***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: BACKGROUND To our knowledge , verum acupuncture has never been directly compared with sham acupuncture and guideline -based conventional therapy in patients with chronic low back pain . METHODS A patient- and observer-blinded r and omized controlled trial conducted in Germany involving 340 outpatient practice s , including 1162 patients aged 18 to 86 years ( mean + /- SD age , 50 + /- 15 years ) with a history of chronic low back pain for a mean of 8 years . Patients underwent ten 30-minute sessions , generally 2 sessions per week , of verum acupuncture ( n = 387 ) according to principles of traditional Chinese medicine ; sham acupuncture ( n = 387 ) consisting of superficial needling at nonacupuncture points ; or conventional therapy , a combination of drugs , physical therapy , and exercise ( n = 388 ) . Five additional sessions were offered to patients who had a partial response to treatment ( 10%-50 % reduction in pain intensity ) . Primary outcome was response after 6 months , defined as 33 % improvement or better on 3 pain-related items on the Von Korff Chronic Pain Grade Scale question naire or 12 % improvement or better on the back-specific Hanover Functional Ability Question naire . Patients who were unblinded or had recourse to other than permitted concomitant therapies during follow-up were classified as nonresponders regardless of symptom improvement . RESULTS At 6 months , response rate was 47.6 % in the verum acupuncture group , 44.2 % in the sham acupuncture group , and 27.4 % in the conventional therapy group . Differences among groups were as follows : verum vs sham , 3.4 % ( 95 % confidence interval , -3.7 % to 10.3 % ; P = .39 ) ; verum vs conventional therapy , 20.2 % ( 95 % confidence interval , 13.4 % to 26.7 % ; P < .001 ) ; and sham vs conventional therapy , 16.8 % ( 95 % confidence interval , 10.1 % to 23.4 % ; P < .001 . CONCLUSIONS Low back pain improved after acupuncture treatment for at least 6 months . Effectiveness of acupuncture , either verum or sham , was almost twice that of conventional therapy UNLABELLED It has been postulated that sensory stimulation ( acupuncture ) affects the cardiovascular system via the autonomic nervous system . Previously , skin temperature , thermography , plethysmography and blood pressure changes have been used in evaluation of sympathetic nerve activity following acupuncture . By using power spectral analysis , the low frequency and high frequency components of heart rate variability can be calculated reflecting the sympathetic and parasympathetic activity . The purpose of this study was to investigate to what extent acupuncture applied into the thenar muscle and into the cavum concha of the ear induced changes in the sympathetic and /or parasympathetic nervous system in healthy subjects . MATERIAL S AND METHODS Twelve healthy volunteers , six men and six women , mean age 34.4 ( range 23 - 48 ) participated in three balanced , r and omly distributed sessions . At an individual initial visit the 12 volunteers were introduced to the needle sensation by having a needle inserted into the point LI 11 . The needle sensation was evoked and the subject was trained to identify the characteristic needle sensation . The introduction was followed by three test sessions . SESSION A A short acupuncture needle , ( Seirin no 3 , ∅0.20x15 mm ) was inserted perpendicular into the earpoint , Lu 1 , in the left inferior hemi-conchae . SESSION B An acupuncture needle ( Hwato , ∅0.30x30 mm ) was inserted perpendicular into the Hegu point ( LI 4 ) in the middle of the right dorsal thenar muscle . SESSION C An acupuncture needle ( Hwato , ∅0.30x30 mm ) was inserted perpendicular superficially into the skin overlying the Hegu point on the left h and . Results . Stimulation of the ear induced a significant increase in the parasympathetic activity during the stimulation period of 25 min ( P<0.05 ) and during the post-stimulation period of 60 min ( P<0.05 ) . No significant changes were observed in either the sympathetic activity , blood pressure or heart rate . Stimulation of the thenar muscle result ed in a significant increase in the sympathetic and the parasympathetic activity during the stimulation period ( P<0.01 ) and during the post-stimulation period ( P<0.01 and P<0.001 , respectively ) . A significant decrease in the heart rate frequency ( P<0.05 ) at the end of the post-stimulation period was also demonstrated . The superficial needle insertion into the skin overlaying the right thenar muscle caused a pronounced balanced increase in both the sympathetic and parasympathetic activity during the post stimulation period of 60 min ( P<0.01 ) while no changes were observed during the stimulation period . CONCLUSION It is indicated that sensory stimulation ( acupunctura ) in healthy persons is associated with changed activity in the sympathetic and parasympathetic nervous system depending on site of stimulation and period of observation OBJECTIVES Auricular acupressure is known to decrease the level of anxiety in patients during ambulance transport . The purpose of this r and omized , double-blind , sham control study was to determine whether auricular acupressure can decrease not only the level of anxiety but also the level of pain in a group of elder patients with acute hip fracture . METHODS With the assistance of the Vienna Red Cross , 38 patients with acute hip fracture were enrolled into this study . Patients were r and omized into two study groups : the true intervention group and the sham control group . Subjects in the true intervention group ( n = 18 ) received bilateral auricular acupressure at three auricular acupressure points for hip pain . Patients in the sham group ( n = 20 ) received bilateral auricular acupressure at sham points . Baseline demographic information , anxiety level , pain level , blood pressure , and heart rate were obtained before the administration of the appropriate acupressure intervention . The level of anxiety , level of pain , hemodynamic profiles , and level of satisfaction were reassessed once the patients arrived at the hospital . RESULTS Patients in the true intervention groups had less pain ( F = 28 , p = 0.0001 ) and anxiety ( F = 4.3 , p = 0.018 ) and lower heart rate ( F = 18 , p = 0.0001 ) on arrival at the hospital than did patients in the sham control group . As a result , the patients in the true intervention group reported higher satisfaction in the care they received during the ride to the hospital . CONCLUSIONS The authors encourage physicians , health care providers , and emergency rescuers to learn this easy , noninvasive , and inexpensive technique for its effects in decreasing anxiety and pain during emergency transportation BACKGROUND Acupuncture is widely used by patients with chronic pain although there is little evidence of its effectiveness . We investigated the efficacy of acupuncture compared with minimal acupuncture and with no acupuncture in patients with osteoarthritis of the knee . METHODS Patients with chronic osteoarthritis of the knee ( Kellgren grade < or = 2 ) were r and omly assigned to acupuncture ( n=150 ) , minimal acupuncture ( superficial needling at non-acupuncture points ; n=76 ) , or a waiting list control ( n=74 ) . Specialised physicians , in 28 outpatient centres , administered acupuncture and minimal acupuncture in 12 sessions over 8 weeks . Patients completed st and ard question naires at baseline and after 8 weeks , 26 weeks , and 52 weeks . The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis ( WOMAC ) index at the end of week 8 ( adjusted for baseline score ) . All main analyses were by intention to treat . RESULTS 294 patients were enrolled from March 6 , 2002 , to January 17 , 2003 ; eight patients were lost to follow-up after r and omisation , but were included in the final analysis . The mean baseline-adjusted WOMAC index at week 8 was 26.9 ( SE 1.4 ) in the acupuncture group , 35.8 ( 1.9 ) in the minimal acupuncture group , and 49.6 ( 2.0 ) in the waiting list group ( treatment difference acupuncture vs minimal acupuncture -8.8 , [ 95 % CI -13.5 to -4.2 ] , p=0.0002 ; acupuncture vs waiting list -22.7 [ -27.5 to -17.9 ] , p<0.0001 ) . After 52 weeks the difference between the acupuncture and minimal acupuncture groups was no longer significant ( p=0.08 ) . INTERPRETATION After 8 weeks of treatment , pain and joint function are improved more with acupuncture than with minimal acupuncture or no acupuncture in patients with osteoarthritis of the knee . However , this benefit decreases over time Acupuncture , one of the Oriental medical therapeutic techniques that can be traced back at least 2500 years , is growing in popularity all over the world . Korea has continued to develop its own unique tradition of medicine throughout its long history , and has formed different types of acupuncture methods . The purpose of this review is to summarize clinical case studies in acupuncture and related therapies , such as acupressure , electric acupuncture , auricular acupuncture and moxibustion in Korea . A survey of Korean journals revealed that a total of 124 studies were published from 1983 to 2001 . Results obtained from the survey showed that most clinical studies using acupuncture , electric acupuncture , moxibustion and other traditional therapies could alleviate a relatively broad range of medical problems . However , it should be emphasized that almost all clinical case studies published in various local journals did not follow the ‘ good clinical practice ’ with respect to regulatory aspects . Since they were not conducted using the r and omized double-blinded controls with a large sample size , all the results should be considered as therapeutic indications . This review is an attempt to show the scope of acupuncture in our country and the kind of diseases , after many years of clinical experience , that were deemed valid targets for clinical trials Auricular acupuncture ( AA ) is effective in treating various pain conditions , but there have been no analyses of AA for the treatment of pain after ambulatory knee surgery . We assessed the range of analgesic requirements under AA after ambulatory knee arthroscopy . Twenty patients r and omly received a true AA procedure ( Lung , Shenmen and Knee points ) or sham procedure ( three non-acupuncture points on the auricular helix )  before ambulatory knee arthroscopy .  Permanent press AA needles were retained in situ for one day after surgery . Post-operative pain was treated with non-steroidal anti-inflammatory ibuprofen , and weak oral opioid tramadol was used for rescue analgesic medication . The quantity of post-operative analgesics and pain intensity were used to assess the effect of AA . The incidence of analgesia-related side effects , time to discharge from the anesthesia recovery room , heart rate and blood pressure were also recorded .  Ibuprofen consumption after surgery in the AA group was lower than in the control group : median 500 versus 800 mg , P = 0.043 . Pain intensity on a 100 mm visual analogue scale for pain measurement and other parameters were similar in both groups . Thus AA might be useful in reducing the post-operative analgesic requirement after ambulatory knee arthroscopy BACKGROUND Acupuncture is widely used by patients with low back pain , although its effectiveness is unclear . We investigated the efficacy of acupuncture compared with minimal acupuncture and with no acupuncture in patients with chronic low back pain .  METHODS Patients were r and omized to treatment with acupuncture , minimal acupuncture ( superficial needling at nonacupuncture points ) , or a waiting list control . Acupuncture and minimal acupuncture were administered by specialized acupuncture physicians in 30 outpatient centers , and consisted of 12 sessions per patient over 8 weeks . Patients completed st and ardized question naires at baseline and at 8 , 26 , and 52 weeks after r and omization . The primary outcome variable was the change in low back pain intensity from baseline to the end of week 8 , as determined on a visual analog scale ( range , 0 - 100 mm ) . RESULTS A total of 298 patients ( 67.8 % female ; mean + /- SD age , 59 + /- 9 years ) were included . Between baseline and week 8 , pain intensity decreased by a mean + /- SD of 28.7 + /- 30.3 mm in the acupuncture group , 23.6 + /- 31.0 mm in the minimal acupuncture group , and 6.9 + /- 22.0 mm in the waiting list group . The difference for the acupuncture vs minimal acupuncture group was 5.1 mm ( 95 % confidence interval , -3.7 to 13.9 mm ; P = .26 ) , and the difference for the acupuncture vs waiting list group was 21.7 mm ( 95 % confidence interval , 13.9 - 30.0 mm ; P<.001 ) . Also , at 26 ( P=.96 ) and 52 ( P=.61 ) weeks , pain did not differ significantly between the acupuncture and the minimal acupuncture groups 
    Output:
    
Removal of poor quality studies did not alter the conclusions .
Auriculotherapy may be effective for the treatment of a variety of types of pain , especially postoperative pain .