***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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    ***EXAMPLES*** 
    Input: Sleep disturbances and related daytime complaints are frequent in rheumatoid arthritis ( RA ) . The aim of the current study was therefore to evaluate the effect of a newer hypnotic on sleep structure and clinical parameters in RA . Forty out patients were r and omized to a two week treatment regimen with either 7.5 mg zopiclone or placebo at bedtime . Clinical examinations were performed before and after treatment and the degree of pain , fatigue , sleepiness , morning stiffness , and activities of daily living were assessed . Two sleep question naires were also completed weekly .  Polysomnography  was performed before the study and after 14 days of treatment . Recordings were evaluated using conventional sleep scoring as well as frequency analysis of the  electroencephalography ( EEG ) . Patients in the zopiclone group had subjective improvement of sleep , but otherwise no differences in pain score or the other clinical parameters were found . Conventional sleep assessment s showed only minor changes during treatment , but frequency analysis demonstrated a shift from the lower towards the higher EEG frequencies in the active treatment group . Although the modulation of the EEG can represent a non-specific pharmacologic epiphenomenon , it might also reflect a disturbance of sleep microstructure . In conclusion , treatment with zopiclone may be of value for subjective sleep complaints in selected patients with RA , but it is doubtful whether hypnotics improve daytime symptoms in this patient group A brief , forced‐choice daily question naire was developed to quantitatively evaluate the efficacy of hypnotics over an extended period in out patients with insomnia . The usefulness of this question naire , combined with the patients ' ranking of successive weeks , was tested in two studies . The first , involVing 44 patients during three weeks , used a relatively potent hypnotic , 100 mg sodium pentobarbital , while the second , involVing 36 patients during four weeks , used a mild hypnotic , 2 Excedrin‐PM tablets . Both studies indicated the two subjective measures to be appropriate ; the potent and the mild hypnotic were significantly discriminated from placebo under double‐blind conditions . The first study also included a magnetic pillow‐insert that was not differentiated from a placebo pillow‐insert , but that , nevertheless , appeared to have some central nervous system effects related to a greater frequency and more vividness of recall of dreams . It was concluded that these subjective measures are valuable for chronic hypnotic assays under “ normal ” ( i.e. , home ) conditions where more objective laboratory techniques are not applicable The efficacy of indomethacin 100 mg , diazepam 10 mg , and placebo in producing sleep , relieving night pain , and reducing the severity of morning stiffness , was compared in 18 patients in hospital with active classical or definite rheumatoid arthritis . There was no statistically significant difference in the preference of patients or sleep score among the three forms of treatment . Both indomethacin and diazepam were more effective than placebo in relieving night pain .  Indomethacin decreased , but diazepam increased , morning stiffness in comparison to placebo . Neither active therapy produced significant side-effects A double-blind controlled trial was carried out in 18 in- patients with classical or definite rheumatoid arthritis to assess the effectiveness of night-time medication with 100 mg indomethacin plus 10 mg diazepam , 200 mg sulindac , and 200 mg sulindac plus 10 mg diazepam in improving sleep and reducing night pain and the duration of morning stiffness . Patients received each treatment regimen for 1 night . The results from the 17 patients completing the full trial protocol indicated that indomethacin plus diazepam was the most effective of the three regimens , although the differences did not reach conventional statistical significance . It is suggested that in further such studies with sulindac a larger dose and a longer duration of treatment should be used Seventeen of eighteen patients hospitalized for active rheumatoid arthritis completed a three-day r and omized , double-blind comparison of 100 mg indomethacin , 100 mg indomethacin with 10 mg diazepam and matching placebo as night medication . The results showed a consistent pattern in the four functions measured -- pain , morning stiffness , sleep score and patient preference . In each , indomethacin proved superior to placebo and the combined therapy better than indomethacin alone . From this it has been concluded that the combination of indomethacin and diazepam should now be considered the treatment of choice for maximum control of night pain and morning stiffness in rheumatoid arthritis Opioid-GABAergic interactions for the treatment of post-operative pain  were investigated in two double-blind , placebo-controlled experiments . We first studied the effect of pre-operatively administered baclofen , a GABAB receptor agonist , on the analgesia produced by intravenously administered morphine , a predominantly mu-opioid analgesic . In a separate trial , we studied the effect of baclofen on the analgesia produced by pentazocine , a predominantly kappa-opioid analgesic . While baclofen alone did not affect the level of post-operative pain , morphine analgesia was significantly enhanced by baclofen compared to placebo . In contrast , baclofen did not affect the level of pentazocine analgesia : however , females receiving pentazocine showed significantly greater analgesia than males Abstract 1 . 1 . Diazepam was compared with chlormezanone and carisoprodol in the symptomatic treatment of chronic rheumatic disorders .  2 . 2 . Sixty-five patients with active arthritis ( rheumatoid , osteo- , or gouty ) , or fibrositis , received 2-week courses of each drug in r and om sequence , utilizing a double-blind cross-over technique . Administered in matching capsules , the average daily dosages amounted to 7.5 mg of diazepam , or 600 mg of chlormezanone , or 1050 mg of carisoprodol . 3 . 3 . Clinical response to each agent was measured by the relative degree of improvement in five symptoms — muscle spasm , pain , limitation of motion , anxiety and tension , and interference with daily activities — over the symptom severity present before each drug course . The differences in averaged symptom improvement scores ( of each group of patients on each drug ) represented the relative efficacy of each drug in relieving each symptom . 4 . 4 . Over-all results showed : 24 per cent of the diazepam-treated patients became symptom-free vs. 11 per cent on each of the two other drugs ; in approximately 65 per cent of patients on each drug , moderate improvement was achieved , while only minimal improvement occurred in 11 per cent of those on diazepam vs. 24 per cent on each of the other drugs . Two patients , one on carisoprodol and one on chlormezanone , were unimproved . 5 . 5 . The differences in scored results between pairs of the 3 drugs , su bmi tted to statistical analysis , indicated that diazepam effected significantly greater symptomatic improvement than did chlormezanone or carisoprodol . 6 . 6 . Side-effects occurred in 27 patients during diazepam therapy , in 38 on chlormezanone , and in 34 on carisoprodol ;  drowsiness was the most common side-reaction with each drug ; none was of sufficient severity to discontinue medications OBJECTIVE Fibromyalgia syndrome ( FMS ) is a musculoskeletal disorder characterized by generalized pain , localized tender points , chronic fatigue and nonrestorative sleep . Since sleep disturbances frequently occur in FMS and alpha intrusion in nonrapid eye movement ( NREM ) sleep probably associates with the nonrefreshing sleep , we prospect ively studied the delta and alpha activity and alpha-delta ratio across sleep cycles , performing polysomnography in 10 patients with FMS and in 14 healthy control subjects . METHODS Night long polysomnography recordings  were performed in all subjects .  Sleep scoring was done visually according to Rechtschaffen and Kales criteria . By means of spectral analysis the conventional electroencephalogram ( EEG ) frequency b and s were automatically computed for the all night recordings . For alpha and delta power the integrated and normalized values were calculated for each sleep cycle , the evolution of these activities across successive sleep cycles was studied . RESULTS Alpha-delta patterns occurred in almost all the patients who had also superficial and fragmented sleep with increased awakenings and reduced REM and slow wave sleep . Delta decay across sleep cycles was different in FMS and alpha activity was greater and declined , whereas the controls were persistently low throughout their sleep . Alpha-delta ratio increased progressively in successive sleep cycles ; this was again different from controls . CONCLUSION Patients with FMS presented a high frequency of subjective sleep disturbances , an increased incidence of alpha EEG NREM sleep and clear abnormalities in sleep cycle organization OBJECTIVE To evaluate the effects of triazolam upon insomnia and daytime sleepiness in patients with rheumatoid arthritis ( RA ) . METHODS Triazolam or placebo was administered during two 7 night periods to 15 patients with RA in a double blind crossover study .  Polysomnographic recordings  were conducted on the last 2 nights of each condition , and  multiple sleep latency tests and mood and arthritis assessment s were performed during the intervening day in each condition . RESULTS In the triazolam condition , total sleep time was increased , daytime sleepiness was reduced , and morning stiffness was improved compared to placebo . Objective measures of sleep fragmentation were unchanged . Clinical arthritis assessment s were similar during both conditions . CONCLUSION Short term hypnotic therapy improves sleep in patients with RA and appears to improve morning stiffness and daytime sleepiness 
    Output:
    
Based upon the currently available evidence in patients with RA , benzodiazepines ( diazepam and triazolam ) do not appear to be beneficial in improving pain over 24 hours or one week .
The non-benzodiazepine agent zopiclone also did not significantly reduce pain over two weeks .
However , even short term muscle relaxant use ( 24 hours to 2 weeks ) is associated with significant adverse events , predominantly drowsiness and dizziness