***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: The aim of this study was to investigate the effect of connective tissue massage in the treatment of individuals with fibromyalgia . The results of this r and om study of 48 individuals diagnosed with fibromyalgia ( 23 in the treatment group and 25 in the reference group ) show that a series of 15 treatments with connective tissue massage conveys a pain relieving effect of 37 % , reduces depression and the use of analgesics , and positively effects quality of life . The treatment effects appeared gradually during the 10-week treatment period . Three months after the treatment period about 30 % of the pain relieving effect was gone , and 6 months after the treatment period pain was back to about 90 % of the basic value . As long as there is a lack of effective medical treatment for individuals with fibromyalgia , they ought to be offered treatments with connective tissue massage . However , further studies are needed in the mechanisms behind the treatment effects . Copyright 1999 European Federation of Chapters of the International Association for the Study of Pain Background Massage is increasingly used to manage  chronic pain  but its benefit has not been clearly established . The aim of the study is to determine the effectiveness of a single session of nurse-administered massage for the short term relief of  chronic non-malignant pain and anxiety . Methods A r and omised controlled trial design was used , in which the patients were assigned to a massage or control group . The massage group received a 15 minute manual massage and the control group a 15 minute visit to talk about their pain .  Adult patients attending a pain relief unit with a diagnosis of chronic pain whose pain was described as moderate or severe were eligible for the study . An observer blind to the patients ' treatment group carried out assessment s immediately before ( baseline ) , after treatment and 1 , 2 , 3 and 4 hours later . Pain was assessed using 100 mm visual analogue scale and the McGill Pain Question naire . Pain Relief was assessed using a five point verbal rating scale . Anxiety was assessed with the Spielberger short form State-Trait Anxiety Inventory . Results 101 patients were r and omised and evaluated , 50 in the massage and 51 in the control group . There were no statistically significant differences between the groups at baseline interview . Patients in the massage but not the control group had significantly less pain compared to baseline immediately after and one hour post treatment . 95 % confidence interval for the difference in mean pain reduction at one hour post treatment between the massage and control groups is 5.47 mm to 24.70 mm . Patients in the massage but not the control group had a statistically significant reduction in anxiety compared to baseline immediately after and at 1 hour post treatment . Conclusion Massage is effective in the short term for chronic pain of moderate to severe intensity . Trial Registration [ IS RCT N98406653 BACKGROUND Massage therapy is an attractive treatment option for osteoarthritis ( OA ) , but its efficacy is uncertain . We conducted a r and omized , controlled trial of massage therapy for OA of the knee . METHODS Sixty-eight adults with radiographically confirmed OA of the knee were assigned either to treatment ( twice-weekly sessions of st and ard Swedish massage in weeks 1 - 4 and once-weekly sessions in weeks 5 - 8 ) or to control ( delayed intervention ) . Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) pain and functional scores and the visual analog scale of pain assessment . The sample provided 80 % statistical power to detect a 20-point difference between groups in the change from baseline on the WOMAC and visual analog scale , with a 2-tailed alpha of .05 . RESULTS The group receiving massage therapy demonstrated significant improvements in the mean ( SD ) WOMAC global scores ( -17.44 [ 23.61 ] mm ; P < .001 ) , pain ( -18.36 [ 23.28 ] ; P < .001 ) , stiffness ( -16.63 [ 28.82 ] mm ; P < .001 ) , and physical function domains ( -17.27 [ 24.36 ] mm ; P < .001 ) and in the visual analog scale of pain assessment ( -19.38 [ 28.16 ] mm ; P < .001 ) , range of motion in degrees ( 3.57 [ 13.61 ] ; P = .03 ) , and time to walk 50 ft ( 15 m ) in seconds ( -1.77 [ 2.73 ] ; P < .01 ) . Findings were unchanged in multivariable models controlling for demographic factors . CONCLUSIONS Massage therapy seems to be efficacious in the treatment of OA of the knee . Further study of cost effectiveness and duration of treatment effect is clearly warranted . OBJECTIVE The purpose of this preliminary study was to determine feasibility of a clinical trial to measure the effects of manual therapy on sternocleidomastoid active trigger points ( TrPs ) in patients with cervicogenic headache ( CeH ) . METHODS Twenty patients , 7 males and 13 females ( mean ± SD age , 39 ± 13 years ) , with a clinical diagnosis of CeH and active TrPs in the sternocleidomastoid muscle were r and omly divided into 2 groups . One group received TrP therapy ( manual pressure applied to taut b and s and passive stretching ) , and the other group received simulated TrP therapy ( after TrP localization no additional pressure was added , and inclusion of longitudinal stroking but no additional stretching ) . The primary outcome was headache intensity ( numeric pain scale ) based on the headaches experienced in the preceding week . Secondary outcomes included neck pain intensity , cervical range of motion ( CROM ) , pressure pain thresholds ( PPT ) over the upper cervical spine joints and deep cervical flexors motor performance . Outcomes were captured at baseline and 1 week after the treatment . RESULTS Patients receiving TrP therapy showed greater reduction in headache and neck pain intensity than those receiving the simulation ( P < .001 ) . Patients receiving the TrP therapy experienced greater improvements in motor performance of the deep cervical flexors , active CROM , and PPT ( all , P < .001 ) than those receiving the simulation . Between-groups effect sizes were large ( all , st and ardized mean difference , > 0.84 ) . CONCLUSION This study provides preliminary evidence that a trial of this nature is feasible . The preliminary findings show that manual therapy targeted to active TrPs in the sternocleidomastoid muscle may be effective for reducing headache and neck pain intensity and increasing motor performance of the deep cervical flexors , PPT , and active CROM in individuals with CeH showing active TrPs in this muscle . Studies including greater sample sizes and examining long-term effects are needed Abstract A r and omized controlled trial was performed to compare the short-term effectiveness of botulinum toxin injections and physiatric treatment provided by means of Fascial Manipulation techniques in the management of myofascial pain of jaw muscles . Thirty patients with a Research Diagnostic Criteria for Temporom and ibular Disorders ( RDC/TMD ) diagnosis of myofascial pain were r and omized to receive either single-session botulinum toxin injections ( Group A ) or multiple-session Fascial Manipulation ( Group B ) . Maximum pain levels ( VAS ratings ) and jaw range of motion in millimeters ( maximum mouth opening , protrusion , right and left laterotrusion ) were assessed at baseline , at the end of treatment , and at a three-month follow-up . Both treatment protocol s provided significant improvement over time for pain symptoms . The two treatments seem to be almost equally effective , Fascial Manipulation being slightly superior to reduce subjective pain perception , and botulinum toxin injections being slightly superior to increase jaw range of motion . Differences between the two treatment protocol s as to changes in the outcome parameters at the three-months follow-up were not relevant clinical ly . Findings from the present investigation are in line with literature data supporting the effectiveness of a wide spectrum of conservative treatment approaches to myofascial pain of the jaw muscles . Future studies on larger sample s over a longer follow-up span are needed on the way to identify tailored treatment strategies Chronic neck pain is a major public health problem with very few evidence -based complementary treatment options . This study aim ed to test the efficacy of 12 weeks of a partner-delivered home-based cupping massage , compared to the same period of progressive muscle relaxation in patients with chronic non-specific neck pain . Patients were r and omly assigned to self-directed cupping massage or progressive muscle relaxation . They were trained and asked to undertake the assigned treatment twice weekly for 12 weeks . Primary outcome measure was the current neck pain intensity ( 0–100 mm visual analog scale ; VAS ) after 12 weeks . Secondary outcome measures included pain on motion , affective pain perception , functional disability , psychological distress , wellbeing , health-related quality of life , pressure pain thresholds and adverse events . Sixty one patients ( 54.1±12.7 years ; 73.8%female ) were r and omized to cupping massage ( n = 30 ) or progressive muscle relaxation ( n = 31 ) . After treatment , both groups showed significantly less pain compared to baseline however without significant group differences . Significant effects in favor of cupping massage were only found for wellbeing and pressure pain thresholds . In conclusion , cupping massage is no more effective than progressive muscle relaxation in reducing chronic non-specific neck pain . Both therapies can be easily used at home and can reduce pain to a minimal clinical ly relevant extent . Cupping massage may however be better than PMR in improving well-being and decreasing pressure pain sensitivity but more studies with larger sample s and longer follow-up periods are needed to confirm these results . Trial Registration Clinical Trials.gov Objective To determine the effectiveness of lessons in the Alex and er technique , massage therapy , and advice from a doctor to take exercise ( exercise prescription ) along with nurse delivered behavioural counselling for patients with chronic or recurrent back pain . Design Factorial r and omised trial . Setting 64 general practice s in Engl and . Participants 579 patients with chronic or recurrent low back pain ; 144 were r and omised to normal care , 147 to massage , 144 to six Alex and er technique lessons , and 144 to 24 Alex and er technique lessons ;  half of each of these groups were r and omised to exercise prescription . Interventions Normal care ( control ) , six sessions of massage , six or 24 lessons on the Alex and er technique , and prescription for exercise from a doctor with nurse delivered behavioural counselling . Main outcome measures Rol and Morris disability score ( number of activities impaired by pain ) and number of days in pain . Results Exercise and lessons in the Alex and er technique , but not massage , remained effective at one year ( compared with control Rol and disability score 8.1 : massage −0.58 , 95 % confidence interval −1.94 to 0.77 , six lessons −1.40 , −2.77 to −0.03 , 24 lessons −3.4 , −4.76 to −2.03 , and exercise −1.29 , −2.25 to −0.34 ) . Exercise after six lessons achieved 72 % of the effect of 24 lessons alone ( Rol and disability score −2.98 and −4.14 , respectively ) . Number of days with back pain in the past four weeks was lower after lessons ( compared with control median 21 days : 24 lessons −18 , six lessons −10 , massage −7 ) and quality of life improved significantly . No significant harms were reported . Conclusions One to one lessons in the Alex and er technique from registered teachers have long term benefits for patients with chronic back pain . Six lessons followed by exercise prescription were nearly as effective as 24 lessons . Trial registration National Research Register N0028108728 . How does the Alex and er Technique work ? What are the authors findings about the clinical and cost effectiveness of the treatment ? Watch this video to find out ( 12 mins ) . PURPOSE The intention of this study was to assess the effectiveness of massage on muscle recovery as a function of therapist education in participants who completed a 10-km running race . METHODS Race participants were offered a 12- to 15-min massage immediately post-event . Participants were r and omly assigned to a student therapist with either 450 , 700 , or 950 h of didactic training in massage .  Muscle soreness was recorded by question naire using a 0- to 10-point visual scale at time points immediately before and after massage , and 24 and 48 h post-event . Eight hundred ninety-five subjects were recruited , with 317 subjects returning question naires from all time points . RESULTS Race participants who received massage from student therapists with 950 h of didactic training reported significantly greater improvement in muscle soreness across time compared with those who received massage from therapists with 700 or 450 h of education in massage ( P < 0.01 ) . On study entry , there was no difference in muscle soreness ( P = 0.99 ) , with a group mean of 4.4 + /- 0.4 ; at the 24-h measurement , soreness was 2.4 + /- 0.6 , 3.7 + /- 0.5 , and 3.6 + /- 0.9 for the 950- , 700- , and 450-h groups , respectively ( P < 0.01 ) . CONCLUSION Level of therapist training was shown to impact effectiveness of  massage  as a post-race recovery tool ; greater reduction in muscle soreness was achieved by therapists with 950 h of training as opposed to those with 700 or 450 AIM This study assessed the effectiveness of blended essential oils on menstrual cramps for out patients with primary dysmenorrhea and explored the analgesic 
    Output:
    
Conclusion Based on the evidence , massage therapy , compared to no treatment , should be strongly recommended as a pain management option .
Massage therapy is weakly recommended for reducing pain , compared to other sham or active comparators , and improving mood and health-related quality of life , compared to other active comparators .