***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 It has previously been suggested that the activity in sensory regions of the brain can be modulated by attentional mechanisms during parallel cognitive processing . To investigate whether such attention‐related modulations are present in the processing of pain , the regional cerebral blood flow was measured using [15O]butanol and positron emission tomography in conditions involving both pain and parallel cognitive dem and s. The painful stimulus consisted of the st and ard cold pressor test and the cognitive task was a computerised perceptual maze test . The activations during the maze test reproduced findings in previous studies of the same cognitive task . The cold pressor test evoked significant activity in the contralateral S1 , and bilaterally in the somatosensory association areas ( including S2 ) , the ACC and the mid‐insula . The activity in the somatosensory association areas and periaqueductal gray/midbrain were significantly modified , i.e. relatively decreased , when the subjects also were performing the maze task . The altered activity was accompanied with significantly lower ratings of pain during the cognitive task . In contrast , lateral orbitofrontal regions showed a relative increase of activity during pain combined with the maze task as compared to only pain , which suggests the possibility of the involvement of frontal cortex in modulation of regions processing pain This study describes the results of a controlled clinical trial involving 44 7- to 14-year-old children with recurrent abdominal pain who were r and omly allocated to either cognitive-behavioral family intervention ( CBFI ) or st and ard pediatric care ( SPC ) .  Both treatment conditions result ed in significant improvements on measures of pain intensity and pain behavior . However , the children receiving CBFI had a higher rate of complete elimination of pain , lower levels of relapse at 6- and 12-month follow-up , and lower levels of interference with their activities as a result of pain and parents reported a higher level of satisfaction with the treatment than children receiving SPC . After controlling for pretreatment levels of pain , children 's active self-coping and mothers ' caregiving strategies were significant independent predictors of pain behavior at posttreatment In a prospect i ve study , the prevalence of 15 physical symptoms and symptom groups was evaluated in 1635 cancer patients referred to a pain clinic . In addition to pain , patients suffered an average of 3.3 symptoms : insomnia ( 59 % ) , anorexia ( 48 % ) , constipation ( 33 % ) , sweating ( 28 % ) , nausea ( 27 % ) , dyspnea ( 24 % ) , dysphagia ( 20 % ) , neuropsychiatric symptoms ( 20 % ) , vomiting ( 20 % ) , urinary symptoms ( 14 % ) , dyspepsia ( 11 % ) , paresis ( 10 % ) , diarrhea ( 6 % ) , pruritus ( 6 % ) , and dermatological symptoms ( 3 % ) . While symptom prevalence was influenced by tumor site , pain intensity , and opioid treatment , only a minor relationship was seen between symptoms and gender , age , or tumor stage . The data emphasize that it is not sufficient to simply address pain during the treatment of patients with cancer pain ; a more global approach to symptom management is necessary BACKGROUND Chronic pain is recognised as an important problem in the community but our underst and ing of the epidemiology of chronic pain remains limited . We undertook a study design ed to quantify and describe the prevalence and distribution of chronic pain in the community . METHODS A r and om sample of 5036 patients , aged 25 and over , was drawn from 29 general practice s in the Grampian region of the UK and surveyed by a postal self-completion question naire . The question naire included case-screening questions , a question on the cause of the pain , the chronic pain grade question naire , the level of expressed needs question naire , and sociodemographic questions . FINDINGS 3605 question naires were returned completed . 1817 ( 50.4 % ) of patients self reported chronic pain , equivalent to 46.5 % of the general population . 576 reported back pain and 570 reported arthritis ; these were the most common complaints and accounted for a third of all complaints . Backward stepwise logistic-regression modelling identified age , sex , housing tenure , and employment status as significant predictors of the presence of chronic pain in the community . 703 ( 48.7 % ) individuals with chronic pain had the least severe grade of pain , and 228 ( 15.8 % ) the most severe grade . Of those who reported chronic pain , 312 ( 17.2 % ) reported no expressed need , and 509 ( 28.0 % ) reported the highest expressed need . INTERPRETATION Chronic pain is a major problem in the community and certain groups within the population are more likely to have chronic pain . A detailed underst and ing of the epidemiology of chronic pain is essential for efficient management of chronic pain in primary care & NA ; Few controlled clinical trials of psychological interventions for cancer pain relief exist in spite of frequent support for their importance as adjuncts to medical treatment . This study compared oral mucositis pain levels in 4 groups of cancer patients receiving bone marrow transplants ( BMT ) : ( 1 ) treatment as usual control , ( 2 ) therapist support , ( 3 ) relaxation and imagery training , and ( 4 ) training in a package of cognitive‐behavioral coping skills which included relaxation and imagery . A total of 94 patients completed the study which involved two training sessions prior to treatment and twice a week ‘ booster ’ sessions during the first 5 weeks of treatment . Results confirmed our hypothesis that patients who received either relaxation and imagery alone or patients who received the package of cognitive‐behavioral coping skills would report less pain than patients in the other 2 groups . The hypothesis that the cognitive‐behavioral skills package would have an additive effect beyond relaxation and imagery alone was not confirmed . Average visual analogue scale ( VAS ) report of pain within the therapist support group was not significantly lower than the control group ( P = 0.103 ) nor significantly higher than the training groups . Patient reports of relative helpfulness of the interventions for managing pain and nausea matched the results of VAS reports . From these results , we conclude that relaxation and imagery training reduces cancer treatment‐related pain ; adding cognitive‐behavioral skills to the relaxation with imagery does not , on average , further improve pain relief Manipulated experimentally mothers ' verbal behavior during a routine intramuscular injection in order to help clarify the role of nonprocedural talk ( distraction ) and parental reassurance on children 's reaction to the injection . 42 child-mother dyads were recruited from a general pediatric primary care clinic and were r and omly assigned to a parental reassurance , parental nonprocedural talk ( distraction ) or minimal-treatment control group . Children in the maternal distraction condition exhibited significantly less distress during the immunization injection than those in the reassurance and control conditions . Specifically , children in the maternal distraction group exhibited less crying than children in the other two groups . Children in the reassurance and control groups did not differ from each other in terms of behavioral distress . The present findings serve further to bolster the evidence for the efficacy of maternal distraction as a way to ameliorate child distress during invasive medical procedures Evaluated distress during invasive procedures in childhood leukemia . Child and parent distress , assessed by question naires and ratings , were compared in two arms of a r and omized , controlled prospect i ve study , one a pharmacologic only ( PO ) ( n = 45 ) and the other a combined pharmacologic and psychological intervention ( Cl ) ( n = 47 ) , at 1 , 2 , and 6 months after diagnosis . The cross-sectional control group ( CC ) consisted of parents of 70 patients in first remission prior to the prospect i ve study .  Mothers ' and nurses ' ratings of child distress indicated less child distress in the Cl group than the PO . When contrasted with the CC group , the Cl group showed lower levels of child distress . Data showed decreases over time in distress and concurrent improvements in quality of life and parenting stress and supported an inverse association between distress and child age BACKGROUND This study examined the nurse outcomes of a cancer pain education program for nurses of patients from 11 different ethnic groups . METHODS Four hundred ninety six home , hospital , and hospice nurses participated in a one-day workshop or two half-day workshops on cancer pain assessment and management .  Of these , 116 were r and omized to participate in a bedside-precepted visit with an oncology nurse specialist with pain specialization and a focus group to discuss attitudinal issues .  Eighty-six nurses served as controls . Pre- , post- and one-year follow-up tests were administered . RESULTS Attitudes , knowledge , and application skills significantly improved for workshop-only and enriched-model nurses relative to controls . CONCLUSION For postgraduate nurses , daylong cancer pain education workshops were , in the group studied , as effective as h and s-on experience in improving cancer pain knowledge and changing attitudes . Both the workshop-only and the enriched-model nurses relative to controls had significantly improved knowledge and changed attitudes towards optimal pain management & NA ; Given the dem and for interventions that may prevent the development of persistent musculoskeletal pain problems , we investigated the effects of a cognitive‐behavioral program in a group of non‐ patients with neck or back pain symptoms . Two hundred and fifty‐three people selected from a population study were invited to participate . These people had experienced four or more episodes of relatively intense spinal pain during the past year but had not been out of work more than 30 days . Participants were r and omly assigned to either a cognitive‐behavioral group intervention or a treatment as usual comparison group . The experimental group received a st and ardized six‐session program , provided by a trained therapist according to a manual . A significant overall analysis at the 1‐year follow‐up showed that the cognitive‐behavioral group produced better results on 26 of the 33 outcome variables . Group comparisons indicated that the cognitive‐behavioral group , relative to the comparison group , had significantly better results with regard to fear‐avoidance beliefs , number of pain‐free days , as well as the key variable of sick leave . Participation in the cognitive behavioral group  reduced the risk for long‐term sick leave during the follow‐up by threefold . Thus , despite the strong natural recovery rate for back pain , the cognitive‐behavioral intervention produced a significant preventive effect with regard to disability The effectiveness of a continuing education programme on pain assessment and management  was investigated in 106 surgical cancer nurses . It was found that the programme led to a more positive attitude towards physical and relaxation interventions ( such as the use of relaxation , distraction and massage techniques ) . In addition , an increase in the duration and quality of psychosocial interventions ( provision of information , emotional support , and promotion of autonomy ) was established . Furthermore , the programme result ed in an increase in the quality of physical and relaxation interventions . However , the programme did not lead to more positive attitudes towards psychosocial interventions , or to increases in the numbers of psychosocial , physical and relaxation interventions Background : Long-term musculoskeletal pain is a common problem in primary health care setting s that is difficult to treat . Two common treatments are mental relaxation and massage . Scientific studies show contradictory results . Furthermore , many studies lack long-term follow-up even though it is a chronic disorder . The purpose of this r and omized clinical trial was to assess possible effects of massage as compared to listening to relaxation tapes in conditions of ‘ diffuse ’ and long-term musculoskeletal pain . Methods : 129 patients from primary health care suffering from long-term musculoskeletal pain were r and omized to either a massage or mental relaxation group , and assessed before , during and after treatment . Results : During treatment there was a significant improvement in the three main outcome measures : self-rated health , mental energy , and muscle pain only in the massage group as compared to the relaxation group . However , at the 3-month post-treatment follow-up , there was a significant worsening in the outcome measures ( time × group effect p < 0.05 ) back to initial rating levels in the massage group as compared to no changes in the relaxation group . Conclusion : Massage , but not mental relaxation , is beneficial in attenuating diffuse musculoskeletal symptoms . Beneficial effects were registered only during treatment . This lack of long-term benefits could be due to the short treatment period or treatments such as these do not address the underlying causes of pain . Future studies of long-term pain should include longer treatment periods and post-treatment follow-up . It might also be worthwhile assessing the long-term benefits from booster treatment after the initial intense treatment period This study evaluated a distraction intervention design ed to reduce the distress of preschool children undergoing repeated chemotherapy injections . Twenty-nine children aged 2 - 5 years were r and omly assigned either to distraction by a developmentally appropriate electronic toy or to a wait-list control . Children who received the distraction intervention demonstrated lower overt behavioral distress and were rated by parents and nurses as less anxious than children in the control condition . The improvements were maintained over the 8-week intervention . The results suggest that a developmentally appropriate , multisensory , variable-distracting activity that requires active cognitive processing and active motor responses may be a viable cost-effective alternative to more time-intensive parent-training programs for preschool-age children CONTEXT Common pain conditions appear to have an adverse effect on work , but no comprehensive estimates exist on the amount of productive time lost in the US workforce due to pain . OBJECTIVE To measure lost productive time ( absence and reduced performance due to common pain conditions ) during a 2-week period . DESIGN AND SETTING Cross-sectional study using survey data from the American Productivity Audit ( a telephone survey that uses the Work and Health Interview ) of working adults between August 1 , 2001 , and July 30 , 2002 . PARTICIPANTS R and om sample of 28 902 working adults in the United States . MAIN OUTCOME MEASURES Lost productive time due to common pain conditions ( arthritis 
    Output:
    
Results of studies evaluating such programs are promising and suggest that training might be an effective means of impacting healthcare professionals '  knowledge , attitudes , and even patient care .