***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: To evaluate the efficacy of Chinese medicine ( CM ) acupuncture for  chronic neck pain ( CNP ) , a single blind , controlled , crossover , clinical trial was undertaken . Twenty-nine volunteers with CNP were r and omly recruited into two groups . Both groups received two phases of treatment with a washout period between the two phases . Group A ( 14 volunteers ) received CM acupuncture in the first phase and sham acupuncture in the second , while Group B ( 15 volunteers ) received sham in the first and real in the second . CM acupuncture was individualized and consisted of nine sessions on both local and distal points . Manual twisting of the needle was applied on all points plus strong electrical stimulation of distal points in CM acupuncture . Sham acupoints ( lateral to the real ) and sham ( weak ) electrical stimulation was used in the control group . Comparison of subjective and objective measures between the two groups was made at different periods , including baseline , after each phase of treatment , after washout , and after the 16th week follow-up . The subjective measures included pain intensity , duration per day , analgesic medication count , visual analogue scales ( VAS ) and neck disability index ( NDI ) . The objective measures consisted of neck range of motion ( ROM ) and pain threshold ( PT ) . Both the real and sham treatments significantly reduced subjective pain , without significant differences between groups for most subjective measures . Objective measures showed no significant change for either group before and after each period or by inter-groups analysis . A minimum 16-week effect of both real and sham acupuncture was found for subjective measures in the follow-up periods . Further study is recommended with an increased sample size , a longer washout period , and a longer baseline period In the majority of patients with neck pain , symptoms will resolve spontaneously or quite quickly in response to therapy . However , some patients ' symptoms persist for a long period , irrespective of therapy . In this study , 20 patients with persistent ( greater than 8 weeks ) neck pain were enrolled in a double blind , placebo-controlled trial of low energy , pulsed electromagnetic therapy (PEMT)--a treatment previously shown to be effective in soft tissue injuries . For the first 3-week period , group A ( 10 patients ) received active PEMT units while group B ( 10 patients ) received facsimile placebo units . After 3 weeks , both pain ( visual analogue scale ( P less than .023 ) and range of movement ( P less than .002 ) had improved in the group on active treatment compared to the controls . After the second 3 weeks , during which both groups used active units , there were significant improvements in observed scores for pain and range of movement in both groups . PEMT , in the form described , can be used at home easily in the treatment of patients with neck pain . It is frequently successful and without side effects 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 OBJECTIVE This article examines the specific and nonspecific effects of Japanese  acupuncture on chronic myofascial neck pain in a r and omized single-blind trial . DESIGN Forty-six patients were r and omly assigned to receive relevant acupuncture , irrelevant acupuncture , or no-acupuncture control treatment consisting of nonsteroidal anti-inflammatory medication . The two acupuncture groups underwent comparable light shallow needling . The irrelevant acupuncture group received acupuncture at specific sites not relevant for cervical pain . OUTCOME MEASURES The study measures included the McGill Pain Question naire-Short Form ( SF-MPQ ) , the Short-Form Health Survey ( SF-36 ) , the Symptom Checklist 90-Revised ( SCL-90-R ) , medication diary , and physiologic measures . The factors examined as predictors of outcome pain ratings were experience with , beliefs about , and knowledge of acupuncture before treatment ; perceived efficacy , credibility , and logic of acupuncture ; perceived competence of the acupuncturist ; and painfulness of acupuncture . RESULTS No differences were found among the three groups at baseline , except that the relevant acupuncture group reported having had more previous acupuncture treatments . No significant differences in terms of perceived credibility or perceived effectiveness of treatment were found between the two acupuncture groups . The relevant acupuncture group had significantly greater pre-/posttreatment differences in pain than the irrelevant acupuncture and control groups ( p < .05 ) . The nonspecific effects of confidence in the acupuncturist , willingness to try any treatment , mood , and physiologic effect of needling were not predictive of treatment outcome , whereas confidence in the treatment and past experiences with acupuncture did correlate significantly with a decrease in pain . CONCLUSIONS Relevant acupuncture with heat contributes to modest pain reduction in persons with myofascial neck pain . Previous experience with and confidence in treatment help to predict benefit . Measurement of nonspecific effects of alternative therapy is recommended in future clinical trials Thirteen patients with neck pain of at least two years ' duration participated in the study . Patients were r and omly assigned to either an acupuncture group or a placebo TNS ( transcutaneous nerve stimulation ) group . Initial pain scores revealed no significant difference between the groups with respect to pain severity . Patients were treated twice weekly for four weeks , at the end of which pain relief was measured using a simple descriptive scale . Even though an attempt was made to maximize the effect of placebo TNS using strong verbal suggestion , acupuncture still proved superior to placebo in the relief of cervical pain ( p less than 0.01 ) . The implication s of these findings are discussed A r and om sample including 2342 cases representative of all occupational back injuries in Quebec ( 1981 ) was followed up prospect ively over three years to assess the recurrence rate of back problems ( lumbar , thoracic , and cervical ) . Each medical and accident report was review ed to obtain the site of symptoms and occupation . Age , sex , industrial sector , and number of episodes of absence from work were abstract ed from the computerised Quebec Compensation Board files . The recurrence rate was 20.0 % at one year follow up and 36.3 % at three years . A multivariate analysis using a Poisson regression , was performed to model the risk of recurrence over time . Men had a higher chance of recurrence ( risk ratio = 1.85 , 95 % CI = 1.50 - 2.27 ) but among recurrent cases , the average total number of episodes was comparable between men and women . Age showed a protective effect on the probability of recurrence ( 10 years : RR = 0.93 , 95 % CI = 0.88 - 0.98 ) due to the lower recurrence rate in the 45 - 64 year old group ( 31.8 % ) . Cervical and lumbar symptoms had identical recurrence profiles whereas thoracic symptoms had a significantly lower recurrence rate . Drivers had the highest recurrence rate ( 42.1 % ) and nurses had the highest average number of recurrences ( 2.03 ) among recurrent cases . Both occupations had statistically significant excesses after controlling for the other variables Abstract Objectives : To compare the efficacy of acupuncture and conventional massage for the treatment of chronic neck pain . Design : Prospect i ve , r and omised , placebo controlled trial . Setting : Three outpatient departments in Germany . Participants : 177 patients aged 18–85 years with chronic neck pain . Interventions : Patients were r and omly allocated to five treatments over three weeks with acupuncture ( 56 ) , massage ( 60 ) , or “ sham ” laser acupuncture ( 61 ) . Main outcome measures : Primary outcome measure : maximum pain related to motion ( visual analogue scale ) irrespective of direction of movement one week after treatment . Secondary outcome measures : range of motion ( 3D ultrasound real time motion analyser ) , pain related to movement in six directions ( visual analogue scale ) , pressure pain threshold ( pressure algometer ) , changes of spontaneous pain , motion related pain , global complaints ( seven point scale ) , and quality of life ( SF-36 ) . Assessment s were performed before , during , and one week and three months after treatment . Patients ' beliefs in treatment were assessed . Results : One week after five treatments the acupuncture group showed a significantly greater improvement in motion related pain compared with massage ( difference 24.22 ( 95 % confidence interval 16.5 to 31.9 ) , P=0.0052 ) but not compared with sham laser ( 17.28 ( 10.0 to 24.6 ) , P=0.327 ) . Differences between acupuncture and massage or sham laser were greater in the subgroup who had had pain for longer than five years ( n=75 ) and in patients with myofascial pain syndrome ( n=129 ) . The acupuncture group had the best results in most secondary outcome measures . There were no differences in patients ' beliefs in treatment . Conclusions : Acupuncture is an effective short term treatment for patients with chronic neck pain , but there is only limited evidence for long term effects after five treatments . What is already known on this topic Acupuncture is a widespread complementary treatment Evidence from trials have given conflicting results on its use in the treatment of neck pain because of method ological shortcomings and because effects were compared either with alternative treatments or with different sham procedures imitating acupuncture , but not both What this study adds Compared with sham laser acupuncture and massage , needle acupuncture has beneficial effects on mobility and pain related to motion in patients with chronic neck pain Acupuncture was clearly more effective than massage , but differences were not always significant compared with sham laser acupuncture Acupuncture was the best treatment for patients with the myofascial syndrome and those who had had pain for longer than five Abstract Objective To determine the effectiveness of dynamic muscle training and relaxation training for  chronic neck pain .  Design R and omised controlled trial . Setting Five occupational healthcare centres , Tampere , Finl and . Participants 393 female office workers ( mean age 45 years ) with chronic non-specific neck pain r and omly assigned to 12 weeks of dynamic muscle training ( n = 135 ) or relaxation training ( n = 128 ) , plus one week of reinforcement training six months after baseline ; or ordinary activity ( control group ; n = 130 ) . Main outcome measure Change in intensity of neck pain at three , six , and 12 months . Results No significant difference was found in neck pain between the groups at follow up . However , the range of motion for cervical rotation and lateral flexion increased more in the training groups than in the control group . Conclusions Dynamic muscle training and relaxation training do not lead to better improvements in neck pain compared with ordinary activity The two northernmost counties in Sweden form together 1 of the 39 collaborating centers in the World Health Organization ( WHO ) MONICA ( MONItoring of trends and determinants in CArdiovascular disease ) project . At the last survey in 1999 , we added some questions about cervical spine complaints . Persons r and omly selected from the population in a geographically well-defined area completed a self-administered question naire . The sample included 8,356 subjects and 6,000 ( 72 % ) of them answered . 43 % of the population reported  neck pain  , more women ( 48 % ) than men ( 38 % ) . Women of working age had more neck pain than older ones , a phenomenon not seen among men . Chronic neck pain , defined as continuous pain of more than 6 months ' duration , was commoner in women ( 22 % ) than men ( 16 % ) . More than one fourth of the cases with chronic symptoms had a history of neck or head trauma and one third of these had sustained a whiplash type of injury . Thus , all types of neck trauma seem to be associated with chronic neck pain Study Design . A r and omized controlled trial with single-blind outcome assessment s. Objective . To evaluate the efficacy of a neck exercise program in patients with chronic neck pain . Summary of Background Data . The effect of exercise for patients with chronic neck pain has been investigated in a number of studies . The efficacy is , however , question able . Methods . A total of 145 patients were r and omly allocated into an exercise ( n = 67 ) and a nonexercise ( control ) group ( n = 78 ) . Patients in the control group were given infrared irradiation and neck care advice . In addition to infrared irradiation and advice , patients in the exercise group had undergone an exercise program with activation of the deep neck muscles and dynamic strengthening of the neck muscles for 6 weeks . Subjective pain and disability and isometric neck muscle strength were measured at baseline , 6 weeks , and 6 months . Analysis was by intention-to-treat . Results . At week 6 , the exercise group had a significantly better improvement in disability score ( P = 0.03 ) , subjective report of pain ( P = 0.01 ) , and in isometric neck muscle strength ( P = 0.57–0.00 ) in most of the directions than the control group . However , significant differences between the two groups were found only in the subjective report of pain and patient satisfaction at the 6-month follow-up . Conclusions . At week 6 , patients with chronic neck pain can benefit from the neck exercise program with significant improvement in disability , pain , and isometric neck muscle strength in different directions . However , the effect of exercise was less favorable at 
    Output:
    
Conclusion It appears that the changes in pain scores in subjects with chronic neck pain not due to whiplash who are enrolled in no-treatment and placebo control groups were similarly small and not significantly different .
As well , they do not appear to increase over longer-term follow-up