***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 Clinical characteristics and patterns of healthcare utilization in patients with painful neuropathic disorders ( PNDs ) who are under the care of general practitioners ( GPs ) in the UK are not well understood . Methods Using a large electronic UK data base , we identified all adults ( age ≥ 18 years ) with any GP encounters between 1 January 2006 - 31 December 2006 at which a diagnosis of PND was noted ( " PND patients ") . An age- and gender-matched comparison group also was constituted consisting of r and omly selected patients with one or more GP encounters-but no mention of PNDs-during  this period . Characteristics and patterns of healthcare utilization of patients in the two groups were then examined over the one-year study period . Results The study sample consisted of 31,688 patients with mention of PNDs and an equal number of matched comparators ; mean age was 56 years , and 62 % were women . The prevalence of various comorbidities was higher among patients in the PND group , including digestive disorders ( 31 % vs. 17 % for comparison group ) , circulatory disorders ( 29 % vs. 22 % ) , and depression ( 4 % vs. 3 % ) ( all p < 0.01 ) . Receipt of prescriptions for pain-related pharmacotherapy also was higher among PND patients , including nonsteroidal anti-inflammatory drugs ( 56 % of PND patients had one or more such prescriptions vs. only 22 % in the comparison group ) , opioids ( 49 % vs. 12 % ) , tricyclic antidepressants ( 20 % vs. 1 % ) , and antiepileptics ( 12 % vs. 1 % ) ( all p < 0.01 ) . PND patients also averaged significantly more GP visits ( 22.8 vs. 14.2 ) and referrals to specialists ( 2.8 vs. 1.4 ) over one year ( both comparisons p < 0.01 ) . Conclusions Patients with PNDs under the care of GPs in the UK have relatively high levels of use of healthcare services and pain-related pharmacotherapy Using a large data base with information from general practitioners ( GP ) throughout Germany , we identified all adults ( age > or = 18 years ) with encounters for painful neuropathic disorders ( PNDs ) between August 1 , 2005 and July 31 , 2006 ( PND patients ) . We also constituted an age- and sex-matched comparison group , consisting of r and omly selected patients without any GP encounters for PNDs during the same period . Selected characteristics were then compared between PND patients and those in the comparison group over the 1-year study period . The study sample consisted of 275,685 PND patients and a similar number in the matched comparison group ; mean age was 53.7 years , and 57 % were women . PND patients were more likely than matched comparators to have encounters for various comorbidities , including circulatory system disorders ( 47 % vs. 20 % , respectively ) , depression ( 9 % vs. 2 % ) , and anxiety ( 4 % vs. 1 % ) ( all P < 0.01 ) . They also were more likely to have received pain-related medications ( 57 % vs. 13 % for comparison group ; P < 0.01)--most commonly ,  nonsteroidal anti-inflammatory drugs , benzodiazepines , and opioids  , and less often ,  tricyclic antidepressants and anti-epileptics .  PND patients averaged 7.3 more GP visits during the year ( mean [ 95 % CI ] = 9.9 [ 9.9 , 9.9 ] vs. 2.6 [ 2.6 , 2.7 ] for comparison group ) ; they also had significantly more specialist referrals and physician-excused absences from work ( all P < 0.01 ) . Patients with PNDs under the care of GPs in Germany have comparatively more comorbidities and higher levels of use of healthcare services . The pain-related medications that these patients receive raise concerns that PNDs may not be optimally treated in these setting Abstract  Variability  in patients ' response to interventions in pain and other clinical setting s is large . Many explanations such as trial methods , environment or culture have been proposed , but this paper sets out to show that the main cause of the variability may be r and om chance , and that if trials are small their estimate of magnitude of effect may be incorrect , simply because of the r and om play of chance . This is highly relevant to the questions of ‘ How large do trials have to be for statistical accuracy ? ’ and ‘ How large do trials have to be for their results to be clinical ly valid ? ’ The true underlying control event rate ( CER ) and experimental event rate ( EER ) were determined from single‐dose acute pain analgesic trials in over 5000 patients . Trial group size required to obtain statistically significant and clinical ly relevant ( 0.95 probability of number‐needed‐to‐treat within ±0.5 of its true value ) results were computed using these values . Ten thous and trials using these CER and EER values were simulated using varying group sizes to investigate the variation due to r and om chance alone . Most common analgesics have EERs in the range 0.4–0.6 and CER of about 0.19 . With such efficacy , to have a 90 % chance of obtaining a statistically significant result in the correct direction requires group sizes in the range 30–60 . For clinical relevance nearly 500 patients are required in each group . Only with an extremely effective drug ( EER>0.8 ) will we be reasonably sure of obtaining a clinical ly relevant NNT with commonly used group sizes of around 40 patients per treatment arm . The simulated trials showed substantial variation in CER and EER , with the probability of obtaining the correct values improving as group size increased . We contend that much of the variability in control and experimental event rates is due to r and om chance alone . Single small trials are unlikely to be correct . If we want to be sure of getting correct ( clinical ly relevant ) results in clinical trials we must study more patients . Credible estimates of clinical efficacy are only likely to come from large trials or from pooling multiple trials of conventional ( small ) size A study comparing ibuprofen ( 600 mg four times a day ) vs sulindac ( 200 mg twice a day ) , and a placebo in the treatment of painful diabetic peripheral neuropathy was conducted in 18 male out patients .  Discomfort was characterized and rated with a subjective neuropathy score . The response to both ibuprofen and sulindac was better than it was to placebo in the entire group . There were no changes in glucose control or renal function . Further studies are necessary to evaluate the significance of aldose reductase-inhibitor properties of nonsteroidal anti-inflammatory drugs and to select the " best " one of these drugs for the treatment of diabetic neuropathy & NA ; The sodium channel blocker oxcarbazepine is efficacious in peripheral neuropathic pain patients , with preserved thermal sensation and some gain of sensory function , that is , the “ irritable nociceptor ” phenotype . & NA ; In neuropathic pain it has been suggested that pain phenotype based on putative pain mechanisms may predict response to treatment . This was a r and omised , double‐blind , placebo‐controlled , and phenotype‐stratified study with 2 6‐week treatment periods of oxcarbazepine ( 1800‐2400 mg ) and placebo . The primary efficacy measure was change in median pain intensity between baseline and the last week of treatment measured on an 11‐point numeric rating scale , and the primary objective was to compare the effect of oxcarbazepine in patients with and without the irritable nociceptor phenotype as defined by hypersensitivity and preserved small nerve fibre function determined by detailed quantitative sensory testing . Ninety‐seven patients with peripheral neuropathic pain due to polyneuropathy , surgical or traumatic nerve injury , or postherpetic neuralgia were r and omised . The intention‐to‐treat population comprised 83 patients : 31 with the irritable and 52 with the nonirritable nociceptor phenotype . In the total sample , oxcarbazepine relieved pain of 0.7 points ( on a numeric rating scale 0‐10 ; 95 % confidence interval [ CI ] 0.4‐1.4 ) more than placebo ( P = 0.015 ) and there was a significant interaction between treatment and phenotype of 0.7 ( 95 % CI 0.01‐1.4 , P = 0.047 ) . The number needed to treat to obtain one patient with more than 50 % pain relief was 6.9 ( 95 % CI 4.2‐22 ) in the total sample , 3.9 ( 95 % CI 2.3‐12 ) in the irritable , and 13 ( 95 % CI 5.3‐∞ ) in the nonirritable nociceptor phenotype . In conclusion , oxcarbazepine is more efficacious for relief of peripheral neuropathic pain in patients with the irritable vs the nonirritable nociceptor phenotype Background The efficacy and safety of the association of celecoxib [ a selective cyclooxygenase-2 ( COX-2 ) inhibitor ] and pregabalin ( commonly used to control neuropathic pain ) , compared with monotherapy of each , were evaluated for the treatment of chronic low-back pain , a condition known to be due to neuropathic as well as nociceptive pain mechanisms . Material s and methods In this prospect i ve r and omized trial , 36 patients received three consecutive 4-week treatment regimes , r and omly assigned : celecoxib plus placebo , pregabalin plus placebo , and celecoxib plus pregabalin . All patients were assessed by using a visual analogue scale ( VAS , 0–100 mm ) and the Leeds Assessment of Neuropathic Symptoms and Signs ( LANSS ) pain scale by an investigator blinded to the administered pharmacological treatment . Results Celecoxib and pregabalin were effective in reducing low-back pain when patients were pooled according to LANSS score . The association of celecoxib and pregabalin was more effective than either monotherapy in a mixed population of patients with chronic low-back pain and when data were pooled according to LANSS score . Adverse effects of drug association and monotherapies were similar , with reduced drug consumption in the combined therapy . Conclusions Combination of celecoxib and pregabalin is more effective than monotherapy for chronic low-back pain , with similar adverse effects Patients with the same disease may suffer from completely different pain symptoms yet receive the same drug treatment . Several studies eluci date neuropathic pain and treatment response in human surrogate pain models . They show promising results toward a patient stratification according to the mechanisms underlying the pain , as reflected in their symptoms . Several promising new drugs produced negative study results in clinical phase III trials . However , retrospective analysis of treatment response based on baseline pain phenotyping could demonstrate positive results for certain subgroups of patients . Thus , a prospect i ve classification of patients according to pain phenotype may play an increasingly important role in personalized treatment of neuropathic pain states . A recent prospect i ve study using stratification based on pain‐related sensory abnormalities confirmed the concept of personalized pharmacological treatment of neuropathic pain BACKGROUND Chronic post-thoracotomy pain ( CPTP ) consists of different types of pain . Some characteristics of CPTP are the same as those of recognized neuropathic pain syndromes . OBJECTIVE We aim ed to determine the safety and efficacy of gabapentin ( GP ) in comparison to naproxen sodium ( NS ) in patients with CPTP . METHODS Forty consecutive patients with CPTP after posterolateral/lateral thoracotomy were prospect ively evaluated . Twenty patients were given GP and another 20 were given NS treatment .  Visual Analogue Scale ( VAS ) and the Leeds Assessment of Neuropathic Symptoms and Signs ( LANSS ) scorings were performed pretreatment ( day 0 ) and on the 15th , 30th , 45th and 60th days . Adverse events were question ed . The mean ages were 45.7+/-14.9 and 49.8+/-15.2 years and the mean duration s of pain were 3.8+/-0.9 and 3.8+/-1.1 months , respectively . RESULTS The mean pretreatment VAS scores ( VAS0 ) were 6.4+/-0.6 and 6.8+/-0.6 , the mean pretreatment LANSS scores ( LANSS0 ) were 18.85+/-1.6 and 20.75+/-2.6 in GP and NS groups , respectively ( p>0.05 ) . Minor adverse events which did not m and ate discontinuation of treatment were observed in seven patients ( 35 % ) in the GP and in four patients ( 20 % ) in the NS group . The number of patients with a VAS score < 5 at the latest follow-up ( VAS60 < 5 ) was 17 ( 85 % ) and 3 ( 15 % ) in GP and NS groups , respectively ( p<0.001 ) . Seventeen patients ( 85 % ) in the GP and 0 patients ( 0 % ) in the NS group had a LANSS score < 12 at the latest follow-up . CONCLUSION Gabapentin is safe and effective in the treatment of CPTP with minimal side effects and a high patient compliance . These results should be supported with multidisciplinary studies with larger sample sizes and longer follow-ups UNLABELLED Progress in the underst and ing of chronic pain with neuropathic features has been hindered by a lack of epidemiologic research in the general population . The Leeds Assessment of Neuropathic Symptoms and Signs score ( S-LANSS ) was recently vali date d for use in postal surve 
    Output:
    
There was no indication of any significant pain reduction with NSAIDs .
There is no evidence to support or refute the use of oral NSAIDs to treat neuropathic pain conditions