results Before drug application , there was no significant difference in VAS and WOMAC scores among the three groups ( p>0.05 ) . Significant pain relief was seen in the meloxicam+pregabalin group in VAS at 1 , 2 , and 4 weeks , and WOMAC score at 4 weeks , compared with the other groups ( p<0.05 ) . No significant pain relief was seen in the meloxicam only group in VAS during 4 weeks and WOMAC score at 4 weeks compared with the pregabalin only group ( p>0.05 ) . Conclusion Meloxicam+pregabalin was effective for pain in OA patients . This finding suggests that OA pain is a combination of inflammatory and NP OBJECTIVE To assess the efficacy and safety of 12-week treatment with ketoprofen in ultradeformable phospholipid vesicles in patients with OA knee pain and to compare the efficacy with that of ketoprofen-free vehicle and celecoxib . METHODS ; A multicentre , double-blind controlled study in which patients with knee OA and moderate pain were r and omized to one of the six arms : topical ketoprofen 50 or 100 mg in ultradeformable vesicles ( IDEA-033 ) , 2.2 or 4.4 g ketoprofen-free vehicle ( TDT 064 ) , oral celecoxib 100 mg or matching oral placebo , all bd . The primary outcome was change from baseline in the WOMAC pain subscale at week 12 . RESULTS A total of 1395 patients received treatment .  Baseline mean WOMAC pain scores ranged from 4.7 to 4.8 across groups . The mean reduction in WOMAC pain score at week 12 was -1.9 ( -40.8 % ) for ketoprofen 50 mg , -1.9 ( -40.9 % ) for ketoprofen 100 mg , -1.9 ( -39.8 % ) for 2.2 g TDT 064 , -1.8 ( -37.8 % ) for 4.4 g TDT 064 , -1.9 ( -40.4 % ) for celecoxib and -1.4 ( -29.3 % ) for oral placebo . IDEA-033 was not statistically superior to TDT 064 . All topical treatments were statistically superior to oral placebo and non-inferior to celecoxib . The most frequent types of treatment-related adverse events reported were gastrointestinal for oral ( 15.9 % for celecoxib ) and dermal for topical applications ( 12.2 % for ketoprofen 100 mg ) . CONCLUSION IDEA-033 was not superior to ketoprofen-free vehicle , but both formulations were superior to oral placebo and non-inferior to celecoxib in reducing OA knee pain . TRIAL REGISTRATION Clinical Trials.gov , http:// clinical trials.gov/ , NCT00716547 OBJECTIVE To evaluate the efficacy and tolerability of aceclofenac , 200 mg/day , and paracetamol , 3000 mg/day , in the treatment of osteoarthritis ( OA ) of the knee . METHODS This was a double-blind , parallel-group , multicentre clinical trial involving patients with symptomatic OA of the knee , conducted in Spain . Patients were r and omly allocated to aceclofenac 100 mg twice daily ( n=82 ) or paracetamol 1000 mg three times daily ( n=86 ) . Patients were assessed at baseline and 6 weeks . Primary efficacy measures were severity of pain ( visual analogue scale , VAS ) , Lequesne OA knee index , and patient 's and physician 's global assessment of disease activity . Severity of knee pain at rest or walking , stiffness , knee swelling and tenderness , and assessment of health-related quality of life ( Health Assessment Question naire , Western Ontario and McMaster Universities Osteoarthritis Index , and Short Form 36 ) were included as secondary endpoints . RESULTS Both treatment groups showed significant improvement compared with their baseline values in the four primary endpoints . Mean between-treatment differences favoured aceclofenac over paracetamol on pain ( VAS , 7.64 mm [ 95 % confidence interval ( CI ) , 0.44 - 14.85 mm ] ) , Lequesne OA index ( 1.41 [ 95 % CI , 0.45 - 2.36 ] ) , and patient 's ( 0.33 [ 95 % CI , 0.06 - 0.61 ] ) and physician 's ( 0.23 [ 95 % CI , 0.01 - 0.47 ] ) global assessment s. Adverse events were similar for both drugs ( paracetamol , 29 % patients vs aceclofenac , 32 % ; P=0.71 ) . Four patients withdrew in each group due to adverse events . Patients tended to prefer aceclofenac to paracetamol ( P=0.001 ) , and more treated with paracetamol withdrew from the study due to lack of efficacy ( n=8 vs n=1 , P=0.035 , for paracetamol and aceclofenac , respectively ) . CONCLUSION At 6 weeks , patients with symptomatic OA of the knee showed a greater improvement in pain and functional capacity with aceclofenac than paracetamol with no difference in tolerability The aim of this 13-week , multicenter , r and omized , double-blind , double-dummy , placebo- and positive-internal (celecoxib)-controlled , parallel-group study was to demonstrate the efficacy , safety , and tolerability of lumiracoxib in primary hip osteoarthritis ( OA ) patients . Eligible patients ( n = 1,262 ; ACR criteria ) were r and omized ( 1:1:1 ) to receive lumiracoxib 100 mg once daily ( o.d . ) ( n = 427 ) , celecoxib 200 mg o.d . ( n = 419 ) , or matching placebo o.d . ( n = 416 ) administered orally . The primary objective was to compare lumiracoxib 100 mg o. 
    Output:
    
The effects of oral NSAIDs , COX-2 inhibitors , and opioids in controlling pain were similar to what has been demonstrated in previous literature .
Topical NSAIDs were found to have a greater RC than oral NSAIDs