***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 AND OBJECTIVE To develop a checklist of items measuring the quality of reports of r and omized clinical trials ( RCTs ) assessing nonpharmacological treatments ( NPTs ) . STUDY DESIGN AND SETTING The Delphi consensus method was used to select and reduce the number of items in the checklist . A total of 154 individuals were invited to participate : epidemiologists and statisticians involved in the field of methodology of RCTs ( n = 55 ) , members of the Cochrane Collaboration ( n = 41 ) , and clinicians involved in planning NPT clinical trials ( n = 58 ) . Participants ranked on a 10-point Likert scale whether an item should be included in the checklist . RESULTS Fifty-five experts ( 36 % ) participated in the survey . They were experienced in systematic review s ( 68 % were involved in the Cochrane Collaboration ) and in planning RCTs ( 76 % ) . Three rounds of the Delphi method were conducted to achieve consensus . The final checklist contains 10 items and 5 subitems , with items related to the st and ardization of the intervention , care provider influence , and additional measures to minimize the potential bias from lack of blinding of participants , care providers , and outcome assessors . CONCLUSIONS This tool can be used to critically appraise the medical literature , design NPT studies , and assess the quality of trial reports included in systematic review Study Design . A prospect i ve , r and omized , single ( investigator ) blind , comparative efficacy trial was conducted . Objective . To compare the efficacy of continuous low-level heat wrap therapy ( 40 C , 8 hours/day ) with that of ibuprofen ( 1200 mg/day ) and acetaminophen ( 4000 mg/day ) in subjects with acute nonspecific low back pain . Summary of Background Data . The efficacy of topical heat methods , as compared with oral analgesic treatment of low back pain , has not been established . Methods . Subjects ( n = 371 ) were r and omly assigned to heat wrap ( n = 113 ) , acetaminophen ( n = 113 ) , or ibuprofen ( n = 106 ) for efficacy evaluation , or to oral placebo ( n = 20 ) or unheated back wrap ( n = 19 ) for blinding . Outcome measures included pain relief , muscle stiffness , lateral trunk flexibility , and disability . Efficacy was measured over two treatment days and two follow-up days . Results . Day 1 pain relief for the heat wrap ( mean , 2 ) was higher than for ibuprofen ( mean , 1.51;P = 0.0007 ) or acetaminophen ( mean , 1.32;P = 0.0001 ) . Extended mean pain relief ( Days 3 to 4 ) for the heat wrap ( mean , 2.61 ) also was higher than for ibuprofen ( mean , 1.68;P = 0.0001 ) or acetaminophen ( mean , 1.95;P = 0.0009 ) . Lateral trunk flexibility was improved with the heat wrap ( mean change , 4.28 cm ) during treatment ( P ≤ 0.009 vs acetaminophen [ mean change , 2.93 cm ] , P ≤ 0.001 vs ibuprofen [ mean change , 2.51 cm ] ) . The results were similar on Day 4 . Day 1 reduction in muscle stiffness with the heat wrap ( mean , 16.3 ) was greater than with acetaminophen ( mean , 10.5;P = 0.001 ) . Disability was reduced with the heat wrap ( mean , 4.9 ) , as compared with ibuprofen ( mean , 2.7;P = 0.01 ) and acetaminophen ( mean , 2.9;P = 0.0007 ) , on Day 4 . None of the adverse events were serious . The highest rate ( 10.4 % ) was reported in the ibuprofen group . Conclusion . Continuous low-level heat wrap therapy was superior to both acetaminophen and ibuprofen for treating low back pain OBJECTIVES This study aim ed to assess analgesia provided by acupuncture , alone or in combination with pharmacotherapy , to patients presenting to emergency departments with acute low back pain , migraine or ankle sprain . DESIGN A pragmatic , multicentre , r and omised , assessor-blinded , equivalence and non-inferiority trial of analgesia , comparing acupuncture alone , acupuncture plus pharmacotherapy , and pharmacotherapy alone for alleviating pain in the emergency department . Setting , participants : Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain , migraine , or ankle sprain , and with a pain score on a 10-point verbal numerical rating scale ( VNRS ) of at least 4 . MAIN OUTCOME MEASURES The primary outcome measure was pain at one hour ( T1 ) . Clinical ly relevant pain relief was defined as achieving a VNRS score below 4 , and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units . RESULTS 1964 patients were assessed between January 2010 and December 2011 ; 528 patients with acute low back pain ( 270 patients ) , migraine ( 92 ) or ankle sprain ( 166 ) were r and omised to acupuncture alone ( 177 patients ) , acupuncture plus pharmacotherapy ( 178 ) or pharmacotherapy alone ( 173 ) . Equivalence and non-inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention-to-treat and per protocol ( PP ) analyses , except in the PP equivalence testing of the ankle sprain group . 15.6 % of patients had clinical ly relevant pain relief and 36.9 % had statistically relevant pain relief at T1 ; there were no between-group differences . CONCLUSION The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy . Acupuncture is a safe and acceptable form of analgesia , but none of the examined therapies provided optimal acute analgesia . More effective options are needed . TRIAL REGISTRATION Australian New Zeal and Clinical Trials Registry , ACTRN12609000989246 A double-blind , 18-center , balanced trial of diflunisal vs. cyclobenzaprine HCl vs. these two drugs combined vs. placebo produced complete results from 175 patients . They had sought treatment at the cooperating centers for acute painful spasms of the back within a day or two of trauma or strain . Global results over the 7 to 10 days of observations revealed a clinical ly and statistically significant superiority of the combined therapy by Day 4 ( P=0.006 ) and almost all patients recovered within a week to 10 days . A combination therapy with an effective safe analgesic and a true muscle relaxant for less than a week appears to be an excellent relief measure for acute back problems Pharmacological therapy of back pain with analgesics and anti-inflammatory drugs is frequently associated with adverse effects , particularly in the elderly . Aim of this study was to compare mesotherapic versus conventional systemic administration of nonsteroidal anti-inflammatory drugs ( NSAIDs ) and corticosteroids in patients with acute low back pain . Eighty-four patients were r and omized to receive anti-inflammatory therapy according to the following protocol s : ( a ) mesotherapy group received the 1st and 4th day 2 % lidocaine ( 1 mL ) + ketoprofen 160 mg ( 1 mL ) + methylprednisolone 40 mg ( 1 mL ) , then on 7th , 10th , and 13th day , 2 % lidocaine ( 1 mL ) + ketoprofen 160 mg ( 1 mL ) + methylprednisolone 20 mg ( 1 mL ) ( b ) conventional therapy group received ketoprofen 80 mg × 2/die and esomeprazole 20 mg/die orally for 12 days , methylprednisolone 40 mg/die intramuscularly for 4 days , followed by methylprednisolone 20 mg/die for 3 days , and thereafter , methylprednisolone 20 mg/die at alternate days . Pain intensity and functional disability were assessed at baseline ( T0 ) , at the end of treatment ( T1 ) , and 6 months thereafter ( T2 ) by using visual analogic scale ( VAS ) and Rol and -Morris disability question naire ( RMDQ ) . In both groups , VAS and RMDQ values were significantly reduced at the end of drug treatment and after 6 months , in comparison with baseline . No significant differences were found between the two groups . This suggests that mesotherapy may be a valid alternative to conventional therapy in the treatment of acute low back pain with corticosteroids and NSAIDs Study objective : In US emergency departments ( EDs ) , patients with low back pain are often treated with nonsteroidal anti‐inflammatory drugs and muscle relaxants . We compare functional outcomes among patients r and omized to a 1‐week course of naproxen+placebo versus naproxen+orphenadrine or naproxen+methocarbamol . Methods : This was a r and omized , double‐blind , comparative effectiveness trial conducted in 2 urban EDs . Patients presenting with acute , nontraumatic , nonradicular low back pain were enrolled . The primary outcome was improvement on the Rol and ‐Morris Disability Question naire ( RMDQ ) between ED discharge and 1 week later . All patients were given 14 tablets of naproxen 500 mg , to be used twice a day , as needed for low back pain . Additionally , patients were r and omized to receive a 1‐week supply of orphenadrine 100 mg , to be used twice a day as needed , methocarbamol 750 mg , to be used as 1 or 2 tablets 3 times per day as needed , or placebo . All patients received a st and ardized 10‐minute low back pain educational session before discharge . Results : Two hundred forty patients were r and omized . Baseline demographic characteristics were comparable . The mean RMDQ score of patients r and omized to naproxen+placebo improved by 10.9 points ( 95 % confidence interval [ CI ] 8.9 to 12.9 ) . The mean RMDQ score of patients r and omized to naproxen+orphenadrine improved by 9.4 points ( 95 % CI 7.4 to 11.5 ) . The mean RMDQ score of patients r and omized to naproxen+methocarbamol improved by 8.1 points ( 95 % CI 6.1 to 10.1 ) . None of the between‐group differences surpassed our threshold for clinical significance . Adverse events were reported by 17 % ( 95 % CI 10 % to 28 % ) of placebo patients , 9 % ( 95 % CI 4 % to 19 % ) of orphenadrine patients , and 19 % ( 95 % CI 11 % to 29 % ) of methocarbamol patients . Conclusion : Among ED patients with acute , nontraumatic , nonradicular low back pain , combining naproxen with either orphenadrine or methocarbamol did not improve functional outcomes compared with naproxen+placebo BACKGROUND Current worldwide clinical practice guidelines recommend acetaminophen as the first option for the treatment of acute low back pain . However , there is no concrete evidence regarding whether acetaminophen or nonsteroidal anti-inflammatory drugs ( NSAIDs ) is more effective for treating acute low back pain ( LBP ) in Japan . The present study aim ed to investigate whether acetaminophen treatment for acute musculoskeletal pain was comparable with loxoprofen ( a traditional NSAID in Japan ) treatment . METHODS Of the 140 patients with acute LBP who visited out-patient hospitals , 127 were considered eligible and were r and omly allocated to a group taking acetaminophen or one taking loxoprofen . As primary outcome measure , pain intensity was measured using a 0 - 10-numeric rating scale ( NRS ) . Moreover , pain disability , pain catastrophizing , anxiety , depression , and quality of life , as well as adverse events , were assessed as secondary outcomes . The primary outcome was tested with a noninferiority margin ( 0.84 on changes in pain-NRS ) , and the secondary outcomes were compared using conventional statistical methods at week 2 and week 4 . RESULTS Seventy patients completed the study ( acetaminophen : 35 , loxoprofen : 35 ) . The dropout rates showed no significant difference between the two medication-groups . We found that the mean differences of changes in pain-NRS from baseline to week 2 or 4 between the two medication groups were not statistically beyond the noninferiority margin ( mean [ 95 % confidence interval ] : -0.51 [ -1.70 , 0.67 ] , at week 2 and -0.80 [ -2.08 , 0.48 ] at week 4 ) . There were no consistent differences between the two medication groups in terms of secondary outcomes . CONCLUSIONS The results suggest that acetaminophen has comparable analgesic effects on acute LBP , based on at least a noninferiority margin , compared with loxoprofen at 4 weeks . Acetaminophen seems to be a reasonable first-line 
    Output:
    
NSAIDs seemed slightly more effective than placebo for short-term pain reduction ( moderate certainty ) , disability ( high certainty ) , and global improvement ( low certainty ) , but the magnitude of the effects is small and probably not clinical ly relevant .
There was no clear difference in short-term pain reduction ( low certainty ) when comparing selective COX-2 inhibitors to non-selective NSAIDs .
We found very low evidence of no clear difference in the proportion of participants experiencing adverse events in both the comparison of NSAIDs versus placebo and selective COX-2 inhibitors versus non-selective NSAIDs .