***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 
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    Input: We present a double-blind trial in which a pulsed infrared beam was compared with a placebo in the treatment of myofascial pain in the cervical region . The patients were su bmi tted to 12 sessions on alternate days to a total energy dose of 5 J each . At each session , the four most painful muscular trigger points and five bilateral homometameric acupuncture points were irradiated . Those in the placebo group su bmi tted to the same number of sessions following an identical procedure , the only difference being that the laser apparatus was nonoperational . Pain was monitored using the Italian version of the McGill pain question naire and the Scott-Huskisson visual analogue scale . The results show a pain attenuation in the treated group and a statistically significant difference between the two groups of patients , both at the end of therapy and at the 3-month follow-up examination & NA ;  Pain intensity is frequently measured on an 11‐point pain intensity numerical rating scale ( PI‐NRS ) , where 0=no pain and 10=worst possible pain . However , it is difficult to interpret the clinical importance of changes from baseline on this scale ( such as a 1‐ or 2‐point change ) . To date , there are no data driven estimates for clinical ly important differences in pain intensity scales used for chronic pain studies . We have estimated a clinical ly important difference on this scale by relating it to global assessment s of change in multiple studies of chronic pain . Data on 2724 subjects from 10 recently completed placebo‐controlled clinical trials of pregabalin in diabetic neuropathy , postherpetic neuralgia , chronic low back pain , fibromyalgia , and osteoarthritis were used . The studies had similar design s and measurement instruments , including the PI‐NRS , collected in a daily diary , and the st and ard seven‐point patient global impression of change ( PGIC ) , collected at the endpoint . The changes in the PI‐NRS from baseline to the endpoint were compared to the PGIC for each subject . Categories of ‘ much improved ’ and ‘ very much improved ’ were used as determinants of a clinical ly important difference and the relationship to the PI‐NRS was explored using graphs , box plots , and sensitivity/specificity analyses . A consistent relationship between the change in PI‐NRS and the PGIC was demonstrated regardless of study , disease type , age , sex , study result , or treatment group . On average , a reduction of approximately two points or a reduction of approximately 30 % in the PI‐NRS represented a clinical ly important difference . The relationship between percent change and the PGIC was also consistent regardless of baseline pain , while higher baseline scores required larger raw changes to represent a clinical ly important difference . The application of these results to future studies may provide a st and ard definition of clinical ly important improvement in clinical trials of chronic pain therapies . Use of a st and ard outcome across chronic pain studies would greatly enhance the comparability , validity , and clinical applicability of these studies OBJECTIVE The objective of the present study was to assess the degree of pain relief obtained by applying infrared ( IR ) energy to the low back in patients with chronic , intractable low back pain . METHODS Forty patients with chronic low back pain of over six years ' duration were recruited from patients attending the Rothbart Pain Management Clinic , North York , Ontario . They came from the patient lists of three physicians at the clinic , and were r and omly assigned to IR therapy or placebo treatment . One patient dropped out of the placebo group ; as a result , 21 patients received IR therapy and 18 received placebo therapy . The IR therapy was provided by two small , portable units in a sturdy waistb and powered by small , rechargeable batteries made by MSCT Infrared Wraps Inc ( Canada ) . These units met safety st and ards for Food and Drug Administration portability , and are registered with the Food and Drug Administration as a therapeutic device . The unit converted electricity to IR energy at 800 nm to 1200 nm wavelength . The treated group received IR therapy . The placebo group had identical units , but the power was not connected to the circuit-board within the IR pad . Patients attended seven weekly sessions . One baseline and six weekly sets of values were recorded . The principle measure of outcome was pain rated on the numerical rating scale ( NRS ) . The pain was assessed overall , then rotating and bending in different directions . RESULTS The mean NRS scores in the treatment group fell from 6.9 of 10 to 3 of 10 at the end of the study . The mean NRS in the placebo group fell from 7.4 of 10 to 6 of 10 . CONCLUSION The IR therapy unit used was demonstrated to be effective in reducing chronic low back pain , and no adverse effects were observed Study Design This study analyzed health-related quality -of-life measures and other clinical and question naire data obtained from the Maine Lumbar Spine Study , a prospect i ve cohort study of persons with low back problems . Objective For persons with sciatica , back pain-specific and general measures of health-related quality -of-life were compared with regard to internal consistency , construct validity , reproducibility , and responsiveness in detecting small changes over a 3-month period . Summary of Background Data Data were collected from 427 participants with sciatica . Baseline in-person interviews were conducted with surgical and medical patients before treatment and by mail at 3 months . Methods  Health-related quality -of-life measures included symptoms ( frequency and bothersomeness of pain and sciatica  ) functional status and well-being ( modified back pain-specific Rol and scale and Medical Outcomes Study 36-item Short Form Health Survey ( SF-36 ) , and disability ( bed rest , work loss , and restricted activity days ) . Results Internal consistency of measures was high . Reproducibility was moderate , as expected after a 3-month interval . The SF-36 bodily pain item and the modified Rol and measure demonstrated the greatest amount of change and were the most highly associated with self-rated improvement . The specific and generic measures changed in the expected direction , except for general health perceptions , which declined slightly . A high correlation between clinical findings or symptoms and the modified Rol and measure , SF-36 , and disability days indicated a high degree of construct validity . Conclusions These measures performed well in measuring the health-related quality -of-life of patients with sciatica . The modified Rol and and the physical dimension of the SF-36 were the measures most responsive to change over time , suggesting their use in prospect i ve evaluation . Disability day measures , although valuable for assessing the societal impact of dysfunction , were less responsive to changes over this short-term follow-up of 3 months QUESTION Is low level laser therapy an effective adjuvant intervention for chronic low back pain ? DESIGN R and omised trial with concealed allocation , blinded assessors and intention-to-treat analysis . PARTICIPANTS Sixty-one patients who had low back pain for at least 12 weeks . INTERVENTION One group received laser therapy alone , one received laser therapy and exercise , and the third group received placebo laser therapy and exercise . Laser therapy was performed twice a week for 6 weeks . OUTCOME MEASURES Outcomes were pain severity measured using a 10-cm visual analogue scale , lumbar range of motion measured by the Schober Test and maximum active flexion , extension and lateral flexion , and disability measured with the Oswestry Disability Index on admission to the study , after 6 weeks of intervention , and after another 6 weeks of no intervention . RESULTS There was no greater effect of  laser therapy compared with exercise for any outcome , at either 6 or 12 weeks . There was also no greater effect of laser therapy plus exercise  compared with exercise for any outcome at 6 weeks . However , in the laser therapy plus exercise group pain had reduced by 1.8 cm ( 95 % CI 0.1 to 3.3 , p = 0.03 ) , lumbar range of movement increased by 0.9 cm ( 95 % CI 0.2 to 1.8 , p < 0.01 ) on the Schober Test and by 15 deg ( 95 % CI 5 to 25 , p < 0.01 ) of active flexion , and disability reduced by 9.4 points ( 95 % CI 2.7 to 16.0 , p = 0.03 ) more than in the exercise group at 12 weeks . CONCLUSION In chronic low back pain low level laser therapy combined with exercise is more beneficial than exercise alone in the long term The purpose of this double-blind study was to ascertain the effects of helium-neon ( He-Ne ) laser irradiation on skin resistance and pain in patients with trigger points in the neck or low back . This study entailed a partial replication of a previous study by Snyder-Mackler and associates that determined the use of the He-Ne laser increased skin resistance overlying a trigger point . Twenty-four patients were r and omly assigned to either a treatment or a control group and received three 20-second applications of laser irradiation or placebo " stimulation , " respectively . Pretreatment and posttreatment skin resistance and pain measurements ( via visual analog scale ) were taken during each session . Results indicated a statistically significant increase in skin resistance ( p less than .001 ) and a decrease in pain ( p less than .005 ) following laser treatment . There was not a significant correlation between skin resistance and pain across subjects . These data substantiate the previous findings of Snyder-Mackler and associates and demonstrate a reduction in pain .  Helium-neon laser treatment , therefore , may be an effective adjunct to conventional physical therapy of these patients INTRODUCTION Low back pain is one of the most frequent health problems . The aim of the study was to investigate clinical effects of complex rehabilitation programs on quality of life of patients with subacute lumbar pain , and also to investigate the relationship between quality of life and the intensity of pain and local functional status of the lumbar spine . MATERIAL AND METHODS The prospect i ve study included 60 patients suffering from subacute low back pain with radiculopathy caused by lumbar disc syndrome , without any previous treatment , and who did not need surgery . In a single blind trial patients were divided into two groups . The first group ( A group , n=30 ) was treated by low level laser therapy ( wavelength 904 nm , frequency 4000 Hz , at dose 2J per point ) ; the whole dose of 12J , then with TENS ( frequency 80 Hz , 30 minutes , pulse duration 200 micros ) , with exercise , and simultaneously with conventional therapy with NSAIDs which inhibit COX-2 ( meloxicam , 15 mg per day ) . Patients were treated 5 times a week , a total of 15 treatments . The second group ( B group , n = 30 ) , was treated only by meloxicam ( 15 mg per day ) . The subjects were evaluated before the first treatment and three days after the last treatment ( 21st to 24th day ) . Data were analyzed using Student 's t test and with analytic statistical methods . RESULTS The mean Oswestry scores before and after therapy for group A have reduced from 25+/-2 to 16+/-3 , with statistical significance ( t= 8.84 p<0.001 ) and in group B from 24+/-2.5 to 22+/-2.5 ( t=2.56 p<0.05 ) . Statistical analysis has shown an increase of mean values for the 12-item health survey ( SF-12 ) from 22.33+/-4.66 to 36.33+/-3.66 ( t=9.12 p<0.001 ) , in group A and from 23.66+/-3.66 to 30.33+/-4.66 ( t=3.15 p < 0.001 ) in group B. Mean values of intensity of pain in group A have been reduced from 82+/-6.50 to 46+/-5.50 , ( t=7.85 , p<0.001 ) and from 80+/-5.50 to 62+/-6.50 in group B ( t=5.65 ; p<0.001 ) . No significant changes have been recorded in Schober measurement . The intensity of pain was in positive correlation with Oswestry score ( Ft=7.84 ; p<0.001 ) in group A and also in group B ( Ft=5.25 : p<0.05 ) , as for the 12-item health survey ( SF-12 ) ( Ft=8.34 : p<0.001 ) in group A and in group B ( Ft=5.98 ; p<0.05 ) . Two measurements of quality of life have shown close relationship ( Ft=5.45 ; p<0.05 ) in group A and group B ( Ft=6.45 : p<0.05 ) . CONCLUSION Results of this study showed that better results were achieved in group treated with complex rehabilitation methods in comparison with patients treated only with anti-inflammatory drugs . Also , the 12-item health survey ( SF-12 ) has shown positive correlation with intensity of pain reduction and with Oswestry disability score and so it is valid for measuring the effectiveness of therapeutic modalities in subacute lumbar pain AIM Back pain is a highly frequent condition due to many causes , although most of them can not be established with certainty . It is also the current clinical and scientific belief that sacroiliac joint syndrome can be a specific low back pain cause . Nonetheless the existence of clinical tests aim ed at highlighting the responsibility for lumbar pain secondary to sacroiliac dysfunction , it is not easy to diagnose it with either manual or instrumental means . Moreover , uncertainty is diffuse when facing a correct treatment for patients involved . The aim of this study was to verify , in patients with acute or sub-acute low back pain and positive sacroiliac signs , the efficacy of a stabilising therapy ( orthosis and exercises , with previous mesotherapy ) directly targeted to sacroiliac dysfunction versus a symptomatic usual care such as He-Ne laser therapy . METHODS Over a period of 14 months , we recruited 22 patients (  
    Output:
    
Based on the heterogeneity of the population s , interventions and comparison groups , we conclude that there are insufficient data to draw firm conclusions on the clinical effect of LLLT for low-back pain .