***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: Objective To evaluate the clinical effectiveness of low-frequency pulsed electromagnetic field ( PEMF ) therapy for women with fibromyalgia ( FM ) . Methods Fifty-six women with FM , aged 18 to 60 years , were r and omly assigned to either PEMF or sham therapy . Both the PEMF group ( n=28 ) and the sham group ( n=28 ) participated in therapy , 30 minutes per session , twice a day for 3 weeks . Treatment outcomes were assessed by the fibromyalgia Impact question naire ( FIQ ) , visual analog scale ( VAS ) , patient global assessment of response to therapy , Beck Depression Inventory ( BDI ) , and Short-Form 36 health survey ( SF-36 ) , after treatment ( at 4 wk ) and follow-up ( at 12 wk ) . Results The PEMF group showed significant improvements in FIQ , VAS pain , BDI score , and SF-36 scale in all domains at the end of therapy . These improvements in FIQ , VAS pain , and SF-36 pain score during follow-up . The sham group also showed improvement were maintained on all outcome measures except total FIQ scores after treatment . At 12 weeks follow-up , only improvements in the BDI and SF-36 scores were present in the sham group . Conclusion Low-frequency PEMF therapy might improve function , pain , fatigue , and global status in FM patients The aim of this r and omized controlled single-blind study is to explore whether addition of mud-pack and hot pool treatments to patient education make a significant difference in short and mild term outcomes of the patients with fibromyalgia . Seventy women with fibromyalgia syndrome were r and omly assigned to either balneotherapy with mud-pack and hot pool treatments ( 35 ) or control ( 35 ) groups . After r and omization , five patients from  balneotherapy group and five patients from control group were dropped out from the study with different excuses . All patients had 6-h patient education programme about fibromyalgia syndrome and were given a home exercise programme . The patients in balneotherapy group had heated pool treatment at 38 ° C for 20 min a day , and mud-pack treatment afterwards on back region at 45 ° C . Balneotherapy was applied on weekdays for 2 weeks . All patients continued to take their medical treatment . An investigator who was blinded to the intervention assessed all the patients before and after the treatment , at the first and the third months of follow-up . Outcome measures were FIQ , BDI and both patient ’s and physician ’s global assessment s.  Balneotherapy group was significantly better than control group at after the treatment and at the end of the first month follow-up assessment s in terms of patient ’s and physician ’s global assessment , total FIQ score , and pain intensity , fatigue , non-refreshed awaking , stiffness , anxiety and depression subscales of FIQ . No significant difference was found between the groups in terms of BDI scores . It is concluded that patient education combined with 2 weeks balneotherapy application has more beneficial effects in patients with fibromyalgia syndrome as compared to patient education alone Low energy lasers are widely used to treat a variety of musculoskeletal conditions including fibromyalgia , despite the lack of scientific evidence to support its efficacy . A r and omised , single-blind , placebo-controlled study was conducted to evaluate the efficacy of low-energy laser therapy in 40 female patients with fibromyalgia . Patients with fibromyalgia were r and omly allocated to active ( Ga-As ) laser or placebo laser treatment daily for two weeks except weekends . Both the laser and placebo laser groups were evaluated for the improvement in pain , number of tender points , skinfold tenderness , stiffness , sleep disturbance , fatigue , and muscular spasm . In both groups , significant improvements were achieved in all parameters ( p<0.05 ) except sleep disturbance , fatigue and skinfold tenderness in the placebo laser group ( p>0.05 ) . It was found that there was no significant difference between the two groups with respect to all parameters before therapy whereas a significant difference was observed in parameters as pain , muscle spasm , morning stiffness and tender point numbers in favour of laser group after therapy ( p<0.05 ) . None of the participants reported any side effects . Our study suggests that laser therapy is effective on pain , muscle spasm , morning stiffness , and total tender point number in fibromyalgia and suggests that this therapy method is a safe and effective way of treatment in the cases with fibromyalgia Fibromyalgia is characterized by a range of symptoms that include muscle pain , fatigue and sleep disorders . Transcutaneous electrical nerve stimulation ( TENS ) is an established method for pain relief . The purpose of the study was to evaluate the effectiveness and safety of the use of two simultaneously new TENS devices for fibromyalgia pain . After Ethics approval and informed consent , 39 patients were prospect ively divided into three groups to evaluate TENS device , applied simultaneously in each patient : ( 1 ) at the lower back ( perpendicular to the vertebrae canal , at the level of the 5th lumbar vertebrae ) and ( 2 ) central ly above and below the space between the C7 and T1 spinous processes . The devices were applied for 20 min at 12-h interval during 7 consecutive days . For the placebo group ( PG ) , the devices did not transmitted electrical stimulus . The single-TENS group ( STG ) ( n = 13 ) had one active and one placebo TENS . The DTG applied both active TENS devices at the low back and cervical areas . Diclofenac was used as rescue analgesic . The efficacy measures were pain relief , reduction in use of daily analgesic tablets , quality of sleep and fatigue . The evaluation within groups revealed that patients from DPG refereed no pain relief when compared to their previous VAS pain score ( 8 cm , p > 0.05 ) , while patients from the STG refereed improvement of 2.5 cm in the pain VAS ( previous 8.5 cm compared to 6 cm after treatment ) ( p < 0.05 ) , and the DPG refereed daily maintained reduction of 4 cm in the VAS pain ( previous 8.5–4.3 cm ) ( p < 0.02 ) . Concurrent daily consumption of analgesic tablets was reduced in both STG ( p < 0.05 ) and DTG ( p < 0.02 ) . Comparison among groups revealed that analgesia , as well as quality of sleep and disposition , was DTG > STG > PG ( p < 0.05 ) . Participants subjectively found the active device useful . While the application of a single active TENS improved pain relief in fibromyalgia pain , pain and fatigue were further improved when two active devices were simultaneously applied at the low back and cervical area , with no side effects Introduction Severe fatigue is a major health problem in fibromyalgia ( FM ) . Obesity is common in FM , but the influence of adipokines and growth factors is not clear . The aim was to examine effects of exercise on fatigue , in lean , overweight and obese FM patients . Methods In a longitudinal study , 48 FM patients ( median 52 years ) exercised for 15 weeks .  Nine patients were lean ( body mass index , BMI 18.5 to 24.9 ) , 26 overweight ( BMI 25 to 29.9 ) and 13 obese .  Fatigue was rated on a 0 to 100 mm scale ( fibromyalgia impact question naire [ FIQ ] fatigue ) and multidimensional fatigue inventory ( MFI-20 ) general fatigue ( MFIGF ) . Higher levels in FIQ fatigue and MFIGF indicate greater degree of fatigue . Free and total IGF-1 , neuropeptides , adipokines were determined in serum and cerebrospinal fluid ( CSF ) . Results Baseline FIQ fatigue correlated negatively with serum leptin ( r = -0.345 ; P = 0.016 ) and nerve growth factor ( NGF ; r = -0.412 ; P = 0.037 ) . In lean patients , baseline MFIGF associated negatively with serum resistin ( r = -0.694 ; P = 0.038 ) . FIQ Fatigue associated negatively with CSF resistin ( r = -0.365 ; P = 0.073 ) . Similarly , FIQ fatigue ( r = -0.444 ; P = 0.026 ) and MFIGF correlated negatively with CSF adiponectin ( r = -0.508 ; P = 0.01 ) . In lean patients , FIQ fatigue ( P = 0.046 ) decreased after 15 weeks . After 30 weeks , MFIGF decreased significantly in lean ( MFIGF : P = 0.017 ) , overweight ( MFIGF : P = 0.001 ) , and obese patients ( MFIGF : P = 0.016 ) . After 15 weeks , total IGF-1 increased in lean ( P = 0.043 ) patients . ∆Total IGF-1 differed significantly between lean and obese patients ( P = 0.010 ) . ∆Total IGF-1 related negatively with ∆MFIGF after 15 weeks ( r = -0.329 ; P = 0.050 ) . After 30 weeks , ∆FIQ fatigue negatively correlated with ∆NGF ( r = -0.463 ; P = 0.034 ) and positively with ∆neuropeptide Y ( NPY ) ( r = 0.469 ; P = 0.032 ) . Resistin increased after 30 weeks ( P = 0.034 ) . ∆MFIGF correlated negatively with ∆resistin ( r = -0.346 ; P = 0.031 ) , being strongest in obese patients ( r = -0.815 ; P = 0.007 ) . In obese patients , ∆FIQ fatigue after 30 weeks correlated negatively with ∆free IGF-1 ( r = -0.711 ; P = 0.032 ) . Conclusions Exercise  reduced fatigue  in all FM patients , this effect was achieved earlier in lean patients . Baseline levels of resistin in both serum and CSF associated negatively with fatigue . Resistin was increased after the exercise period which correlated with decreased fatigue . Changes in IGF-1 indicate similar long-term effects in obese patients . This study shows reduced fatigue  after moderate exercise in FM and indicates the involvement of IGF-1 and resistin in these beneficial effects . Trial registration Clinical Trials.gov : The purpose of this study was to investigate the clinical effects of balneotherapy in the treatment of Fibromyalgia Syndrome ( FMS ) and to determine if balneotherapy influences serum levels of inflammation markers , IL-1 , PGE2 and LTB4 . 24 primary fibromyalgia female patients diagnosed according to American College of Rheumatology criteria were included to the study . Their ages ranged between 33 and 55 years . FMS patients were r and omly assigned in two groups as , group 1 ( n = 12 ) and group 2 ( n = 12 ) . Group 1 received 20-min bathing , once in a day for five days per week . Patients participated in the study for 3 weeks ( total of 15 sessions ) in Denizli . Group 2 did not receive balneotherapy . FMS patients were evaluated by tenderness measurements ( tender point count and algometry ) , Visual Analogue Scale , Beck ’s Depression Index , Fibromyalgia Impact Question naire .  Ten healthy women recruited group three as the controls .  Serum PGE2 , LTB4 and IL1-α levels were measured in all three groups . The biochemical measurements and clinical assessment s were performed before and at the end of general period of therapy . Statistically significant alterations in algometric score , Visual Analogue score , Beck ’s Depression Index and PGE2 levels ( P < 0.001 ) , numbers of tender points ( P < 0.01 ) and Fibromyalgia Impact Question naire score ( P < 0.05 ) were found after the balneotherapy between group 1 and 2 . Mean PGE2 level of FMS patients were higher compared to healthy control group ( P < 0.0001 ) and decreased after the treatment period , only in group 1 ( P < 0.05 ) . As in the group 2 and 3 , detectable IL-1 and LTB4 measurements were insufficient , statistical analysis was performed , only in group 1 . After balneotherapy  IL-1 and LTB4 significantly decreased in group 1 ( P < 0.05 ) . In conclusion , balneotherapy is an effective choice of treatment in patients with FMS relieving the clinical symptoms , and possibly influencing the inflammatory mediators Abstract . The purpose of this study was to examine the effectiveness of low power laser ( LPL ) and low-dose amitriptyline therapy and to investigate effects of these therapy modalities on clinical symptoms and quality of life ( QOL ) in patients with fibromyalgia ( FM ) . Seventy-five patients with FM were r and omly allocated to active gallium-arsenide ( Ga-As ) laser ( 25 patients ) , placebo laser ( 25 patients ) , and amitriptyline therapy ( 25 patients ) . All groups were evaluated for the improvement in pain , number of tender points , skin fold tenderness , morning stiffness , sleep disturbance , muscular spasm , and fatigue . Depression was evaluated by a psychiatrist according to the Hamilton Depression Rate Scale and DSM IV criteria . Quality of life of the FM patients was assessed according to the Fibromyalgia Impact Question naire ( FIQ ) . In the laser group , patients were treated for 3 min at each tender point daily for 2 weeks , except weekends , at each point with approximately 2 J/cm2 using a Ga-As laser . The same unit was used for the placebo treatment , for which no laser beam was emitted . Patients in the amitriptyline group took 10 mg daily at bedtime throughout the 8 weeks . Significant 
    Output:
    
LLLT did not reduce VAS scores , but it significantly reduced both the number of tender points and FIQ score .
Thermal therapy was associated with significantly reduced VAS scores , tender points , and FIQ scores .
Electromagnetic field therapy was associated with significantly reduced VAS score and FIQ score .
TENS significantly reduced VAS scores .
Conclusion Our analyses revealed that thermal therapy and LLLT had a partial effect on pain relief in FM patients , and this beneficial effect may have a positive influence on FM patients ' health status