***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: Objectives To examine the efficacy and safety of Prosaptide ™ ( PRO ) for the treatment of painful HIV-associated sensory neuropathies ( HIV-SN ) . Design A r and omized , double-blind , placebo-controlled , multicenter study in participants with sensory neuropathy .  Pain modulating therapy was discontinued prior to baseline . Participants were stratified by sural sensory nerve action potential ( SNAP ) amplitude . Participants were trained to use an electronic diary ( ED ) to record pain . Setting Peripheral neuropathies are common complications of HIV infection . The pathogenesis is unknown and currently treatments are restricted to symptomatic measures . We examined PRO against placebo ( PBO ) for treatment of painful HIV-SN and performed a post-hoc evaluation of an electronic diary ( ED ) to record HIV-associated neuropathic pain . Participants Eligible participants included adults with neurologist-confirmed painful HIV-SN . Interventions 2 , 4 , 8 , or 16 mg/d PRO or PBO administered via subcutaneous ( SC ) injection for six weeks . Neurotoxic antiretroviral drug usage was held constant . Outcome Measures Changes from baseline in the weekly average of evaluable daily r and om prompts measuring pain using the Gracely pain scale and adverse events . Results 237 participants were r and omized . The study was stopped after a planned futility analysis . There were no between-group differences in the frequency of adverse events or laboratory toxicities . The 6-week mean ( sd ) Gracely pain scale changes were −0.12 ( 0.23 ) , −0.24 ( 0.35 ) , −0.15 ( 0.32 ) , −0.18 ( 0.34 ) , and −0.18 ( 0.32 ) for the 2 , 4 , 8 , 16 mg , and PBO arms respectively . A similar variability of pain changes recorded using the ED were noted compared to previous trials that used paper collection methods . Conclusions 6-week treatment with PRO was safe but not effective at reducing HIV-associated neuropathic pain . Use of an ED to record neuropathic pain is novel in HIV-SN , result ed in reasonable compliance in recording pain data , but did not decrease the variability of pain scores compared to historical paper collection methods . Trial Registration Current Controlled Trials Distal sensory polyneuropathy ( DSP ) is the most frequent neurological complication of HIV infection . Neuropathic symptoms vary from mild paresthesias to severe pain that respond only partially to symptomatic treatment . Forty-five subjects with human immunodeficiency virus (HIV)-associated symptomatic DSP ( SDSP ) were enrolled in a r and omized , multicenter , 16-week placebo-controlled study of memantine , an N-methyl-d-aspartate ( NMDA ) uncompetitive antagonist . Although memantine was well tolerated , no trend toward clinical benefit was observed . Results were similar to those of other pilot studies of memantine for neuropathic pain unrelated to HIV , suggesting that memantine is ineffective for the symptomatic treatment of HIV-associated SDSP Objective : To determine the effect of smoked cannabis on the neuropathic pain of HIV-associated sensory neuropathy and an experimental pain model . Methods : Prospect i ve r and omized placebo-controlled trial conducted in the inpatient General Clinical Research Center between May 2003 and May 2005 involving adults with painful HIV-associated sensory neuropathy . Patients were r and omly assigned to smoke either cannabis ( 3.56 % tetrahydrocannabinol ) or identical placebo cigarettes with the cannabinoids extracted three times daily for 5 days . Primary outcome measures included ratings of chronic pain and the percentage achieving > 30 % reduction in pain intensity . Acute analgesic and anti-hyperalgesic effects of smoked cannabis were assessed using a cutaneous heat stimulation procedure and the heat/capsaicin sensitization model . Results : Fifty patients completed the entire trial . Smoked cannabis reduced daily pain by 34 % ( median reduction ; IQR = −71 , −16 ) vs 17 % ( IQR = −29 , 8) with placebo ( p = 0.03 ) . Greater than 30 % reduction in pain was reported by 52 % in the cannabis group and by 24 % in the placebo group ( p = 0.04 ) . The first cannabis cigarette reduced chronic pain by a median of 72 % vs 15 % with placebo ( p < 0.001 ) . Cannabis reduced experimentally induced hyperalgesia to both brush and von Frey hair stimuli ( p ≤ 0.05 ) but appeared to have little effect on the painfulness of noxious heat stimulation . No serious adverse events were reported . Conclusion : Smoked cannabis was well tolerated and effectively relieved chronic neuropathic pain from HIV-associated sensory neuropathy . The findings are comparable to oral drugs used for chronic neuropathic pain Objective Distal symmetrical polyneuropathy is a common neurological sequela after HIV , which leads to neuropathic pain and functional limitations . Rehabilitation programs with exercises are used to augment pharmacological therapy to relieve pain but appropriate and effective exercises are unknown . This study explored the safety and effect of moderate-intensity aerobic exercises and progressive resisted exercises for HIV-induced distal symmetrical polyneuropathy neuropathic pain . Design A r and omized pretest , posttest of 12 wks of aerobic exercise or progressive resisted exercise compared with a control . Outcome measures were assessed using the subjective periphery neuropathy , brief peripheral neuropathy screening , and numeric pain rating scale . Pain was assessed at baseline , 6 and 12 wks . Data between groups were compared using Kruskal-Wallis , Mann-Whitney U test , and within-groups Friedman and Wilcoxon signed rank tests . Results There were 136 participants ( mean [ SD ] age = 36.79 [ 8.23 ] yrs ) and the exercise groups completed the protocol s without any adverse effects . Pain scores within and between aerobic exercise and progressive resisted exercise groups showed significant improvement ( P < 0.05 ) from baseline to 6 and 12 wks compared with the control ( P > 0.05 ) . Conclusions This study supports a rehabilitation program of moderate-intensity aerobic exercise and progressive resisted exercise being safe and effective for reducing neuropathic pain and is beneficial with analgesics for HIV-induced distal symmetrical polyneuropathy Objective : To evaluate the efficacy and tolerability of lamotrigine ( LTG ) for the treatment of pain in HIV-associated sensory neuropathies . Methods : In a r and omized , double-blind study , patients with HIV-associated distal sensory polyneuropathy ( DSP ) received LTG or placebo during a 7-week dose escalation phase followed by a 4-week maintenance phase . R and omization was stratified according to whether or not patients were currently using neurotoxic antiretroviral therapy ( ART ) . Results : The number of patients r and omized was 92 ( 62 LTG , 30 placebo ) in the stratum receiving neurotoxic ART and 135 ( 88 LTG , 47 placebo ) in the stratum not receiving neurotoxic ART . Mean change from baseline in Gracely Pain Scale score for average pain was not different between LTG and placebo at the end of the maintenance phase in either stratum , but the slope of the change in Gracely Pain Scale score for average pain reflected greater improvement with LTG than with placebo in the stratum receiving neurotoxic ART ( p = 0.004 ) , as did the mean change from baseline scores on the Visual Analogue Scale for Pain Intensity and the McGill Pain Assessment Scale and patient and clinician ratings of global impression of change in pain ( p ≤ 0.02 ) . The incidence of adverse events , including rash , was similar between LTG and placebo . Conclusions : Lamotrigine was well-tolerated and effective for HIV-associated neuropathic pain in patients receiving neurotoxic antiretroviral therapy . Additional research is warranted to underst and the differing response among patients receiving neurotoxic antiretroviral therapy compared with those not receiving neurotoxic antiretroviral therapy We conducted a r and omized , double-blind , placebo-controlled , crossover study at a single center in South Africa , to ascertain whether amitriptyline is an effective analgesic for painful HIV-associated sensory neuropathy of moderate to severe intensity in : i ) antiretroviral drug naive individuals , and ii ) antiretroviral drug users . 124 HIV-infected participants ( antiretroviral drug naive = 62 , antiretroviral drug users = 62 ) who met the study criteria for painful HIV-associated sensory neuropathy were r and omized to once-daily oral amitriptyline ( titrated to a median : interquartile range of 50 : 25 - 50 mg ) or placebo for six weeks , followed by a three-week washout period and subsequent treatment crossover . The primary outcome measure was change from baseline in worst pain intensity of the feet ( measured by participant self-report using an 11-point numerical pain rating scale ) after six weeks of treatment . 122 of 124 participants completed all study visits and were included in the analysis of the primary outcome . In the antiretroviral drug-naive group ( n = 61 ) there was no significant difference in the mean change in pain score from baseline after six weeks of treatment with placebo or amitriptyline [ amitriptyline : 2.8 ( SD 3.3 ) vs. placebo : 2.8 ( 3.4 ) ] . Similarly , there was no significant difference in the change in pain score after six weeks of treatment with placebo or amitriptyline in the antiretroviral drug-user group ( n = 61 ) [ amitriptyline : 2.7 ( 3.3 ) vs. placebo : 2.1 ( 2.8 ) ] . Controlling for period effects and treatment order effects did not alter the outcome of the analyses . Nor did analyzing the intention-to-treat cohort ( missing data interpolated using baseline observation carried forward ) alter the outcome of the analyses . In summary , amitriptyline , at the doses used here , was no more effective than an inactive placebo at reducing pain intensity in individuals with painful HIV-associated sensory neuropathy of moderate to severe intensity , irrespective of whether they were on antiretroviral therapy or not . Trial Registration IS RCT N CONTEXT Peripheral neuropathy is common in persons infected with the human immunodeficiency virus ( HIV ) but few data on symptomatic treatment are available . OBJECTIVE To evaluate the efficacy of a st and ardized acupuncture regimen ( SAR ) and amitriptyline hydrochloride for the relief of pain due to HIV-related peripheral neuropathy in HIV-infected patients . DESIGN R and omized , placebo-controlled , multicenter clinical trial . Each site enrolled patients into 1 of the following 3 options : ( 1 ) a modified double-blind 2 x 2 factorial design of SAR , amitriptyline , or the combination compared with placebo , ( 2 ) a modified double-blind design of an SAR vs control points , or ( 3 ) a double-blind design of amitriptyline vs placebo . SETTING Terry Beirn Community Programs for Clinical Research on AIDS ( HIV primary care providers ) in 10 US cities . PATIENTS Patients with HIV-associated , symptomatic , lower-extremity peripheral neuropathy . Of 250 patients enrolled , 239 were in the acupuncture comparison ( 125 in the factorial option and 114 in the SAR option vs control points option ) , and 136 patients were in the amitriptyline comparison ( 125 in the factorial option and 11 in amitriptyline option vs placebo option ) . INTERVENTIONS St and ardized acupuncture regimen vs control points , amitriptyline ( 75 mg/d ) vs placebo , or both for 14 weeks . MAIN OUTCOME MEASURE Changes in mean pain scores at 6 and 14 weeks , using a pain scale ranging from 0.0 ( no pain ) to 1.75 ( extremely intense ) , recorded daily . RESULTS Patients in all 4 groups showed reduction in mean pain scores at 6 and 14 weeks compared with baseline values . For both the acupuncture and amitriptyline comparisons , changes in pain score were not significantly different between the 2 groups . At 6 weeks , the estimated difference in pain reduction for patients in the SAR group compared with those in the control points group ( a negative value indicates a greater reduction for the " active " treatment ) was 0.01 ( 95 % confidence interval [ CI ] , -0.11 to 0.12 ; P=.88 ) and for patients in the amitriptyline group vs those in the placebo group was -0.07 ( 95 % CI , -0.22 to 0.08 ; P=.38 ) . At 14 weeks , the difference for those in the SAR group compared with those in the control points group was -0.08 ( 95 % CI , -0.21 to 0.06 ; P=.26 ) and for amitriptyline compared with placebo was 0.00 ( 95 % CI , -0.18 to 0.19 ; P=.99 ) . CONCLUSIONS In this study 
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Conclusion : Despite various modalities for pain control in HIV-SN , strongest evidence exists for capsaicin 8 % and smoked cannabis , although of low method ological quality .
Among non-pharmacologic modalities , only Acu/Moxa gave a marginal beneficial effect in one study , possibly limited by inherent method ological flaws