***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: Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials This experiment was design ed to study the effect of L-tryptophan on nocturnal bruxism .  Portable EMG recorders were used to monitor unilateral masseter muscle activity during sleep in eight patients identified as nocturnal bruxists . Following an initial baseline period , the patients were given , in a r and omized double-blind study , either tryptophan ( 50 mg/kg of body weight ) or a placebo for 8 days followed by an additional 8 days of reverse medication . Dietary patterns and food intake were monitored throughout the experimental period . No significant treatment differences in bruxing levels were found , suggesting that L-tryptophan supplementation in the absence of dietary manipulation is ineffective in the treatment of nocturnal bruxism PURPOSE The purpose of this clinical pilot study was to evaluate the effect of a tricyclic antidepressant , amitriptyline , on  pain-intensity level and level of stress in bruxers .  MATERIAL S AND METHODS In a r and omized , double-blind , crossover experimental design , 10 subjects received active ( amitriptyline 25 mg/night ) and inactive ( placebo 25 mg/night ) medication  , over a period of 4 weeks . RESULTS The administration of amitriptyline for 4 weeks did not significantly ( p > .05 ) reduce pain intensity . However , it significantly ( p < .05 ) reduced the level of stress perception . CONCLUSION The results of this limited study do not support the administration of small doses of amitriptyline over a period of 4 weeks for the management of pain result ing from sleep bruxism . However , the results support the administration of small doses of amitriptyline for the management of the perception of stress levels associated with sleep bruxism AIMS An 8-week parallel , placebo-controlled , double-blind trial evaluated the efficacy of the antidepressant trazodone in the treatment of  chronic burning mouth pain .  METHODS Thirty-seven carefully selected women aged 39 to 71 ( mean 58.6 years ) were r and omized to receive either 200 mg of trazodone or a placebo in a similar manner . Pain and pain-related symptoms were evaluated on a visual analogue scale and other measures at 0 , 2 , 4 , and 8 weeks . RESULTS There were no significant differences between the groups in treatment effects for pain or pain-related symptoms . Seven patients in the trazodone group and 2 in the placebo group failed to complete the trial because of side effects . The most common side effects were dizziness and drowsiness . CONCLUSION In this controlled trial , trazodone failed to relieve burning mouth pain The aim of this study is to assess the reported quality of r and omized controlled trials ( RCTs ) on the effectiveness of neglect rehabilitation using a st and ardized scale . A search of seven electronic data bases was carried out . Selected articles were scored using the PEDro scale and classified as high or low quality study both with the original cut off of 6 and a modified cut off of 5 . A linear regression analysis between year of publication and quality rate was used to test whether the quality of the studies improved with time . A total of 18 RCTs were selected . Six articles ( 33.3 % ) and 10 articles ( 55.56 % ) were classified as having high quality when the original cut off or the modified cut off of the PEDro scale were used , respectively . Analysis shows no time-related changes in PEDro scores . The results show that reported quality is moderate for RCTs in neglect rehabilitation The most common complication of herpes zoster in immunocompetent patients is postherpetic neuralgia , which is very difficult to treat . Significant beneficial effects have been found for amitriptyline , gabapentin , pregabalin , carbamazepine , sodium valproate , oxycodone , corticosteroid , topical capsaicin , tramadol , etc . The aim of this open r and omized comparative study was to demonstrate clinical efficacy of amitriptyline and pregabalin . The study included 50 patients , 32 ( 64 % ) male and 18 ( 36 % ) female , r and omized to receive either amitriptyline or pregabalin ( n=25 each ) .  Amitriptyline was administered in a dose of 25 mg once daily and pregabalin in a dose of 75 mg twice daily . Inclusion criteria were as follows : postherpetic neuralgia of more than 1 month duration ; pain of at least moderate severity ; and patient age 40 years or older and no pregnancy . Patients with a history of any serious diseases ( renal , cardiac , hepatic or seizure ) were excluded . Total treatment period spanned 8 weeks , with patient follow up visits at 2 , 4 and 8 weeks to assess the degree of improvement in pain perception and any adverse reaction . Patients with four herpes zoster types were included in this study , of which thoracic type predominated ( 54 % ) . Other types were cervical in 12 ( 24 % ) , trigeminal in 8 ( 16 % ) and lumbosacral in 3 ( 6 % ) patients .  Prodromal symptoms before herpes zoster were reported by 66 % of study patients . Satisfactory improvements of pain perception at the end of 8 weeks ( > 75 % ) were noticed in pregabalin group , which was statistically significant ( χ(2)2=10.08 ; P<0.05 ) . Dry mouth was the commonest complication in amitriptyline group and dizziness in pregabalin group . More importantly , none of the patients stopped treatment due to adverse reaction . In conclusion , therapy with pregabalin is better compared to amitriptyline in postherpetic neuralgia patients . However , a similar study in a larger sample is required to vali date the present findings The analgesic efficacy of amitriptyline 25 mg was compared with placebo in 41 patients with chronic ( more than 3 months ) nonmalignant pain , using a double‐blind r and omised multiple‐dose 3‐week treatment period crossover design . Amitriptyline 25 mg provided significantly greater efficacy than placebo , with significant differences evident within the first week . There was no significant difference on mood scores between amitriptyline and placebo . The results suggest that surprisingly low doses of amitriptyline may be effective without substantial adverse effects , that the effect is evident early , and that the effect is distinguishable from any effect of the amitriptyline on mood Objective ( Background ): Amitriptyline ( AT ) is a st and ard therapy for postherpetic neuralgia ( PHN ) . Our hypothesis was that nortriptyline ( NT ) , a noradrenergic metabolite of AT , may be more effective . Methods : A r and omized , double-blind , crossover trial of AT versus NT was conducted in 33 patients . Results : Thirty-one patients completed the trial . Twenty-one of 31 ( 67.7 % ) had at least a good response to AT or NT , or both . We found no difference with regard to relief of steady , brief , or skin pain by visual analog scales for pain and pain relief ; mood ; disability ; satisfaction ; or preference between the two drugs . Intolerable side effects were more common with AT . Most patients ( 26/33 ) were not depressed , and most responding showed no change in rating scales for depression despite the occurrence of pain relief . Conclusions : We concluded that this study provides a scientific basis for an analgesic action of NT in PHN because pain relief occurred without an antidepressant effect , and that although there were fewer side effects with NT , AT and NT appear to have a similar analgesic action for most individuals BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . To date , no universally applicable recommendations are available for the treatment of patients with postherpetic neuralgia . A mixture of clinical anecdotes , experimental findings and observations from clinical trials form the basis of the medical arsenal for this condition . Tricyclic antidepressants are commonly used , and clinical experience and several investigations have documented their effectiveness . Today , single entity antidepressants , which can be combined with neuroleptics to increase analgesia , are generally recommended for the treatment of postherpetic neuralgia . Some authors also recommend the additional administration of an opioid if analgesia is inadequate . Just over a decade ago , opioids were considered ineffective for the treatment of neuropathic pain ; however , more recent investigations relating to the use of opioids , primarily in the treatment of nontumour-related chronic pain , have led to a revision of their use in neuropathic pain . Nevertheless , the use of opioid therapy for neurogenic pain remains controversial . Tramadol is a synthetic , central ly acting analgesic with both opioid and nonopioid analgesic activity . The nonopioid component is related to the inhibition of noradrenaline ( norepinephrine ) reuptake and stimulation of serotonin ( 5-hydroxytryptamine ; 5-HT ) release at the spinal level . In this regard , there are parallels with antidepressants , which are believed to potentiate the effect of biogenic amines in endogenous pain-relieving systems . There is evidence that , in tramadol , both mechanisms act synergistically with respect to analgesia . The aim of this pilot study was to investigate , for the first time , the analgesic efficacy and tolerability of tramadol , compared with the antidepressant clomipramine , in the treatment of postherpetic neuralgia . If necessary , clomipramine was used in combination with the neuroleptic levomepromazine . The study allowed individualised dosages at predetermined intervals up to a maximum daily dose of tramadol 600 mg and clomipramine 100 mg , or clomipramine 100 mg with or without levomepromazine 100 mg . 21 ( 60 % ) of 35 r and omised patients ( > or = 65 years ) received the study medication over the 6-week period [ tramadol n = 10 ; clomipramine with or without levomepromazine ) n = 11 ] . After 3 weeks ' treatment the dosage in both groups remained almost constant for the rest of the 6-week treatment phase ( mean daily dose : tramadol 250 to 290 mg ; clomipramine 59.1 to 63.6 mg ) . Only 3 patients required the combination of clomipramine and levomepromazine . At the outset , both groups recorded an average pain level of ' moderate ' to ' very severe ' . In correlation with increasing the study medication , this had decreased to ' slight ' by the end of the treatment , when 9 of 10 patients in the tramadol group and of 6 of 11 patients in the clomipramine group retrospectively rated their analgesia as excellent , good or satisfactory . The psychological/physical condition of the patients did not change significantly during tramadol treatment . Sensitivity and depression parameters decreased in the clomipramine group . The incidence of adverse events for all patients was similar in both groups ( tramadol 76.5 % ; clomipramine with or without levomepromazine 83.3 % ) . In conclusion , tramadol would appear to be an interesting therapeutic alternative for pain relief 
    Output:
    
In summary , there is rationality for the indication of this class of medicine in dentistry in specific clinical situations