***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: OBJECTIVE The objective of the EPISER study was to estimate the prevalence of rheumatoid arthritis ( RA ) , low back pain , h and and knee osteoarthritis ( OA ) , and fibromyalgia in the adult Spanish population , and to assess the impact of these diseases on function and quality of life , and use of health and social re sources . METHODS 2998 subjects aged 20 years or above were r and omly selected by stratified multistage cluster sampling from the censuses of 20 municipalities .  Trained rheumatologists carried out structured visits at which subjects were asked about rheumatic symptoms and sociodemographic characteristics , completed vali date d instruments for measuring function ( HAQ ) and  quality of life  ( SF-12 ) , and underwent a st and ardised physical examination . Cases were defined by previously vali date d criteria . RESULTS The estimated prevalences with 95 % confidence intervals were as follows : RA lifetime cumulative : 0.5 % ( 0.3 to 0.9 ) ; low back pain : 14.8 % ( 12.2 to 17.4 ) ; symptomatic knee OA : 10.2 % ( 8.5 to 11.9 ) ; h and OA : 6.2 % ( 5.9 to 6.5 ) ; fibromyalgia : 2.4 % ( 1.5 to 3.2 ) . Most conditions significantly impaired function and quality of life . CONCLUSIONS The EPISER study has internal and external validity for application of the results to the adult Spanish population . The diseases studied affect a significant proportion of the population , with various degrees of impact on disability and quality of life result ing in a significant number of physician visits , work disability , and medication use Abstract The efficacy and tolerability of aceclofenac was compared with diclofenac resinate in a double-blind , multicentre r and omised study in patients with acute low back pain suffering from degenerative spinal disorders . The study included 227 patients r and omised to receive either aceclofenac 2 × 100 mg daily or diclofenac resinate 2 × 75 mg daily for up to 10 days . The primary objective was to demonstrate the clinical non-inferiority of the analgesic efficacy of aceclofenac compared with diclofenac resinate , as assessed by changes from baseline in the visual analogue scale ( 0–100 mm ) pain score , at rest and at visit 3 ( final visit on day 's 8–10 ) . Secondary objectives included the time to early cure ( resolution of pain ) and global assessment of tolerability . Mean change in pain score at rest , and as visit 3 , compared with baseline , was 61.6 mm ( SD 24.5 ) for the aceclofenac group ( n = 100 ) and 57.3 mm ( SD 22.8 ) for the diclofenac resinate group ( n = 105 ) in the per- protocol population . Similar changes were observed in the intention-to-treat population . Between-group differences of 4.5 mm and 5.5 mm for the per- protocol and intention-to-treat population s , respectively , demonstrated clinical non-inferiority of aceclofenac compared with diclofenac resinate . Furthermore , there was evidence for superiority of aceclofenac over diclofenac resinate in terms of statistical significance , as the one-sided 97.5 % confidence interval was above −10 mm and 0 mm . In the intention-to treat population , a total of six aceclofenac-treated patients discontinued their medication owing to early cure , compared with only one patient receiving diclofenac resinate . Seventeen aceclofenac- ( 14.9 % ) , and 18 diclofenac resinate-treated patients ( 15.9 % ) reported at least one adverse event . However , the total number of adverse events reported was lower in patients receiving aceclofenac ( 22 versus 31 in the diclofenac resinate group ) . In conclusion , non-inferiority of the analgesic efficacy of aceclofenac compared with diclofenac resinate was demonstrated in patients with localised , uncomplicated acute lumbosacral pain . For the reduction in pain levels from baseline there was also evidence for superiority of aceclofenac compared with diclofenac resinate in terms of statistical significance , although this difference was not considered clinical ly relevant . The results also showed a trend towards a better safety and tolerability profile of aceclofenac over diclofenac resinate from a clinical point of view Two hundred and sixty patients with lumbago or sciatic pain participated in a multicenter observer-blind r and omized trial to compare the efficacy and tolerability of dipyrone 2.5 g , diclofenac 75 mg , and placebo administered as an intramuscular injection once daily for the duration of one to two days . The effectiveness of the test treatments in relieving sciatic pain was measured by a visual analog scale ( VAS ) before and 30 minutes , 1 , 2 , 3 , 6 and 24 hours after each injection . In addition , the patient 's general well-being was measured on a 5-point rating scale on day 0 , 1 and 2 . At the end of the trial , the patients evaluated the overall efficacy of the study drugs on a 5-point rating scale . Minimal finger-toe distance was measured every day of the trial . Pain intensity on VAS ( primary endpoint ) showed a significantly greater reduction with dipyrone than with diclofenac or placebo between 1 and 6 hours after application ( p < 0.01 ) and at the end of the trial ( after 48 hours ) . Improvement in general well-being and minimal finger-toe distance was greatest in the dipyrone group . 59 % of the patients with dipyrone assessed the overall efficacy as " excellent " or " very good " , compared with 30 % with diclofenac , and 18 % with placebo .  Adverse reactions were reported in only 7 patients ( 3 % ) , 4 ( 5 % ) in the dipyrone , 1 ( 1 % ) in the diclofenac , and 2 ( 2 % ) in the placebo group Ketorolac tromethamine injected intramuscularly ( IM ) has been shown to be an effective analgesic in treating patients with acute musculoskeletal pain in the emergency department ( ED ) . The authors compare the efficacy of a single dose of IM ketorolac to osteopathic manipulative treatment ( OMT ) as delivered in the ED for the management of acute neck pain . A r and omized clinical trial was conducted in three EDs . A convenience sample of 58 patients with acute neck pain of less than three weeks ' duration were enrolled . Subjective measures of pain intensity on an 11-point numerical rating scale were gathered from patients immediately before treatment and one hour afterward . Subjects received either OMT or 30 mg , IM ketorolac . Subjects ' perceived pain relief was also recorded at one hour after treatment on a subjective 5-point pain relief scale . Twenty-nine patients received IM ketorolac , and 29 patients received OMT . Although both groups showed a significant reduction in pain intensity , 1.7+/-1.6 ( P < .001 [ 95 % CI , 1.1 - 2.3 ] ) and 2.8+/-1.7 ( P < .001 [ 95 % CI , 2.1 - 3.4 ] ) , respectively , patients receiving OMT reported a significantly greater decrease in pain intensity ( P=.02 [ 95 % CI , 0.2 - 1.9 ] ) . When comparing pain relief at one hour posttreatment , there was no significant difference between the OMT and ketorolac study groups ( P=.10 ) . The authors found that , at one hour posttreatment , OMT is as efficacious as IM ketorolac in providing pain relief and significantly better in reducing pain intensity . The authors conclude that OMT is a reasonable alternative to parenteral nonsteroidal anti-inflammatory medication for patients with acute neck pain in the ED setting Background .Neck and low back pain are leading causes of morbidity and health care utilization . However , little is known about the characteristics that differentiate those who seek from those who do not seek health care for their pain . Objectives .The objectives of this study were to : 1 ) describe health care utilization for neck and back pain ; 2 ) determine the characteristics of individuals seeking health care for neck and back pain ; and 3 ) identify the characteristics of patients who consult medical doctors , chiropractors , or both .  Design . Population -based cross-sectional mailed survey . Subjects . Subjects were r and omly selected adults from the Saskatchewan Health Insurance and Registration File . Measures .Demographic , socio-economic , general health , comorbidity , health-related- quality -of-life , pain severity and health care utilization data were collected . The main outcome was whether subjects with prevalent neck or low back pain visited a  health care provider in the previous month . Results .Twenty-five percent of individuals with neck or low back pain visited a health care provider . Seeking health care was associated with disabling neck or back pain , digestive disorders , worse bodily pain and worse physical-role-functioning . Compared with medical patients , fewer chiropractic patients lived in rural areas or reported arthritis , but they reported better social and physical functioning . More patients consulting both providers reported disabling neck or back pain . Conclusions .Individuals seeking care for neck or back pain have worse health status than those who do not seek care . Patients consulting chiropractors alone report fewer comorbidities and are less limited in their activities than those consulting medical doctors Abstract : Objective : Two r and omised , double-blind , double-dummy trials evaluated the efficacy and tolerability of meloxicam compared with placebo or diclofenac in patients with acute sciatica.¶Subjects : 1021 patients with acute sciatica.¶Treatment and methods : In the first study , 532 patients received meloxicam 7.5 mg , meloxicam 15 mg , or placebo for 7 days . The second study r and omised 489 patients to meloxicam 7.5 mg , meloxicam 15 mg , or diclofenac 150 mg for 14 days.¶ Results : Meloxicam 7.5 mg and 15 mg significantly improved overall pain between baseline and day 7 ( p<0.05 ) compared with placebo . Furthermore , both meloxicam doses showed similar improvements on all primary and secondary efficacy endpoints compared with diclofenac 150 mg . No significant differences in tolerability were observed between any of the treatment groups in either study .¶ Conclusions : Meloxicam ( 7.5 mg or 15 mg ) was well tolerated and was more effective than placebo , and as effective as diclofenac , in acute Study Design . Population ‐based , cross‐sectional mailed survey . Objective . To determine the lifetime , period , and point prevalence of neck pain and its related disability among Saskatchewan adults and investigate the presence and strength of nonresponse bias . Summary of Background Data . In Europe , the life‐time and point prevalence of neck pain is almost as high as the prevalence of low back pain . Similarly , chronic neck pain is highly prevalent and a common source of disability in the working‐age population . However , no studies specifically have documented the prevalence of neck pain and its related disability in North America . Methods . The Saskatchewan Health and Back Pain Survey was mailed to 2184 r and omly selected Saskatchewan adults aged 20‐69 years . Fifty‐five percent of the study population participated . The presence of nonresponse bias was investigated through logistic regression and wave analysis . The Chronic Pain Question naire was used to classify the severity of chronic neck pain . Results . The age‐st and ardized lifetime prevalence of neck pain is 66.7 % ( 95 % confidence interval , 63.8‐69.5 ) , and the point prevalence is 22.2 % ( 95 % confidence interval , 19.7‐24.7 ) . The age‐st and ardized 6‐month prevalence of low‐intensity and low‐disability neck pain is 39.7 % ( 95 % confidence interval , 36.7‐42.7 ) , whereas it is 10.1 % ( 95 % confidence interval , 8.2‐11.9 ) for high‐intensity and low‐disability neck pain and 4.6 % ( 95 % confidence interval , 3.3‐5.8 ) for significantly disabling neck pain . The prevalence of low‐intensity and low‐disability neck pain decreases with age . More women experience high‐disability neck pain than men . Wave analysis suggests that the point prevalence and 6‐month prevalence of high‐intensity and low‐disability neck pain are overestimated in this survey . Conclusion . This cross‐sectional study shows that neck pain is highly prevalent in Saskatchewan and that it significantly disables 4.6 % ( 95 % confidence interval , 3.3‐5.8 ) of the adult population Thirty-seven patients with chronic back pain were entered into a r and omised , 3-way , double-blind , cross-over comparison of naproxen sodium 550 mg twice daily , diflunisal 500 mg twice daily , and placebo . Each treatment was given for 14 days after a preadmission wash-out week during which only paracetamol was allowed . Patients were assessed on admission and at the end of each treatment with respect to global pain , night pain , pain on movement , and pain on st and ing .  Both visual analogue scales and simple descriptive scales were used to measure pain . Side effects were elicited by a nonleading question . Both methods of pain measurement gave similar results and were highly correlated . Naproxen sodium was superior to placebo in relieving global pain and depending on the method of measurement , in relieving night pain and pain on movement . Diflunisal showed no significant differences from placebo .  Side effects were similar on all 3 treatments . The final preference of the patients 
    Output:
    
For recent-onset NAD , evidence suggests that intramuscular NSAIDs lead to similar outcomes as combined manipulation and soft tissue therapy .
For NAD ( duration not specified ) , oral NSAIDs may be more effective than placebo .
For recent-onset LBP , evidence suggests that : ( 1 ) oral NSAIDs lead to similar outcomes to placebo or a muscle relaxant ; and ( 2 ) oral NSAIDs with bed rest lead to similar outcomes as placebo with bed rest .
For persistent LBP , evidence suggests that : ( 1 ) oral NSAIDs are more effective than placebo ; and ( 2 ) oral NSAIDs may be more effective than acetaminophen .
For recent-onset LBP with radiculopathy , there is inconsistent evidence on the effectiveness of oral NSAIDs versus placebo .
Finally , different oral NSAIDs lead to similar outcomes for neck and LBP with or without radiculopathy .
Conclusions For NAD , oral NSAIDs may be more effective than placebo .
Oral NSAIDs are more effective than placebo for persistent LBP , but not for recent-onset LBP .
Different oral NSAIDs lead to similar outcomes for neck pain and LBP