***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 assess the efficacy of individualized classical homeopathy in the treatment of fibromyalgia . METHODS This study was a double-blind , r and omized , parallel-group , placebo-controlled trial of homeopathy .  Community-recruited persons ( N = 62 ) with physician-confirmed fibromyalgia ( mean age 49 yr , s.d . 10 yr , 94 % women ) were treated in a homeopathic private practice setting . Participants were r and omized to receive oral daily liquid LM ( 1/50,000 ) potencies with an individually chosen homeopathic remedy or an indistinguishable placebo . Homeopathic visits involved joint interviews and concurrence on remedy selection by two experienced homeopaths , at baseline , 2 months and 4 months ( prior to a subsequent optional crossover phase of the study which is reported elsewhere ) . Tender point count and tender point pain on examination by a medical assessor uninvolved in providing care , self-rating scales on fibromyalgia-related quality of life , pain , mood and global health at baseline and 3 months , were the primary clinical outcome measures for this report . RESULTS Fifty-three people completed the treatment protocol . Participants on active treatment showed significantly greater improvements in tender point count and tender point pain , quality of life , global health and a trend toward less depression compared with those on placebo . CONCLUSIONS This study replicates and extends a previous 1-month placebo-controlled crossover study in fibromyalgia that pre-screened for only one homeopathic remedy . Using a broad selection of remedies and the flexible LM dose ( 1/50,000 dilution factor ) series , the present study demonstrated that individualized homeopathy is significantly better than placebo in lessening tender point pain and improving the quality of life and global health of persons with fibromyalgia OBJECTIVES To study the effect of a combination of thalassotherapy , exercise and patient education in people with fibromyalgia . METHODS Patients with fibromyalgia , selected from a rheumatology out-patient department and from members of the Dutch fibromyalgia patient association , were pre-r and omized to receive either 2(1/2 ) weeks of treatment in a Tunisian spa resort , including thalassotherapy , supervised exercise and group education ( active treatment ) or treatment as usual ( control treatment ) . Primary outcome measure was health-related quality of life , measured with the R AND -36 question naire . Secondary measures included the Fibromyalgia Impact Question naire , the McGill Pain Question naire , the Beck Depression Inventory , tender point score and a 6-min treadmill walk test . RESULTS Fifty-eight participants receiving the active treatment reported significant improvement on R AND -36 physical and mental component summary scales . For physical health , differences from the 76 controls were statistically significant after 3 months , but not after 6 and 12 months . A similar pattern of temporary improvement was seen in the self-reported secondary measures . Tender point scores and treadmill walk tests improved more after active treatment , but did not reach significant between-group differences , except for walk tests after 12 months . CONCLUSIONS A combination of thalassotherapy , exercise and patient education may temporarily improve fibromyalgia symptoms and health-related quality of life Background Alterations in the intestinal bacterial flora are believed to be contributing factors to many chronic inflammatory and degenerative diseases including rheumatic diseases . While microbiological fecal culture analysis is now increasingly used , little is known about the relationship of changes in intestinal flora , dietary patterns and clinical outcome in specific diseases . To clarify the role of microbiological culture analysis we aim ed to evaluate whether in patients with rheumatoid arthritis ( RA ) or fibromyalgia ( FM ) a Mediterranean diet or an 8-day fasting period are associated with changes in fecal flora and whether changes in fecal flora are associated with clinical outcome . Methods During a two-months-period 51 consecutive patients from an Integrative Medicine hospital department with an established diagnosis of RA ( n = 16 ) or FM ( n = 35 ) were included in the study . According to predefined clinical criteria and the subjects ' choice the patients received a mostly vegetarian Mediterranean diet ( n = 21 ; mean age 50.9 + /-13.3 y ) or participated in an intermittent modified 8-day fasting therapy ( n = 30 ; mean age 53.7 + /- 9.4 y ) . Quantitative aerob and anaerob bacterial flora , stool pH and concentrations of secretory immunoglobulin A ( sIgA ) were analysed from stool sample s at the beginning , at the end of the 2-week hospital stay and at a 3-months follow-up . Clinical outcome was assessed with the DAS 28 for RA patients and with a disease severity rating scale in FM patients . Results We found no significant changes in the fecal bacterial counts following the two dietary interventions within and between groups , nor were significant differences found in the analysis of sIgA and stool ph . Clinical improvement at the end of the hospital stay tended to be greater in fasting vs. non-fasting patients with RA ( p = 0.09 ) . Clinical outcome was not related to alterations in the intestinal flora . Conclusion Neither Mediterranean diet nor fasting treatments affect the microbiologically assessed intestinal flora and sIgA levels in patients with RA and FM . The impact of dietary interventions on the human intestinal flora and the role of the fecal flora in rheumatic diseases have to be clarified with newer molecular analysis techniques . The potential benefit of fasting treatment in RA and FM should be further tested in r and omised trials This article describes an ongoing , long-term clinical exercise program for women with fibromyalgia syndrome ( FMS ) , some of whom also have chronic fatigue and immune dysfunction syndrome ( CFIDS ) . The recorded outcomes from the most recent year of the program also are reported . Participants engaged in sessions lasting 50 - 70 minutes , 5 days per week ; each session involved aerobic activity , resistance training , and other dynamic exercise . One group was in the program for 3 years and another group was in the program for 2 years . Program outcomes for the year ( comparing beginning and end-of-year results ) are presented for both groups on physical fitness , psychosocial , and FMS/CFIDS symptoms . The outcomes support that all of the women appear to have benefited from the program in numerous ways , suggesting that the program works . Also , those outcomes are in agreement with past research reported in this journal . Implication s for clinical nurse specialists working with FMS/CFIDS patients are discussed Objectives : To assess the effectiveness of multidisciplinary rehabilitation in the treatment of fibromyalgia in comparison to st and ard medical care . Methods : Seventy-nine men and women were r and omly assigned to one of two groups . The intervention group consisted of a rheumatologist and physical therapist intake and discharge , 18 group supervised exercise therapy sessions , 2 group pain and stress management lectures , 1 group education lecture , 1 group dietary lecture , and 2 massage therapy sessions . The control group consisted of st and ard medical care with the patients ' family physician . Outcome measures included self-perceived health status , pain-related disability , average pain intensity , depressed mood , days in pain , hours in pain , prescription and nonprescription medication usage , and work status . Outcomes were measured at the end of the 6-week intervention and at 15-month follow-up . Results : Thirty-five out of 43 patients from the intervention group and 36 out of 36 patients from the control group completed the study . There were no statistically significant differences between the 2 groups prior to intervention . Intention-to-treat analysis revealed that the intervention group , in comparison to the control group , experienced statistically significant changes at intervention completion in self-perceived health status , average pain intensity , pain related disability , depressed mood , days in pain , and hours in pain , but no significant differences in nonprescription drug use , prescription drug use , or work status . At 15 months , all health outcomes retained their significance except health status . Nonprescription and prescription drug use demonstrated significant reductions at 15 months . Binary logistic regression indicated that long-term changes in Pain Disability Index were influenced by long-term exercise adherence and income status . Conclusions : Positive health-related outcomes in this mostly unresponsive condition can be obtained with a low-cost , group multidisciplinary intervention in a community-based , non clinical setting OBJECTIVE To evaluate the effects of body awareness therapy combined with qigong for patients with fibromyalgia . DESIGN A controlled r and omized pilot study . SUBJECTS Thirty-six female patients with fibromyalgia were r and omized to either qigong plus body awareness therapy ( n = 19 ) or a control group ( n = 17 ) . METHODS The programme was conducted once a week over a period of 3 months . The outcome measures were an observational method called the Body Awareness Rating Scale , the Fibromyalgia Impact Question naire and 2 tests of physical function . An interview was conducted with the patients in the treatment group . RESULTS Seven patients in each group ( 39 % ) were lost to the post-test examination . The inter-group analysis revealed a significant improvement in movement harmony for the treatment group ( p = 0.03 ) , while no differences were found in the Fibromyalgia Impact Question naire or the functional tests . The intra-group analysis revealed an improvement in movement harmony for the treatment group ( p = 0.01 ) , while the total score of the Fibromyalgia Impact Question naire deteriorated ( p = 0.04 ) in the control group . The interviews indicated that several patients had experienced exacerbation of symptoms while st and ing still , and /or difficulty in concentrating on the movements . CONCLUSIONS Although improvement in movement harmony occurred in the patients completing the treatment programme , no improvement was found for fibromyalgia symptoms or physical function The 5-HT3 receptor antagonists are a novel therapy for patients suffering from fibromyalgia , although the optimal duration of treatment is still unclear . The objective of this phase II study was to evaluate whether prolonging treatment with tropisetron to 4 weeks is tolerable and correlated with an improved clinical benefit . Thirty female patients with fibromyalgia received oral tropisetron ( 5 mg ) daily for 28 days in an open-label fashion . Treatment result ed in significantly decreased pain as measured by visual analog scale ( VAS ) , with a mean reduction of 59.7 % and an absolute median change of -25.0 from baseline to day 28 ( p<0.0001 ) . A similar , significant reduction of 55.7 % and absolute median change of -31.0 was observed in the painscore ( p<0.0001 ) . The response rate with patients showing a > or = 35 % reduction in individual pain scores was 72.4 % at day 28 . The pressure tolerance of tender-points was slightly increased at the end of the treatment period . In addition , significant improvements were observed in the State-Trait-Anxiety-Inventory ( STAI ) , scales of von Zerssen ( Bf-S ) and Beck Depression Index ( BDI ) . Functional symptoms were compared with the results from a 10-day , r and omized , double-blind phase III study of tropisetron in 418 fibromyalgia patients . In both studies several functional symptoms such as sleep disturbances and dizziness improved significantly ( p<0.05 ) . In the 28 days study , the number and extent of improvement in functional symptoms was increased compared with the shorter trial . Tolerability and safety of tropisetron was good , and typically for 5-HT3-receptor antagonists , gastrointestinal symptoms and headache were the most frequently reported events . In conclusion , 28 days treatment of fibromyalgia patients with 5 mg tropisetron result ed in significant pain reduction , which was most pronounced after 10 days with a further reduction up to day 28 . Psychometric tests showed significant improvements in depression and anxiety state scores , while functional symptoms improved with extended tropisetron treatment OBJECTIVES To characterize initial central nervous system responses to olfactory administration of homeopathic remedies as biomarkers for subsequently exceptional , simillimum-like clinical outcomes at a systemic level ( i.e. , both locally and globally ) . DESIGN Double-blinded , r and omized , placebo-controlled clinical trial . SETTING A private homeopathic clinic in Phoenix , AZ , and a university laboratory in Tucson , AZ . PATIENTS Sixty-two ( 62 ) persons with physician-confirmed fibromyalgia ( FM ) ( mean age , 49 years ; 94 % women ) enrolled ; 53 completed the 3-month assessment visit . Exceptional responders ( n = 6 , 23 % of active treatment group ; none on placebo ) were those with improvements in the top one-third for both tender point pain and global health ratings after 3 months . INTERVENTION Patients took daily oral doses of treatment solution in LM ( 1/50,000 dilution ) potency ( active group received individualized remedy ; placebo group received plain solvent ) . Dependent measures : Baseline and 3-month difference scores for initial prefrontal electroencephalographic alpha frequency cordance ( EEG-C , a correlate of functional brain activity ) during 16 pairs of r and omized , double-blinded bottle sniffs ( treatment minus control solutions ) . RESULTS Exceptional responders versus other patients exhibited significantly more negative initial EEG-C difference scores at prefrontal sites . Right prefrontal cordance findings correlated with subsequently reduced pain ( r = 0.85 , p = 0.03 ) , better global health ( r = -0.73 , p = 0.10 ) , and trait absorption ( genetically determined ability to focus attention selectively and fully ) ( r = 0.91 , p = 0.012 ) . CONCLUSIONS These observations suggest prefrontal EEG-C as an early biomarker of individualized homeopathic medicine effects in patients with 
    Output:
    
Review of these articles result ed in the following recommendations regarding  nonpharmaceutical treatments  of FMS .
Strong evidence supports  aerobic exercise and cognitive behavioral therapy .
Moderate evidence supports  massage , muscle strength training , acupuncture , and spa therapy ( balneotherapy )  .
Limited evidence supports spinal manipulation , movement/body awareness , vitamins , herbs , and dietary modification .
CONCLUSIONS Several nonpharmacologic treatments and manual-type therapies have acceptable evidentiary support in the treatment of FMS