***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: OBJECTIVES To compare the efficacies of dry needling of trigger points ( TrPs ) with and without paraspinal needling in myofascial pain syndrome of elderly patients . DESIGN Single-blinded , r and omized controlled trial . SUBJECTS Forty ( 40 ) subjects , between the ages of 63 and 90 with myofascial pain syndrome of the upper trapezius muscle . INTERVENTIONS Eighteen ( 18 ) subjects were treated with dry needling of all the TrPs only and another 22 with additional paraspinal needling on days 0 , 7 , and 14 . RESULTS At 4-week follow-up the results were as follows : ( 1 ) TrP and paraspinal dry needling result ed in more continuous subjective pain reduction than TrP dry needling only ; ( 2 ) TrP and paraspinal dry needling result ed in significant improvements on the geriatric depression scale but TrP dry needling only did not ; ( 3 ) TrP and paraspinal dry needling result ed in improvements of all the cervical range of motions but TrP dry needling  only did not in extensional cervical range of motion ; and ( 4 ) no cases of gross hemorrhage were noted . CONCLUSIONS TrP and paraspinal dry needling is suggested to be a better method than TrP dry needling only for treating myofascial pain syndrome in elderly patients OBJECTIVE We aim ed to evaluate the effectiveness of laser therapy in myofascial pain syndrome treatment . BACKGROUND DATA Myofascial pain syndrome is a disease that is characterized by hypersensitive points called trigger points found in one or more muscles and /or connective tissues . It can cause pain , muscle spasm , sensitivity , stiffness , weakness , limitation of range of motion and rarely autonomic dysfunction . Physical therapy modalities and exercise are used in the treatment of this frequently encountered disease . METHODS The placebo controlled , prospect i ve , long-term follow up study was planned with 60 patients who had trigger points in their upper trapezius muscles . The patients were divided into three groups r and omly . Stretching exercises were taught to each group and they were asked to exercise at home . Treatment duration was 4 weeks . Placebo laser was applied to group 1 , dry needling to group 2 and laser to group 3 . He-Ne laser was applied to three trigger points in the upper trapezius muscles on both sides with 632.8 nm . The patients were assessed at before , post-treatment , and 6 months after-treatment for pain , cervical range of motion and functional status . RESULTS We observed a significant decrease in pain at rest , at activity , and increase in pain threshold in the laser group compared to other groups . Improvement according to Nottingham Health Profile gave the superiority of the laser treatment . However , those differences among the groups were not observed at 6-month follow up . CONCLUSIONS Laser therapy could be useful as a treatment modality in myofascial pain syndrome because of its noninvasiveness , ease , and short-term application OBJECTIVE EMG examination at tender points affects myofascial pain symptoms related to cervical nerve root irritation . METHODS Consecutive patients with neck and arm pain had physical examinations immediately before and after having EMGs of bilateral C3-C8 myotomes . Patients were r and omly chosen for EMG either at the most tender point along the palpated myofascial b and or at a nonselected site . The myotomal presence of > or = 30 % incidence of normal duration and amplitude , and polyphasic motor unit potentials confirm the diagnosis of cervical nerve root irritation . RESULTS 52 % returned patient question naires 2 weeks post EMG examination . Group I ( 82/122 patients [ 67.2 % ] ) , averaged pain relief of 51.8 + /- 21.9 % , a mean of 10.2 + /- 8 days ; 14 % had > or = 75 % relief . The number of days of pain relief correlated positively with the percentage of pain relief ( p < 0.005 ) , but negatively with the number of nerve roots involved on EMG ( p < 0.05 ) . Group 2 ( 23/42 patients [ 54.8 % ] ) , averaged relief of 39.0 + /- 18.7 % , lasting 8.8 + /- 11.2 days . None had > or = 75 % pain relief . Both groups ' duration of pain symptoms affected onset of relief . Evidence of bilateral multiple-level cervical nerve root irritation , especially noted at bilateral C6 and C7 levels . CONCLUSION EMG at tender points on myofascial b and s tends to improve symptoms . Needling these points elicits motor endplate activity and twitches , and induces more relief than when needling r and om points & NA ;  Pain intensity is frequently measured on an 11‐point pain intensity numerical rating scale ( PI‐NRS ) , where 0=no pain and 10=worst possible pain . However , it is difficult to interpret the clinical importance of changes from baseline on this scale ( such as a 1‐ or 2‐point change ) . To date , there are no data driven estimates for clinical ly important differences in pain intensity scales used for chronic pain studies . We have estimated a clinical ly important difference on this scale by relating it to global assessment s of change in multiple studies of chronic pain . Data on 2724 subjects from 10 recently completed placebo‐controlled clinical trials of pregabalin in diabetic neuropathy , postherpetic neuralgia , chronic low back pain , fibromyalgia , and osteoarthritis were used . The studies had similar design s and measurement instruments , including the PI‐NRS , collected in a daily diary , and the st and ard seven‐point patient global impression of change ( PGIC ) , collected at the endpoint . The changes in the PI‐NRS from baseline to the endpoint were compared to the PGIC for each subject . Categories of ‘ much improved ’ and ‘ very much improved ’ were used as determinants of a clinical ly important difference and the relationship to the PI‐NRS was explored using graphs , box plots , and sensitivity/specificity analyses . A consistent relationship between the change in PI‐NRS and the PGIC was demonstrated regardless of study , disease type , age , sex , study result , or treatment group . On average , a reduction of approximately two points or a reduction of approximately 30 % in the PI‐NRS represented a clinical ly important difference . The relationship between percent change and the PGIC was also consistent regardless of baseline pain , while higher baseline scores required larger raw changes to represent a clinical ly important difference . The application of these results to future studies may provide a st and ard definition of clinical ly important improvement in clinical trials of chronic pain therapies . Use of a st and ard outcome across chronic pain studies would greatly enhance the comparability , validity , and clinical applicability of these studies Background Rotator cuff tendinopathy and subacromial impingement syndrome present complex patomechanical situations , frequent difficulties in clinical diagnosis and lack of effectiveness in treatment . Based on clinical experience , we have therefore considered the existence of another pathological entity as the possible origin of pain and dysfunction . The hypothesis of this study is to relate subacromial impingement syndrome ( SIS ) with myofascial pain syndrome ( MPS ) , since myofascial trigger points ( MTrPs ) cause pain , functional limitation , lack of coordination and alterations in quality of movement , even prior to a tendinopathy . MTrPs can coexist with any degenerative subacromial condition . If they are not taken into consideration , they could perpetuate and aggravate the problem , hindering diagnosis and making the applied treatments ineffective . The aims and methods of this study are related with providing evidence of the relationship that may exist between this condition and MPS in the diagnosis and treatment of rotator cuff tendonitis and /or SIS . Method / design A descriptive transversal study will be made to find the correlation between the diagnosis of SIS and rotator cuff tendonitis , positive provocation test responses , the existence of active MTrPs and the results obtained with ultrasonography ( US ) and Magnetic Renonance Imaging ( MRI ) . A r and omized double blinded clinical trial will be carried out in experimental conditions : A Protocol ized treatment based on active and passive joint repositioning , stabilization exercises , stretching of the periarticular shoulder muscles and postural reeducation . B. The previously described protocol ized treatment , with the addition of dry needling applied to active MTrPs with the purpose of isolating the efficacy of dry needling in treatment . Discussion This study aims to provide a new vision of shoulder pain , from the perspective of MPS . This syndrome can , by itself , account for shoulder pain and dysfunction , although it can coexist with real conditions involving the tendons . Trail Registration IS RCT N Number : In this study ; we aim ed to compare the efficacy of local anesthetic injection and dry needling methods on pain , cervical range of motion ( ROM ) , and depression in myofascial pain syndrome patients ( MPS ) . This study was design ed as a prospect i ve r and omized controlled study . Eighty patients ( female 52/male 28 ) admitted to a physical medicine and rehabilitation outpatient clinic diagnosed as MPS were included in the study . Patients were r and omly assigned into two groups . Group 1 ( n = 40 ) received local anesthetic injection ( 2 ml lidocaine of 1 % ) and group 2 ( n = 40 ) received dry injecting on trigger points . Both patient groups were given stretching exercises aim ed at the trapezius muscle to be applied at home . Patients were evaluated according to pain , cervical ROM , and depression . Pain was assessed using Visual Analog Scale ( VAS ) and active cervical ROM was measured using goniometry . Beck Depression Inventory ( BDI ) was used to assess the level of depression . There were no statistically significant differences in the pre-treatment evaluation parameters of the patients . There were statistically significant improvements in VAS , cervical ROM , and BDI scores after 4 and 12 weeks in both groups compared to pre-treatment results ( p < 0.05 ) . No significant differences were observed between the groups ( p > 0.05 ) . Our study indicated that exercise associated with local anesthetic and dry needling injections were effective in decrease of pain level in MPS as well as increase of cervical ROM and decrease of depressive mood levels of individuals & NA ; To evaluate immediate effects of two different modes of acupuncture on motion‐related pain and cervical spine mobility in chronic neck pain patients compared to a sham procedure . Thirty‐six patients with chronic neck pain and limited cervical spine mobility participated in a prospect i ve , r and omized , double‐blind , sham‐controlled crossover trial . Every patient was treated once with needle acupuncture at distant points , dry needling ( DN ) of local myofascial trigger points and sham laser acupuncture ( Sham ) . Outcome measures were motion‐related pain intensity ( visual analogue scale , 0–100 mm ) and range of motion ( ROM ) . In addition , patients scored changes of general complaints using an 11‐point verbal rating scale . Patients were assessed immediately before and after each treatment by an independent ( blinded ) investigator . Multivariate analysis was used to assess the effects of true acupuncture and needle site independently . For motion‐related pain , use of acupuncture at non‐local points reduced pain scores by about a third ( 11.2 mm ; 95 % CI 5.7 , 16.7 ; P=0.00006 ) compared to DN and sham . DN led to an estimated reduction in pain of 1.0 mm ( 95 % CI −4.5 , 6.5 ; P=0.7 ) . Use of DN  slightly improved ROM by 1.7 ° ( 95 % CI 0.2 , 3.2 ; P=0.032 ) with use of non‐local points improving ROM by an additional 1.9 ° ( 95 % CI 0.3 , 3.4 ; P=0.016 ) . For patient assessment of change , non‐local acupuncture was significantly superior both to Sham ( 1.7 points ; 95 % CI 1.0 , 2.5 ; P=0.0001 ) and DN ( 1.5 points ; 95 % CI 0.4 , 2.6 ; P=0.008 ) but there was no difference between DN and Sham ( 0.1 point ; 95 % CI −1.0 , 1.2 ; P=0.8 ) . Acupuncture is superior to Sham in improving motion‐related pain and ROM following a single session of treatment in chronic neck pain patients . Acupuncture at distant points improves ROM more than DN ; DN was ineffective for motion‐related pain The objective of this study was to test the hypothesis that dry needling is more effective than sham dry needling in the treatment of myofascial pain syndrome ( MPS ) . This was a prospect i ve , double-blinded , r and omized-controlled study conducted in an outpatient clinic . Thirty-nine subjects with established myofascial trigger points were r and omized into two groups : study group ( N = 22 ) and placebo group ( N = 17 ) . Dry needling was applied using acupuncture needles , and sham dry needling was applied in the placebo group . The treatment was composed of six sessions which were performed in 4 weeks ; the first four sessions were performed twice a week ( for 2 weeks ) and the last two , once a week ( for 2 weeks ) . The visual analog scale ( VAS ) and Short Form-36 ( SF-36 ) were used . When compared with the initial values , VAS scores of the dry needling group following the first and sixth sessions were significantly lower ( p = 0.000 and p < 0.000 , respectively ) . When VAS scores were compared between the groups , the first assessment scores were found to be similar , but the second and third assessment scores were found to be significantly lower in the dry needling group ( p = 0. 
    Output:
    
Based on the best current available evidence ( grade A ) , we recommend dry needling , compared to sham or placebo , for decreasing pain immediately after treatment and at 4 weeks in patients with upper-quarter MPS .