***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 The mechanisms thorough which spinal manipulative therapy ( SMT ) exerts clinical effects are not established . A prior study has suggested a dorsal horn modulated effect ; however , the role of subject expectation was not considered . The purpose of the current study was to determine the effect of subject expectation on hypoalgesia associated with SMT . Methods Sixty healthy subjects agreed to participate and underwent quantitative sensory testing ( QST ) to their leg and low back . Next , participants were r and omly assigned to receive a positive , negative , or neutral expectation instructional set regarding the effects of a specific SMT technique on pain perception . Following the instructional set , all subjects received SMT and underwent repeat QST . Results No interaction ( p = 0.38 ) between group assignment and pain response was present in the lower extremity following SMT ; however , a main effect ( p < 0.01 ) for hypoalgesia was present . A significant interaction was present between change in pain perception and group assignment in the low back ( p = 0.01 ) with participants receiving a negative expectation instructional set demonstrating significant hyper algesia ( p < 0.01 ) . Conclusion The current study replicates prior findings of c- fiber mediated hypoalgesia in the lower extremity following SMT and this occurred regardless of expectation . A significant increase in pain perception occurred following SMT in the low back of participants receiving negative expectation suggesting a potential influence of expectation on SMT induced hypoalgesia in the body area to which the expectation is directed OBJECTIVE To examine the effects of adjunctive postoperative massage and vibration therapy on short-term postsurgical pain , negative affect , and physiologic stress reactivity . DESIGN Prospect i ve , r and omized controlled trial . The treatment groups were : ( 1 ) usual postoperative care ( UC ) ; ( 2 ) UC plus massage therapy ; or ( 3 ) UC plus vibration therapy . SETTING The University of Virginia Hospital Surgical Units , Gynecology-Oncology Clinic , and General Clinical Research Center . SUBJECTS One hundred and five ( N = 105 ) women who underwent an abdominal laparotomy for removal of suspected cancerous lesions . INTERVENTIONS All patients received UC with analgesic medication . Additionally , the massage group received st and ardized 45-minute sessions of gentle Swedish massage on the 3 consecutive evenings after surgery and the vibration group received 20-minute sessions of inaudible vibration therapy ( physiotones ) on the 3 consecutive evenings after surgery , as well as additional sessions as desired . OUTCOME MEASURES Sensory pain , affective pain , anxiety , distress , analgesic use , systolic blood pressure , 24-hour urine free cortisol , number of postoperative complications , and days of hospitalization . RESULTS On the day of surgery , massage was more effective than UC for affective ( p = 0.0244 ) and sensory pain ( p = 0.0428 ) , and better than vibration for affective pain ( p = 0.0015 ) . On postoperative day 2 , massage was more effective than UC  for distress ( p = 0.0085 ) , and better than vibration for sensory pain ( p = 0.0085 ) . Vibration was also more effective than UC for sensory pain ( p = 0.0090 ) and distress ( p = .0090 ) . However , after controlling for multiple comparisons and multiple outcomes , no significant differences were found . CONCLUSIONS Gentle Swedish massage applied postoperatively may have minor effects on short-term sensory pain , affective pain , and distress among women undergoing an abdominal laparotomy for removal of suspected malignant tissues OBJECTIVE The purpose of this study was to investigate the effects of ice massage postexercise on pressure pain thresholds ( PPTs ) over the quadriceps muscle and the electromyography ( EMG ) root mean square ( RMS ) . METHODS Fifteen athletes ( female , 8 ; age , 19 + /- 2 years ) participated . Subjects were required to visit the laboratory on 2 separate occasions with a 1-week interval between sessions . Participants performed 5 isokinetic concentric dominant knee extension contractions at 60 degrees , 120 degrees , 180 degrees , and 240 degrees /s . After exercise , they were r and omly assigned to receive either an ice massage or detuned ultrasound for 15 minutes , 1 on each session . The PPT and RMS during maximal voluntary contraction were measured over the vastus medialis ( VM ) , vastus lateralis ( VL ) , and rectus femoris ( RF ) muscles at baseline , postexercise , and 5 minutes postintervention . The hypothesis of interest was the intervention x time interaction . RESULTS The analysis of covariance found a significant intervention x time interaction for PPT over the VM ( F = 17.3 , P < .001 ) and VL ( F = 5.4 , P = .03 ) muscles but not over the RF ( F = 1.2 , P = .3 ) , indicating an increase in PPT after the ice massage . An intervention x time interaction was found for RMS of the VL ( F = 5.8 , P = .01 ) but not of the VM ( F = 0.5 , P = .5 ) or RF ( F = 0.01 , P = .9 ) muscles , indicating an increase in RMS after the ice massage . A significant positive correlation between PPT and RMS for the VL muscle was identified ( r = 0.6 , P = .03 ) . CONCLUSION Ice massage after isokinetic exercise produced an immediate increase of PPT over the VL and VM and EMG activity over the VL muscle in recreational athletes , suggesting that ice massage may result in a hypoalgesic effect and improvements in EMG activity The treatment of lateral epicondylalgia , a widely-used model of musculoskeletal pain in the evaluation of many physical therapy treatments , remains somewhat of an enigma . The protagonists of a new treatment technique for lateral epicondylalgia report that it produces substantial and rapid pain relief , despite a lack of experimental evidence . A r and omized , double blind , placebo-controlled repeated- measures study evaluated the initial effect of this new treatment in 24 patients with unilateral , chronic lateral epicondylalgia .  Pain-free grip strength was assessed as an outcome measure before , during and after the application of the treatment , placebo and control conditions .  Pressure-pain thresholds were also measured before and after the application of treatment , placebo and control conditions . The results demonstrated a significant and substantial increase in pain-free grip strength of 58 % ( of the order of 60 N ) during treatment but not during placebo and control . In contrast , the 10 % change in pressure-pain threshold after treatment , although significantly greater than placebo and control , was substantially smaller than the change demonstrated for pain-free grip strength . This effect was only present in the affected limb . The selective and specific effect of this treatment technique provides a valuable insight into the physical modulation of musculoskeletal pain and requires further investigation AIM The purpose of this study was to examine the effects of ice massage on the signs and symptoms associated with exercise-induced muscle damage . METHODS Nine recreationally resistance trained males performed an exercise protocol design ed to induce muscle damage on 2 separate occasions ; this was performed on the dominant or non-dominant arm in a r and om cross over design . The protocol consisted of 3 sets of 10 repetitions of single arm biceps curls , at 70 % of a pre-determined one repetition maximum ( 1RM ) , with the eccentric phase of the contraction extended to 7 seconds . Subjects were also r and omly assigned to an ice massage group or control group in the cross over design and received treatments immediately post-exercise , 24 hours and 48 hours post-exercise .  1RM , plasma creatine kinase ( CK ) , muscle soreness ( DOMS ) , limb girth and range of motion ( ROM ) were measured pre , immediately post , 24 hours , 48 hours and 72 hours post-exercise . RESULTS Significant time effects were observed for all dependent variables ( p<0.05 ) , though no significant group effects were observed . A group by time interaction was found for CK ( p<0.05 ) , which at 72 hours post-exercise was significantly lower in the ice massage group ( p<0.05 ) . CONCLUSION These results indicate that although ice massage reduces the appearance of CK it has no other effect on signs and symptoms associated with exercise-induced muscle damage OBJECTIVE This study analyzed and compared the effects of manual lymph drainage therapy ( MLDT ) and connective tissue massage ( CTM ) in women with primary fibromyalgia ( PFM ) . METHODS The study design was a r and omized controlled trial . Fifty women with PFM completed the study . The patients were divided r and omly into 2 groups . Whereas 25 of them received MLDT , the other 25 underwent CTM . The treatment program was carried out 5 times a week for 3 weeks in each group . Pain was evaluated by a visual analogue scale and algometry . The Fibromyalgia Impact Question naire ( FIQ ) and Nottingham Health Profile were used to describe health status and health-related quality of life ( HRQoL ) . Wilcoxon signed rank test and Mann-Whitney U test were used to analyze the data . RESULTS In both groups , significant improvements were found regarding pain intensity , pain pressure threshold , and HRQoL ( P < .05 ) . However , the scores of FIQ-7 ( P = .006 ) , FIQ-9 ( P = .006 ) , and FIQ-total ( P = .010 ) were significantly lower in the MLDT group than they were in the CTM group at the end of treatment . CONCLUSIONS For this particular group of patients , both MLDT and CTM appear to yield improvements in terms of pain , health status , and HRQoL. The results indicate that these manual therapy techniques might be used in the treatment of PFM . However , MLDT was found to be more effective than CTM according to some subitems of FIQ ( morning tiredness and anxiety ) and FIQ total score . Manual lymph drainage therapy might be preferred ; however , further long-term follow-up studies are needed 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 This study tested the effectiveness of episodic transcutaneous electrical nerve stimulation ( TENS ) as a supplement to pharmacologic analgesia on pain with movement and at rest after abdominal surgery and evaluated whether its use during walking and vital capacity maneuvers enhances performance of these activities . TENS , with a modulated frequency , intensity as high as the subject could tolerate , and electrodes placed on either side and parallel to the incision , was compared to placebo TENS and pharmacologic analgesia alone ( control ) by using a crossover design . Self-report of pain intensity , walking function , and vital capacity were assessed on 33 subjects .  TENS result ed in significantly less pain than the control during both walking ( P < .5 ) and vital capacity activities ( P < .1 ) and significantly less pain than placebo TENS during vital capacity ( P < .01 ) . TENS also produced significantly better gait speeds than the control ( P < .05 ) and greater gait distances ( P < .01 ) than the control and placebo TENS .  Vital capacity and pain intensity at rest were not significantly different among the 3 treatments . These results suggest TEN 
    Output:
    
MBT demonstrated a favorable and consistent ability to modulate pain sensitivity .
Short-term modulation of pain sensitivity was associated with short-term beneficial effects on clinical pain .
Intensity of MBT , but not duration , was linked with change in pain sensitivity .
The results suggest that MBT had a favorable effect on pressure pain thresholds when compared with no-treatment and sham/inert groups , and effects comparable with those of other active treatments .