***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: Abstract This double-blind , sham-controlled study sought to investigate the effectiveness of cranial electrotherapy stimulation ( CES ) for the treatment of  bipolar II depression ( BD II ) .  After r and omization , the active group participants ( n = 7 ) received 2 mA  CES treatment for 20 minutes five days a week for 2 weeks , whereas the sham group ( n = 9 ) had the CES device turned on and off . Symptom non-remitters from both groups received an additional 2 weeks of open-label active treatment . Active CES treatment but not sham treatment was associated with a significant decrease in the Beck Depression Inventory ( BDI ) scores from baseline to the second week ( p = 0.003 ) maintaining significance until week 4 ( p = 0.002 ) . There was no difference between the groups in side effects frequency . The results of this small study indicate that CES may be a safe and effective treatment for BD II suggesting that further studies on safety and efficacy of CES may be warranted OBJECTIVES This pilot study examined the potential efficacy of cranial electric stimulation for the treatment of  insomnia .  DESIGN The research ers tested the hypothesis through a r and omized , double-blind , and placebo controlled clinical trial . The research ers approached eligible subjects who scored 21 or above on the Pittsburgh Insomnia Rating Scale . The research ers then r and omly assigned the subjects to receive either an active or sham device . Each study subject received 60min of active or sham treatment for five days . Following each intervention the subjects completed a sleep log , as well as three and ten days later . SETTING The research ers conducted the study among active duty service members receiving mental health care on the Psychiatry Continuity Service ( PCS ) , Walter Reed National Military Medical Center in Bethesda , MD . MAIN OUTCOME MEASURES The study 's primary outcome variables were the time to sleep onset , total time slept , and number of awakenings as reported by the subjects in the serial sleep logs . The research ers identified a nearly significant increase in total time slept after three cranial electric stimulation treatments among all study subjects . A closer examination of this group revealed an interesting gender bias , with men reporting a robust increase in total time slept after one treatment , decay in effect over the next two interventions , and then an increase in total time slept after the fourth treatment . The research ers speculate that the up and down effect on total time slept could be the result of an insufficient dose of cranial electric stimulation Results of a r and omized , double-blind pilot study indicate that transcranial electrotherapy stimulation may be an effective treatment for the temporary reduction of pain in osteoarthritis patients . Presently , the predominant method for pain management is medication . One very different approach is the application of micro- to milliamp current applied to specific areas of the head , result ing in a release of endogenous opioids from pain management regions of the brain . For the pilot study , 64 subjects suffering from osteoarthritis of the knee and /or hip were enrolled . For two weeks prior , then during and after treatment , subject pain was self-assessed using the visual scale ( VS ) . In addition , subjects were globally assessed by a physician . All subjects , device operators and physicians were blinded as to whether subjects were treated with an active or sham device . Data collected from the study indicate both a decrease in VS pain scores and a significant improvement ( p = 0.05 ) in physician assessment in subjects treated with active devices compared to those treated with the sham device To investigate the effects of microcurrent cranial electrical stimulation ( CES ) therapy on reducing pain and its associated symptoms in fibromyalgia ( FM ) , we conducted a r and omized , controlled , three-group ( active CES device , sham device , and usual care alone [ UC ] )  , double-blind study to determine the potential benefit of CES therapy for symptom management in FM . Those individuals using the active CES device had a greater decrease in average pain ( p = .023 ) , fatigue ( p = .071 ) , and sleep disturbance ( p = .001 ) than individuals using the sham device or those receiving usual care alone over time . Additionally , individuals using the active CES device had improved functional status versus the sham device and UC groups over time ( p = .028 ) Abstract Background Chronic pain is a significant problem for many individuals following spinal cord injury ( SCI ) . Unfortunately , SCI-related neuropathic pain has proven to be largely refractory to analgesic medications and other available treatments . Cranial electrotherapy stimulation ( CES ) has been effective in managing some types of pain . It involves the application of a small amount of current through the head via ear clip electrodes . Objective Explore the effectiveness of CES for neuropathic pain in persons with SCI and chronic pain . Study design Multi-site , double-blind , sham-controlled study . Participants Adults with SCI and chronic neuropathic pain at or below the level of injury were r and omized to receive active or sham CES . Intervention Application of active CES or sham CES 1 hour daily for 21 days . Six-month open-label phase to assess ‘ as-needed ’ CES use . Outcome measures Change in pre- to post-session pain ratings as well as change in pain intensity , pain interference , pain quality , pain beliefs and coping strategies , general physical and mental health status , depressive symptomatology , perceived stress , and anxiety pre- to post-treatment . Results The active group reported a significantly greater average decrease in pain during daily treatments than the sham group ( Kruskal – Wallis chi-square = 4.70 , P < 0.05 ) . During the 21-day trial , there was a significant group × time interaction for only one outcome variable ; the active group showed larger pre- to post-treatment decreases in pain interference than the sham group did ( F = 8.50 , P < 0.01 , d = 0.59 ) . Conclusions On average , CES appears to have provided a small but statistically significant improvement in pain intensity and pain interference with few troublesome side effects . Individual results varied from no pain relief to a great deal of relief Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE To examine the efficacy of transcranial electrical stimulation a non-invasive method of reducing pain . DESIGN A r and omized , double-blind , placebo-controlled trial . SUBJECTS A total of 119 patients with chronic pain . METHODS Patients were treated with either transcranial electrical stimulation or an active placebo device . Short- and long-term follow-ups were evaluated for treatment efficacy with 4 ordinal scale variables : visual analogue scale ( pain level ) , SLEEP ( how often does pain disturb sleep ) , FREQ ( frequency of pain ) and MED ( frequency of use of medications to relieve pain ) . RESULTS Pain level decreased significantly in the transcranial electrical stimulation-treated group compared with the active-placebo group 3 weeks after the end of treatment ( p = 0.0017 between groups ) . Other parameters did not demonstrate significant differences . Three months after the end of treatment this effect was maintained and other treatment parameters showed similar improvements . CONCLUSION Transcranial electrical stimulation is an effective non-invasive method for pain relief . The active placebo device has a powerful effect on reported pain , which diminishes in the long-term . The involvement of possible neural mechanisms is discussed Objectives . To assess the feasibility of treating musculoskeletal pain in the lower back and /or lower extremities in persons with Parkinson 's disease ( PD ) with cranial electrotherapy stimulation ( CES ) . Design . R and omized , controlled , double-blind trial . Setting . Veterans Affairs Medical Center , Community . Participants . Nineteen persons with PD and pain in the lower back and /or lower extremities . Thirteen provided daily pain rating data . Intervention . Of the thirteen participants who provided daily pain data , 6 were r and omly provided with active CES devices and 7 with sham devices to use at home 40 minutes per day for six weeks . They recorded their pain ratings on a 0-to-10 scale immediately before and after each session . Main Outcome Measure . Average daily change in pain intensity . Results . Persons receiving active CES had , on average , a 1.14-point decrease in pain compared with a 0.23-point decrease for those receiving sham CES ( Wilcoxon Z = −2.20 , P = .028 ) . Conclusion . Use of CES at home by persons with PD is feasible and may be somewhat helpful in decreasing pain . A larger study is needed to determine the characteristics of persons who may experience meaningful pain reduction with CES . Guidelines for future studies are provided Treatments for chronic pain in persons with spinal cord injury ( SCI ) have been less than effective . Cranial electrotherapy stimulation ( CES ) , a noninvasive technique that delivers a microcurrent to the brain via ear clip electrodes , has been shown to effectively treat several neurological and psychiatric disorders . The present study examined the effects of daily 1-hour active CES or sham CES treatment ( r and omly assigned ) for 21 days on pain intensity and interference with activities in 38 males with SCI . The active CES group ( n = 18 ) reported significantly decreased daily pain intensity compared with the sham CES group ( n = 20 ) ( mean change : active CES = -0.73 , sham CES = -0.08 ; p = 0.03 ) . Additionally , the active CES group reported significantly decreased pain interference ( -14.6 pre- vs postintervention , p = 0.004 ) in contrast to the nonsignificant decrease in the sham CES group ( -4.7 pre- vs postintervention , p = 0.24 ) . These results suggest that CES can effectively treat chronic pain in persons with SCI OBJECTIVE To investigate the effects of microcurrent cranial electrical stimulation ( CES ) therapy on activity in pain processing brain regions . DESIGN A r and omized , controlled , three-group , double-blind pilot study . PARTICIPANTS Persons with physician-diagnosed fibromyalgia . INTERVENTION Active CES device , sham device , and usual care alone . RESULTS Those individuals using the active device had a greater decrease in average pain ( P = .023 ) than individuals using the sham device or receiving usual care alone over time . Preliminary analyses of the functional magnetic resonance imaging data on a subset of six participants from each of the two device groups show that individuals using an active CES device had a decrease in activation in the pain processing regions of the brain compared to those using a sham device . CONCLUSIONS The observed decrease in activation in the pain processing regions may indicate a decrease in neural activity in these regions that may be related to decreased pain . This is the first r and omized , controlled trial of CES in patients diagnosed with fibromyalgia to report functional magnetic resonance imaging data We examined efficacy and safety of one specific cranial electrical stimulator ( CES ) device at a fixed setting in subjects with treatment-resistant major depressive disorder ( MDD ) . Thirty subjects ( 57 % female , mean age 48.1 ± 12.3 years ) with MDD and inadequate response to st and ard antidepressants were r and omized to 3 weeks of treatment with CES ( 15/500/15,000 Hz , symmetrical rectangular biphasic current of 1 - 4 mAmp , 40 V ) or sham CES ( device off ) for 20 min , 5 days per week . The primary outcome measure was improvement in the 17-item Hamilton Depression Rating Scale ( HAM-D-17 ) . Adverse effects ( AEs ) were assessed using the Patient Related Inventory of Side Effects ( PRISE ) . Completion rates were 88 % for CES , 100 % for sham . Both treatment groups demonstrated improvement of about 3 - 5 points in HAM-D-17 scores ( p < 0.05 for both ) , and no significant differences were observed between groups . Remission rates were 12 % for CES , and 15 % for sham , a nonsignificant difference . CES was deemed safe , with good tolerability ; poor concentration and malaise were the only distressing AEs that differed significantly between CES and sham ( p = 0.019 and p = 0.043 , respectively ) . Limitations include a small sample and lack of an active comparator therapy . Although both treatment groups improved significantly , this CES at the setting chosen did not separate from sham in this sample . Thus we can not rule out that the benefit from this setting used in this particular form of CES was due to placebo effects . Since this form of CES has other setting s , future studies should test these setting s and compare it against other CES devices . Clinical trials.gov ID : NCT01325532 Since the late 1940s investigators in Russia and Europe have reported that electrosleep therapy is effective for the full spectrum of psychiatric disorders and many “ psychophysiological ” disorders , such as acid-peptic disease , essential hypertension , neurodermatitis etc . Few of these studies are controlled , and to date there is a paucity of double blind , controlled inquiries to aid the clinician in objective evaluation of the indications , contraindications , efficacy , and mode of application for this somatic therapy . A recent controlled study indicates that electrosleep therapy is effective for patients with prominent symptoms of anxiety , insomnia and depression . Our study was design ed to test on a double blind , controlled basis the efficacy of electrosleep therapy on patients with chronic ( more than 2 years ) psychiatric illness unresponsive to current treatment modalities in which the prominent symptoms were anxiety , insomnia , and depression with no evidence of medical illness that could account for these symptoms . All patients received a comprehensive , systematic , diagnostic research interview with diagnoses based on criteria for scoring symptoms positive ( Appendix 1 ) and criteria for each psychiatric syndrome involved ( Appendix 2 ) . Patients were r and omly assigned to one of two groups . Group I patients received 10 active electrosleep treatments 
    Output:
    
Pooled effects for anxiety were statistically significant , favoring active treatment .
The analysis found no benefit for insomnia or brain dysfunction and a small beneficial effect for headache .