***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 Our objective is to assess the effect of mechanical and manual intermittent cervical traction on pain , use of analgesics and disability during the recent cervical radiculopathy ( CR ) . METHODS We made a prospect i ve r and omized study including patients sent for rehabilitation between April 2005 and October 2006 . Thirty-nine patients were divided into three groups of 13 patients each . A group ( A ) treated by conventional rehabilitation with manual traction , a group ( B ) treated with conventional rehabilitation with intermittent mechanical traction and a third group ( C ) treated with conventional rehabilitation alone . We evaluated cervical pain , radicular pain , disability and the use of analgesics at baseline , at the end and at 1 , 3 and 6 months after treatment . RESULTS At the end of treatment improving of cervical pain , radicular pain and disability is significantly better in groups A and B compared to group C. The decrease in consumption of analgesics is comparable in the three groups . At 6 months improving of cervical and radicular pain and disability is still significant compared to baseline in both groups A and B. The gain in consumption of analgesics is significant in the three groups : A , B and C. CONCLUSION Manual or mechanical cervical traction appears to be a major contribution in the rehabilitation of CR particularly if it is included in a multimodal approach of rehabilitation Background : To date , optimal strategies for the management of patients with cervical radiculopathy remain elusive . Preliminary evidence suggests that a multimodal treatment program consisting of manual therapy , exercise , and cervical traction may result in positive outcomes for patients with cervical radiculopathy . However , limited evidence exists to support the use of mechanical cervical traction in patients with cervical radiculopathy . Objective : The purpose of this study was to examine the effects of manual therapy and exercise , with or without the addition of cervical traction , on pain , function , and disability in patients with cervical radiculopathy . Design : This study was a multicenter r and omized clinical trial . Setting : The study was conducted in orthopedic physical therapy clinics . Patients : Patients diagnosed with cervical radiculopathy ( N=81 ) were r and omly assigned to 1 of 2 groups : a group that received manual therapy , exercise , and intermittent cervical traction ( MT EXTraction group ) and a group that received manual therapy , exercise , and sham intermittent cervical traction ( MTEX group ) . Intervention : Patients were treated , on average , 2 times per week for an average of 4.2 weeks . Measurements : Outcome measurements were collected at baseline and at 2 weeks and 4 weeks using the Numeric Pain Rating Scale ( NPRS ) , the Patient-Specific Functional Scale ( PSFS ) , and the Neck Disability Index ( NDI ) . Results : There were no significant differences between the groups for any of the primary or secondary outcome measures at 2 weeks or 4 weeks . The effect size between groups for each of the primary outcomes was small ( NDI=1.5 , 95 % confidence interval [CI]=−6.8 to 3.8 ; PSFS=0.29 , 95 % CI=−1.8 to 1.2 ; and NPRS=0.52 , 95 % CI=−1.8 to 1.2 ) . Limitations : The use of a nonvali date d clinical prediction rule to diagnose cervical radiculopathy and the lack of a control group without treatment were limitations of this study . Conclusions : The results suggest that the addition of mechanical cervical traction to a multimodal treatment program of manual therapy and exercise yields no significant additional benefit to pain , function , or disability in patients with cervical radiculopathy Ongoing efforts to develop mechanisms-based assessment and treatment of chronic pain have been hindered by the lack of assessment tools differentially sensitive to various phenomena underlying different mechanisms of pain . This study describes the development of an assessment instrument intended to measure neuropathic pain based on qualities of pain as they are inferred from pain descriptors . Subjects were 528 chronic pain patients from several clinics . Of these , 149 had strictly neuropathic pain , while 233 had non-neuropathic pain . Subjects completed a 32 item preliminary question naire , which asked them to rate their usual pain on multiple descriptors , as well as the degree to which their pain differed in response to various internal and external factors . This preliminary question naire was su bmi tted to factor analysis , and this yielded 6 factors . Representatives of each of these factors were combined with additional items that demonstrated significant differences between neuropathic and non-neuropathic pain groups , to yield a 12 item Neuropathic Pain Question naire ( NPQ ) . These items were able to differentiate neuropathic pain patients from non-neuropathic pain patients in a holdout sample with 66.6 % sensitivity and 74.4 % specificity . The newly developed instrument , NPQ , may be used for the initial screening of neuropathic pain patients . It also has the ability to provide a quantitative measure for the descriptors important in the diagnosis and assessment of neuropathic pain . Consequently , it can be used for monitoring of neuropathic pain treatments and as an outcome measure A new design of cervical traction modality with closed loop traction weight control based on electromyographic ( EMG ) biofeedback was developed . It consists of the development of a high signal-to-noise ratio EMG scanner , on-line self-adjusted traction weight controller , computer interface hardware , and closed loop biofeedback control software . Six healthy , young adults received conventional cervical traction  to establish basic information of cervical EMG activities . Twenty-four patients with cervical radiculopathy were r and omly divided into two groups for clinical assessment by conventional and new EMG biofeedback traction modality . The average electromyographic activity in healthy subjects ranged from 2.41 to 3.49 microV , whereas EMG activity in patients with neck pain ranged from 4.75 to 6.97 microV. There was a significant decrease of EMG activity during the whole traction phase , especially at pull phase in healthy subjects , but it was not as significant in patients with cervical radiculopathy . There was no significant change of myoelectric activity in the paraspinal muscles at vertebral levels C1 - 2 , C3 - 4 , and C5 - 6 . Comparison of the average EMG activity of the paraspinal C-5 muscle in different phases of cervical traction showed a more significant decrease of EMG activity during the pull phase of traction as well as after traction in the high muscle tension group ( with EMG activity above 5 microV ) , especially with the biofeedback traction modality . The raised traction force from start to optimum was shortened from 4 to 2 wk to achieve the same effective outcome by biofeedback as conventional traction modality OBJECTIVE The objective of this study was to investigate the effect of the cervical traction modality with and without electromyographic ( EMG ) biofeedback for neck muscles in patients with cervical radiculopathy . METHODS This study was carried out at the Department of Rehabilitation Sciences , College of Applied Medical Sciences , King Saud University , Riyadh , Kingdom of Saudi Arabia between February and May 2002 . Twenty patients with cervical radiculopathy were r and omly divided into 2 equal groups . Group A was treated by a conventional traction modality and group B was treated by a conventional traction modality with EMG biofeedback ( to obtain relaxation of paraspinal neck muscles ) . The average EMG activity was recorded pre and post treatment at cervical ( C ) 5 - 6 level for both groups during pull , rest and post traction for a period of 6 weeks . RESULTS Comparison of the average EMG activity of the paraspinal C5 - 6 muscle in different phases of cervical traction showed significant decrease of EMG activity during the pull phases of traction as well as after traction , especially with group B which was treated by the EMG biofeedback modality . CONCLUSION Electromyographic biofeedback with cervical traction showed a significant effect in avoiding muscle spasm and decreasing root compression during traction Objective : To determine if combining intermittent cervical traction with conventional physical therapy methods is more effective than using conventional approaches alone in the improvement of the grip strength and treatment of the patients with unilateral cervical 7 ( C7 ) radiculopathy . Design : R and omized controlled trial ( RCT ) . Setting : An outpatient physical therapy clinic , University of Social Welfare and Rehabilitation Science , Iran . Patients : A sample of convenience of 30 patients with unilateral C7 radiculopathy participated in this study . Patients were assigned r and omly to a control ( N=15 , mean age=46.939 ±5.32 ) and an experimental group ( N=15 , mean age=47.53 ±5.6 ) .  Interventions : Electrotherapyu/exercise treatment for control group and combined cervical traction and electrotherapyu/exercise for experimental group . Ten physical therapy sessions , three times a week for each group . Main outcome measures : Grip strength as an appropriate objective parameter was measured before treatment and after 5 and 10 treatment sessions . Results : Statistical analysis ( paired t-test ) revealed significant increase in grip strength after 10 treatment sessions in control ( p<0.01 ) and experimental group ( p<0.01 ) compared with pretreatment score . In the ANCOVA , controlling for pretest scores , no significant difference was found between the two groups in the after 10 treatment sessions grip score ( p=0.65 ) . However , the change in grip strength after five sessions was significantly greater for the experimental group than for the control group ( P=0.04 ) . Conclusions : The application of cervical traction combined with electrotherapy and exercise produced an immediate improvement in the h and grip function in patients with cervical radiculopathy Previous investigations with plain radiography , myelography , and computed tomography have shown that degenerative disease of the cervical spine frequently occurs in the absence of clinical symptoms . We studied the magnetic resonance-imaging scans of sixty-three volunteers who had no history of symptoms indicative of cervical disease . The scans were mixed r and omly with thirty-seven scans of patients who had a symptomatic lesion of the cervical spine , and all of the scans were interpreted independently by three neuroradiologists . The scans were interpreted as demonstrating an abnormality in 19 per cent of the asymptomatic subjects : 14 per cent of those who were less than forty years old and 28 per cent of those who were older than forty . Of the subjects who were less than forty , 10 per cent had a herniated nucleus pulposus and 4 per cent had foraminal stenosis . Of the subjects who were older than forty , 5 per cent had a herniated nucleus pulposus ; 3 per cent , bulging of the disc ; and 20 per cent , foraminal stenosis . Narrowing of a disc space , degeneration of a disc , spurs , or compression of the cord were also recorded . The disc was degenerated or narrowed at one level or more in 25 per cent of the subjects who were less than forty years old and in almost 60 per cent of those who were older than forty . The prevalence of abnormal magnetic-resonance images of the cervical spine as related to age in asymptomatic individuals emphasizes the dangers of predicating operative decisions on diagnostic tests without precisely matching those findings with clinical signs and symptoms PURPOSE To describe and explore the relationships between pain , emotional state and coping strategies in patients with chronic radicular neck pain before and after surgery or conservative treatments . METHODS We r and omize 81 conseutive patients with cervical radicular pain and nerve root compression , verified by MRI , to either surgical decompression with fusion or physiotherapy or neck collar .  Emotional state was both measured with Mood Adjective Check List . Hospital Anxiety and Depression Scale and with a Coping Strategies Question naire . Pain was measured with VAS and function with Disability Index Rating . Measurements were made before treatment , and follow ups after 3 and 12 months post treatment . RESULTS We found generally a low emotional state with anxiety , depression and sleep-disturbances not only connected to pain . Pain improved faster in the surgery group but after one year no differences were seen . Surgery and physiotherapy improved function with heavy work compared to collar after 3 months . Many patients used active coping before treatment , but after treatment more passive coping strategies were found . CONCLUSION We recommend a multidisciplinary rehabilitation with cognitive behavioural therapy and psychological interventions This prospect i ve , r and omised study compares the efficacy of surgery , physiotherapy and cervical collar with respect to pain , motor weakness and sensory loss in 81 patients with long-lasting cervical radiculopathy corresponding to a nerve root that was significantly compressed by spondylotic encroachment , with or without an additional bulging disk , as verified by MRI or CT-myelography .  Pain intensity was registered on a visual analogue scale ( VAS ) , muscle strength was measured by a h and -held dynamometer , Vigorometer and pinchometer .  Sensory loss and paraesthesia were recorded . The measurements were performed before treatment ( control 1 ) , 4 months after the start of treatment ( control 2 ) and after a further 12 months ( control 3 ) . A healthy control group was used for comparison and to test the reliability of the muscle-strength measurements . The study found that before start of treatment the groups were uniform with respect to pain , motor weakness and sensory loss . At control 2 the surgery group reported less pain , less sensory loss and had better muscle strength , measured as the ratio of the affected side to the non-affected side , compared to the two conservative treatment groups . After a further year ( control 3 ) , there were no differences in pain intensity , sensory loss or paraesthesia between the groups . An improvement in muscle strengths , measured as the ratio of the affected to the non-affected side , was seen in the surg 
    Output:
    
There is consensus on the presence of pain , but not on the exact location of pain