***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: Curcumin is known to possess potent antiinflammatory and antiarthritic properties . This pilot clinical study evaluated the safety and effectiveness of curcumin alone , and in combination with diclofenac sodium in patients with active rheumatoid arthritis ( RA ) . Forty-five patients diagnosed with RA were r and omized into three groups with patients receiving curcumin ( 500 mg ) and diclofenac sodium ( 50 mg ) alone or their combination . The primary endpoints were reduction in Disease Activity Score ( DAS ) 28 . The secondary endpoints included American College of Rheumatology ( ACR ) criteria for reduction in tenderness and swelling of joint scores . Patients in all three treatment groups showed statistically significant changes in their DAS scores . Interestingly , the curcumin group showed the highest percentage of improvement in overall DAS and ACR scores ( ACR 20 , 50 and 70 ) and these scores were significantly better than the patients in the diclofenac sodium group . More importantly , curcumin treatment was found to be safe and did not relate with any adverse events . Our study provides the first evidence for the safety and superiority of curcumin treatment in patients with active RA , and highlights the need for future large-scale trials to vali date these findings in patients with RA and other arthritic conditions OBJECTIVE To determine the efficacy of topical curcumin in reducing breast inflammation in women suffering from lactational mastitis . METHODS A r and omized double-blind , placebo-controlled study including 63 breastfeeding women with lactational mastitis were r and omly assigned to receive curcumin topical cream , one pump every 8 hours for 3 days ( n=32 ) or topical moisturizer as placebo ( n=31 ) . Using an index for severity of breast inflammation , all of the patients had moderate breast inflammation before entering the study . The outcome of treatment was evaluated using the same index at 24 , 48 and 72 hours of starting the treatment . RESULTS There was no significant difference between two study groups regarding the baseline characteristics such as age ( p=0.361 ) and duration of lactation ( p=0.551 ) . After 72-hour of therapy , patients in curcumin groups had significantly lower rate of moderate ( p=0.019 ) and mild ( p=0.002 ) mastitis . Patients in curcumin group had significantly lower scores for tension ( p<0.001 ) , erythema ( p<0.001 ) and pain ( p<0.001 ) , after 72-hour of treatment . CONCLUSION The results of the current study indicate that topical preparation of curcumin successfully decrease the markers of lactational mastitis such as pain , breast tension and erythema within 72 hours of administration without side effects . Thus , topical preparation of curcumin could be safely administered for those suffering from lactational mastitis after excluding infectious etiologies Background Fast-acting medications for the management of anxiety are important to patients and society . Measuring early onset , however , requires a sensitive and clinical ly responsive tool . This study evaluates the psychometric properties of a patient-reported Global Anxiety - Visual Analog Scale ( GA-VAS ) . Methods Data from a double-blind , r and omized , placebo-controlled study of lorazepam and paroxetine in patients with Generalized Anxiety Disorder were analyzed to assess the reliability , validity , responsiveness , and utility of the GA-VAS . The GA-VAS was completed at clinic visits and at home during the first week of treatment . Targeted psychometric analyses — test-retest reliabilities , validity correlations , responsiveness statistics , and minimum important differences — were conducted . Results The GA-VAS correlates well with other anxiety measures , at Week 4 , r = 0.60 ( p < 0.0001 ) with the Hamilton Rating Scale for Anxiety and r = 0.74 ( p < 0.0001 ) with the Hospital Anxiety and Depression Scale - Anxiety subscale . In terms of convergent and divergent validity , the GA-VAS correlated -0.54 ( p < 0.0001 ) , -0.48 ( p < 0.0001 ) , and -0.68 ( p < 0.0001 ) with the SF-36 Emotional Role , Social Function , and Mental Health subscales , respectively , but correlated much lower with the SF-36 physical functioning subscales . Preliminary minimum important difference estimates cluster between 10 and 15 mm . Conclusions The GA-VAS is capable of validly and effectively capturing a reduction in anxiety as quickly as 24 hours post-dose OBJECTIVE To examine the rates of use and expenditures on alternative therapies by adults with osteoarthritis ( OA ) . METHODS Adults with OA recruited from the community to participate in a r and omized clinical trial recorded alternative and traditional health care use on postcard diaries . General and arthritis-specific quality of life was assessed by question naires . RESULTS More than 47 % of participants reported using at least one type of alternative care  during the 20-week intervention period . Among alternative care consumers , the most commonly used treatments were massage therapy ( 57 % ) , chiropractic services ( 20.7 % ) , and nonprescribed alternative medications ( 17.2 % ) . Four percent of subjects reported using only alternative care during the study period . Expenditures for alternative therapy averaged $ 1,127 per year , compared with $ 1,148 for traditional therapies . CONCLUSION Use of and expenditures for alternative care  were high among this cohort of older adults with OA . Clinicians may want to inquire about use of these therapies before recommending treatments for this condition We conducted an 8-week , open , r and omized controlled clinical trial on 141 subjects affected by neuropathic pain to investigate the role of an adjunctive therapy added to the administration of dexibuprofen ( 400 mg twice a day ) and based on a multi-ingredient formula ( Lipicur ) , consisting of lipoic acid plus curcumin phytosome and piperine , in patients with a diagnosis of lumbar sciatica , lumbar disk herniation , and /or lumbar canal stenosis ( 96 subjects ) , or with carpal tunnel syndrome ( 45 subjects ) . A total of 135 participants completed the study . Treatment with the multi-ingredient formula ( Lipicur ) reduced neuropathic pain by more than 66 % in both conditions ( subjects with lumbar sciatica and with carpal tunnel syndrome ) , and these reductions were statistically significant . Moreover , the treatment reduced dexibuprofen use by about 40 % . An add-on therapy with only lipoic acid has not shown any significant results . On the basis of its safety and efficacy , Lipicur could be considered an effective complementary therapy to be added to conventional treatments to achieve better efficacy in reducing neuropathic pain Background The purpose of this study was to assess the effect of 8-weeks ingestion of a commercialized joint pain dietary supplement ( InstaflexTM Joint Support , Direct Digital , Charlotte , NC ) compared to placebo on joint pain , stiffness , and function in adults with self-reported joint pain .  InstaflexTM is a joint pain supplement containing glucosamine sulfate , methylsufonlylmethane ( MSM ) , white willow bark extract ( 15 % salicin ) , ginger root concentrate , boswella serrata extract ( 65 % boswellic acid ) , turmeric root extract , cayenne , and hyaluronic acid . Methods Subjects included 100 men and women , ages 50 - 75 years , with a history ( > 3 months ) of joint pain , and were r and omized to Instaflex ™ or placebo ( 3 colored gel capsules per day for 8 weeks , double-blind administration ) . Subjects agreed to avoid the use of non-steroidal anti-inflammatory drugs ( NSAID ) and all other medications and supplements targeted for joint pain . Primary outcome measures were obtained pre- and post- study and included joint pain severity , stiffness , and function ( Western Ontario and McMaster Universities [ WOMAC ] ) , and secondary outcome measures included health-related quality of life ( Short Form 36 or SF-36 ) , systemic inflammation ( serum C-reactive protein and 9 plasma cytokines ) , and physical function ( 6-minute walk test ) . Joint pain symptom severity was assessed bi-weekly using a 12-point Likert visual scale ( 12-VS ) . Results Joint pain severity was significantly reduced in Instaflex ™ compared to placebo ( 8-week WOMAC , ↓37 % versus ↓16 % , respectively , interaction effect P = 0.025 ) , with group differences using the 12-VS emerging by week 4 of the study ( interaction effect , P = 0.0125 ) . Improvements in ability to perform daily activities and stiffness scores  in Instaflex ™ compared to placebo were most evident for the 74 % of subjects reporting knee pain ( 8-week WOMAC function score , ↓39 % versus ↓14 % , respectively , interaction effect P = 0.027 ; stiffness score , ↓30 % versus ↓12 % , respectively , interaction effect P = 0.081 ) . Patterns of change in SF-36 , systemic inflammation biomarkers , and the 6-minute walk test did not differ significantly between groups during the 8-week study Conclusions Results from this r and omized , double blind , placebo-controlled community trial support the use of the Instaflex ™ dietary supplement in alleviating  joint pain severity in middle-aged and older adults , with mitigation of difficulty performing daily activities most apparent in subjects with knee pain . Trial registration Clinical Trials.gov Identifier : Background The Knee injury and Osteoarthritis Outcome Score ( KOOS ) is an extension of the Western Ontario and McMaster Universities Osteoarthrtis Index ( WOMAC ) , the most commonly used outcome instrument for assessment of patient-relevant treatment effects in osteoarthritis . KOOS was developed for younger and /or more active patients with knee injury and knee osteoarthritis and has in previous studies on these groups been the more responsive instrument compared to the WOMAC . Some patients eligible for total knee replacement have expectations of more dem and ing physical functions than required for daily living . This encouraged us to study the use of the Knee injury and Osteoarthritis Outcome Score ( KOOS ) to assess the outcome of total knee replacement . Methods We studied the test-retest reliability , validity and responsiveness of the Swedish version LK 1.0 of the KOOS when used to prospect ively evaluate the outcome of 105 patients ( mean age 71.3 , 66 women ) after total knee replacement .  The follow-up rates at 6 and 12 months were 92 % and 86 % , respectively . Results The intraclass correlation coefficients were over 0.75 for all subscales indicating sufficient test-retest reliability . Bl and -Altman plots confirmed this finding . Over 90 % of the patients regarded improvement in the subscales Pain , Symptoms , Activities of Daily Living , and knee-related Quality of Life to be extremely or very important when deciding to have their knee operated on indicating good content validity . The correlations found in comparison to the SF-36 indicated the KOOS measured expected constructs . The most responsive subscale was knee-related Quality of Life . The effect sizes of the five KOOS subscales at 12 months ranged from 1.08 to 3.54 and for the WOMAC from 1.65 to 2.56 . Conclusion The Knee injury and Osteoarthritis Outcome Score ( KOOS ) is a valid , reliable , and responsive outcome measure in total joint replacement . In comparison to the WOMAC , the KOOS improved validity and may be at least as responsive as the WOMAC Background Delayed onset muscle soreness ( DOMS ) is muscle pain and discomfort experienced approximately one to three days after exercise . DOMS is thought to be a result of microscopic muscle fiber tears that occur more commonly after eccentric exercise rather than concentric exercise . This study sought to test the efficacy of a proprietary dietary supplement , BounceBack ™ , to alleviate the severity of DOMS after st and ardized eccentric exercise . Methods The study was a r and omized , double-blind , placebo-controlled , crossover study . Ten healthy community-dwelling untrained subjects , ranging in age from 18–45 years , were enrolled . Mean differences within and between groups were assessed inferentially at each data collection time-point using t-tests for all outcome measures . Results In this controlled pilot study , intake of BounceBack ™ capsules for 30 days result ed in a significant reduction in st and ardized measures of pain and tenderness post-eccentric exercise compared to the placebo group . There were trends towards reductions in plasma indicators of inflammation ( high sensitivity C-reactive protein ) and muscle damage ( creatine phosphokinase and myoglobin ) . Conclusion BounceBack ™ capsules were able to significantly reduce st and ardized measures of pain and tenderness at several post-eccentric exercise time points in comparison to placebo . The differences in the serological markers of DOMS , while not statistically significant , appear to support the clinical findings . The product appears to have a good safety profile and further study with a larger sample size is warranted based on the current results Objective To determine the efficacy and safety of Curcuma domestica extracts in pain reduction and functional improvement . Methods 367 primary knee osteoarthritis patients with a pain score of 5 or higher were r and omized to receive ibuprofen 1,200 mg/day or C. domestica extracts 1,500 m 
    Output:
    
Conclusion There is insufficient evidence to recommend that curcuminoids be considered for relieving pain and improving function in musculoskeletal pain conditions .