***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 This study was carried out to evaluate the therapeutic effect of epidural steroid injection on pseudoclaudication in patients with lumbar degenerative spinal canal stenosis . DESIGN Fifty-three patients who complained of pseudoclaudication of less than 20 m in walking distance were r and omly divided into three groups . Group 1 ( n = 16 ) underwent epidural injection with 8 ml of saline . Group 2 ( n = 18 ) underwent epidural block with 8 ml of 1 % mepivacaine . Group 3 ( n = 19 ) underwent epidural block with a combination of 8 ml of 1 % mepivacaine and 40 mg of methylprednisolone . The criteria of evaluation were as follows : excellent effect , > 100 m in walking distance ; good effect , 20 - 100 m in walking distance ; poor effect , < 20 m in walking distance . RESULTS In group 1 , the numbers of patients who showed a good effect were two ( 12.5 % ) after 1 week , one ( 6.5 % ) after 1 month , and one ( 6.5 % ) after 3 months . In group 2 , the numbers of patients who showed a good or excellent result were 10 ( 55.5 % ) after 1 week , three ( 16.7 % ) after 1 month , and one ( 5.6 % ) after 3 months . In group 3 , the numbers of patients who showed a good or excellent result were 12 ( 63.2 % ) after 1 week , three ( 15.8 % ) after 1 month , and one ( 5.3 % ) after 3 months . There was no significant difference in the effectiveness of treatment between group 2 and group 3 throughout the time course . CONCLUSION The results suggest that epidural steroid injection has no beneficial effect on the pseudoclaudication associated with spinal canal stenosis as compared with epidural block with a local anesthetic alone BACKGROUND Chronic pain in the cervical zygapophyseal joints is a common problem after a whiplash injury . Treatment with intraarticular injections of corticosteroid preparations has been advocated , but the value of this approach has not been established . We compared the efficacy of a depot injection of a corticosteroid preparation with the efficacy of an injection of a local anesthetic agent in patients with painful cervical zygapophyseal joints . METHODS Sixteen men and 25 women with pain in one or more cervical zygapophyseal joints after automobile accidents ( mean age , 43 years ; median duration of pain , 39 months ) were r and omly assigned to receive an intraarticular injection of either bupivacaine ( 0.5 percent ) or betamethasone ( 5.7 mg ) under double-blind conditions . The patients were followed by means of regular telephone contact and clinic visits until they reported a return to a level of pain equivalent to 50 percent of the preinjection level . The time from treatment to a 50 percent return of pain was compared in the two groups with the use of a survival analysis . RESULTS Less than half the patients reported relief of pain for more than one week , and less than one in five patients reported relief for more than one month , irrespective of the treatment received . The median time to a return of 50 percent of the preinjection level of pain was 3 days in the 21 patients in the corticosteroid group and 3.5 days in the 20 patients in the local-anesthetic group ( P = 0.42 ) . CONCLUSIONS Intraarticular injection of betamethasone is not effective therapy for pain in the cervical zygapophyseal joints after a whiplash injury OBJECTIVE To address the question whether general practitioners ( GPs ) should receive practical training in shoulder problems and to test whether cortisone injections are better than anaesthetic injections for rotator cuff problems . METHODS A pragmatic split-plot , r and omized trial with a cluster factorial design , conducted in general practice s across five centres across the United Kingdom . Ninety-one practice s were r and omized to receive additional training in diagnosing and injecting rotator cuff problems or no additional training .  Two hundred patients consulting their general practice s with shoulder pain were then r and omized to receive either a corticosteroid or lignocaine injection . The main outcome was score on the British Shoulder Disability Question naire ( BSDQ ) . The Short-Form 36-item Health Survey and EuroQol at 12 months from entry to the trial were also scored . RESULTS Over the course of the trial there was a mean difference of 0.94 ( s.e . = 1.01 ) on the BSDQ score between the groups , with patients treated by the untrained group having a mean of 9.46 ( s.e . = 0.82 ) and those by the trained group having a mean of 8.51 ( s.e . = 0.60 ) . There were no statistically significant differences between the groups . Analysing by substance injected , there was a mean difference of 0.15 ( s.e . = 0.48 ) throughout the trial between the groups , with patients given the cortisone having a mean BSDQ of 9.67 ( s.e . = 0.39 ) and those given lignocaine , 9.82 ( s.e . = 0.39 ) . This was not statistically significantly different . CONCLUSIONS Training GPs in the diagnosis and treatment of shoulder disorders does not make any difference to the outcome , in terms of pain and disability , 1 yr later . Further , there is no advantage to injecting steroid in a group with predominant rotator cuff disorder . Trial registration . International St and ard R and omized Controlled Trial Number 58537244 . Trial steering committee comprised Prof. Paul Dieppe , Prof. Elaine Hay , Dr Brian Hazleman and Dr Kerenza Hood BACKGROUND Local anesthetics ( LA ) are frequently used in dentistry . Although these drugs are usually well-tolerated , they can sometimes provoke adverse reactions of various types and severity . The true incidence of LA allergic reactions is unknown . The objectives of this study were ( i ) to evaluate the incidence of immediate adverse events in subjects requiring local anesthetic injection in order to receive dental treatment ; ( ii ) to assess the incidence of anaphylactic allergic reactions among those recorded as adverse events and ( iii ) to analyze the relationship between the atopic antecedents of these patients and documented allergic reactions . MATERIAL S AND METHODS A prospect i ve , open-label , non-comparative study including 5,018 subjects who received LA during dental treatment , despite their age , was carried out in 7 private or public odontological centers . All the possible reactions that could appear during the first hour of anesthetic administration were assessed . RESULTS Twenty-five adverse reactions were diagnosed , representing 0.5 % of the study population . None of these reactions was due to an allergic cause . Most ( 22/25 ) were mild , quickly reversible psychogenic or vasovagal reactions . One case was related to defects in the anesthetic technique . In two further cases , allergic etiology was ruled out after skin and dose provocative challenge tests with the anesthetic . In conclusion , allergic reactions to LA  are very rare . Most adverse reactions are psychogenic or vasovagal . Physicians and dentists should be aware of these facts in order to minimize the frequent fears and myths concerning the use of LA in the dentist 's office In a double-blind study 28 patients with acute , localised muscle pain received four local injections of mepivacaine 0.5 % , and 25 patients with the same type of pain received local injections of an equivalent volume of physiological saline . The group receiving saline tended to have more relief of pain , especially after the first injection . The results thus show that pain relief is not due merely to the local anaesthetic . The study therefore raises questions about the mechanism by which local injections into muscle relieves pain , since there is the possibility that a similar effect might also be achieved by merely inserting a needle into the trigger point . Physiological saline is considered to be a more appropriate fluid for injection therapy than local anaesthetics since it is less likely to produce side-effects More than two-thirds of patients in Germany use complementary and alternative medicine ( CAM ) provided either by physicians or non-medical practitioners ( “ Heilpraktiker ” ) . There is little information about the number of family physicians ( FPs ) providing CAM . Given the widespread public interest in the use of CAM , this study aim ed to ascertain the use of and attitude toward CAM among FPs in Germany . A postal question naire developed based on qualitatively derived data was sent to 3000 r and omly selected FPs in Germany . A reminder letter including a postcard ( containing a single question about CAM use in practice and reasons for non-particpation in the survey ) was sent to all FPs who had not returned the question naire . Of the 3000 FPs , 1027 ( 34 % ) returned the question naire and 444 ( 15 % ) returned the postcard . Altogether , 886 of the 1471 responding FPs ( 60 % ) reported using CAM  in their practice . A positive attitude toward CAM  was indicated by 503 FPs ( 55 % ) , a rather negative attitude by 127 FPs ( 14 % ) .  Chirotherapy , relaxation and neural therapy  were rated as most beneficial CAM  therapies by FPs , whereas  neural therapy , phytotherapy and acupuncture  were the most commonly used therapies in German family practice s. This survey clearly demonstrates that CAM is highly valued by many FPs and is already making a substantial contribution to first-contact primary care in Germany . Therefore , education and research about CAM should be increased . Furthermore , with the provision of CAM by FPs , the role of non-medical CAM practitioners within the German healthcare system is to be question ed Abstract Trigger point injections with different solutions have been studied mainly with regard to the management of myofascial pain ( MFP ) patient management . However , few studies have analyzed their effect in a chronic headache population with associated MFP . The purpose of this study was to assess if trigger point injections using botulinum toxin , lidocaine , and dry-needling injections for the management of local pain and associated headache management .  Forty-five ( 45 ) myofascial pain patients with headaches that could be reproduced by activating at least one trigger point , were r and omly assigned into one of the three groups : G1 , dry-needling , G2 , 0.25 % lidocaine , at 0.25 % and G3 botulinum toxin and were assessed during a 12 week period . Levels of pain intensity , frequency and duration , local post-injection sensitivity , obtainment time and duration of relief , and the use of rescue medication were evaluated . Statistically , all the groups showed favorable results for the evaluated requisites ( p≤0.05 ) , except for the use of rescue medication and local post injection sensitivity ( G3 showed better results ) . Considering its reduced cost , lidocaine could be adopted as a substance of choice , and botulinum toxin should be reserved for refractory cases , in which the expected effects could not be achieved , and the use of a more expensive therapy would be m and atory Study Design . Clinical practice guideline . Objective . To develop evidence -based recommendations on use of interventional diagnostic tests and therapies , surgeries , and interdisciplinary rehabilitation for low back pain of any duration , with or without leg pain . Summary of Background Data . Management of patients with persistent and disabling low back pain remains a clinical challenge . A number of interventional diagnostic tests and therapies and surgery are available and their use is increasing , but in some cases their utility remains uncertain or controversial . Interdisciplinary rehabilitation has also been proposed as a potentially effective noninvasive intervention for persistent and disabling low back pain . Methods . A multidisciplinary panel was convened by the American Pain Society . Its recommendations were based on a systematic review that focused on evidence from r and omized controlled trials . Recommendations were grade d using methods adapted from the US Preventive Services Task Force and the Grading of Recommendations , Assessment , Development , and Evaluation Working Group . Results . Investigators review ed 3348 abstract s. A total of 161 r and omized trials were deemed relevant to the recommendations in this guideline . The panel developed a total of 8 recommendations . Conclusion . Recommendations on use of interventional diagnostic tests and therapies , surgery , and interdisciplinary rehabilitation are presented . Due to important trade-offs between potential benefits , harms , costs , and burdens of alternative therapies , shared decision-making is an important component of a number of the recommendations Objectives We report a r and omized , double-blinded comparative study assessing the efficacy of local anesthetic with N-saline intradermal blocks around the knee to reduce pain and improve patient satisfaction while waiting for a total knee joint replacement . Methods Patients were offered involvement in this study while on the hospital waiting list for a knee replacement . Eligible patients , after completing a pre study assessment , received an average of 6.3 ( range : 1 to 10 ) intradermal injections of 0.5 mL either saline or 1 % lignocaine injections into tender points around the knee . Patients were assessed at 2 hours and 1 week after the injections . Pain was assessed using 0 to 100 visual analog pain scale . Global perceived effect ( satisfaction ) was measured on a 7-point Likert scale . Results Thirty-two of 34 patients attended at 1-week assessment , 24 ( 75 % ) felt that they were improved , and 8 ( 25 % ) considered they were unchanged or worse . In both the saline and lignocaine groups , 12 of 16 patients felt that 
    Output:
    
The qualitative data analysis revealed no clear trend for or against TLA .