***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: Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials Abstract Thirty-seven adults with spinal-cord injury and chronic pain were r and omly assigned to receive 10 sessions of self-hypnosis ( HYP ) or EMG biofeedback relaxation ( BIO ) training for pain management . Participants in both treatment conditions reported substantial , but similar , decreases in pain intensity from before to after the treatment sessions . However , participants in the HYP condition , but not the BIO condition , reported statistically significant decreases in daily average pain pre- to posttreatment . These pre- to posttreatment decreases in pain reported by the HYP participants were maintained at 3-month follow-up . Participants in the HYP condition , but not the BIO condition , also reported significant pre- to posttreatment increases in perceived control over pain , but this change was not maintained at the 3-month follow-up Sickle cell disease ( SCD ) is the most common genetic disease in African-Americans , characterized by recurrent painful vaso-occlusive crises . Medical therapies for controlling or preventing crises are limited because of efficacy and /or toxicity . This is a r and omized , controlled , single-crossover protocol of hypnosis for managing pain in SCD patients . Participants receive hypnosis from a trained hypnosis therapist followed by six weeks of self-hypnosis using digital media .  Those in the control arm receive SCD education followed by a six-week waiting period before crossing over to the hypnosis arm of the study . Outcome measures include assessment s of pain ( frequency , intensity and quality ) , anxiety , coping strategies , sleep , depression , and health care utilization . To date , there are no published r and omized , controlled trials evaluating the efficacy of hypnosis on SCD pain modulation in adults .  Self-hypnosis for pain management may be helpful in modulating chronic pain , improving sleep quality , and decreasing use of narcotics in patients with SCD . TRIAL REGISTRATION Clinical Trials.gov : Tension  headaches  can form a chronic ( very long duration ) condition . EMG biofeedback , relaxation training and analgesia by hypnotic suggestion can reduce the pain . So far , no differences have been demonstrated between the effects of various psychological treatments . In a constructively design ed study , we firstly compared an abbreviated form of autogenic training to a form of hypnotherapy ( future oriented hypnotic imagery ) which was not presented as hypnosis and secondly we compared both treatments to the same future oriented hypnotic imagery , but this time explicitly presented as hypnosis . The three treatments were equally effective at post-treatment , but after a 6-month follow-up period , the future oriented hypnotic imagery which had been explicitly presented as hypnosis was superior to autogenic training . Contrary to common belief , it could be demonstrated that the therapists were as effective with the treatment modality they preferred as with the treatment modality they felt to be less remedial Objective Postpr and ial symptoms in irritable bowel syndrome are common and relate to an exaggerated motor and sensory component of the gastrocolonic response . We investigated whether this response can be affected by hypnotherapy . Methods We included 28 patients with irritable bowel syndrome refractory to other treatments . They were r and omized to receive gut-directed hypnotherapy 1 hour per week for 12 weeks ( N = 14 ) or were provided with supportive therapy ( control group ; N = 14 ) . Before r and omization and after 3 months , all patients underwent a colonic distension trial before and after a 1-hour duodenal lipid infusion .  Colonic sensory thresholds and tonic and phasic motor activity were assessed . Results Before r and omization , reduced thresholds after vs. before lipid infusion were seen in both groups for all studied sensations . At 3 months , the colonic sensitivity before duodenal lipids did not differ between groups . Controls reduced their thresholds after duodenal lipids for gas ( 22 ± 1.7 mm Hg vs. 16 ± 1.6 mm Hg , p < .01 ) , discomfort ( 29 ± 2.9 mm Hg vs. 22 ± 2.6 mm Hg , p < .01 ) , and pain ( 33 ± 2.7 mm Hg vs. 26 ± 3.3 mm Hg , p < .01 ) , whereas the hypnotherapy group reduced their thresholds after lipids only for pain ( 35 ± 4.0 mm Hg vs. 29 ± 4.7 mm Hg , p < .01 ) . The colonic balloon volumes and tone response at r and omization were similar in both groups . At 3 months , baseline balloon volumes were lower in the hypnotherapy group than in controls ( 83 ± 14 ml vs. 141 ± 15 ml , p < .01 ) . In the control group , reduced balloon volumes during lipid infusion were seen ( 141 ± 15 ml vs. 111 ± 19 ml , p < .05 ) , but not after hypnotherapy ( 83 ± 14 ml vs. 80 ± 16 ml , p > .20 ) . Conclusion Hypnotherapy reduces the sensory and motor component of the gastrocolonic response in patients with irritable bowel syndrome . These effects may be involved in the clinical efficacy of hypnotherapy in IBS The main aims of this experimental study are : ( 1 ) to compare the relative effects of analgesia suggestions and relaxation suggestions on clinical pain , and ( 2 ) to compare the relative effect of relaxation suggestions when they are presented as “ hypnosis ” and as “ relaxation training ” . Forty‐five patients with fibromyalgia were r and omly assigned to one of the following experimental conditions : ( a ) hypnosis with relaxation suggestions ; ( b ) hypnosis with analgesia suggestions ; ( c ) relaxation . Before and after the experimental session , the pain intensity was measured using a visual analogue scale ( VAS ) and the sensory and affective dimensions were measured with the McGill Pain Question naire . The results showed : ( 1 ) that hypnosis followed by analgesia suggestions has a greater effect on the intensity of pain and on the sensory dimension of pain than hypnosis followed by relaxation suggestions ; ( 2 ) that the effect of hypnosis followed by relaxation suggestions is not greater than relaxation . We discuss the implication s of the study on our underst and ing of the importance of suggestions used in hypnosis and of the differences and similarities between hypnotic relaxation and relaxation training In a controlled study , 40 patients with refractory fibromyalgia were r and omly allocated to treatment with either hypnotherapy or physical therapy for 12 weeks with followup at 24 weeks . Compared with the patients in the physical therapy group , the patients in the hypnotherapy group showed a significantly better outcome with respect to their pain experience , fatigue on awakening , sleep pattern and global assessment at 12 and 24 weeks , but this was not reflected in an improvement of the total myalgic score measured by a dolorimeter . At baseline most patients in both groups had strong feelings of somatic and psychic discomfort as measured by the Hopkins Symptom Checklist . These feelings showed a significant decrease in patients treated by hypnotherapy compared with physical therapy , but they remained abnormally strong in many cases . We conclude hypnotherapy may be useful in relieving symptoms in patients with refractory fibromyalgia BACKGROUND In western population s irritable bowel syndrome ( IBS ) affects between 10 % and 30 % of the population and has a significant effect on quality of life . It generates a substantial workload in both primary and secondary care and has significant cost implication s. Gut-directed hypnotherapy has been demonstrated to alleviate symptoms and improve quality of life but has not been assessed outside of secondary and tertiary referral centres . AIM To assess the effectiveness of gut-directed hypnotherapy as a complementary therapy in the management of IBS . DESIGN OF STUDY R and omised controlled trial . SETTING Primary care patients aged 18 - 65 years inclusive , with a diagnosis of IBS of greater than 6 weeks ' duration and having failed conventional management , located in South Staffordshire and North Birmingham , UK . METHOD Intervention patients received five sessions of hypnotherapy in addition to their usual management .  Control patients received usual management alone . Data regarding symptoms and quality of life were collected at baseline and again 3 , 6 , and 12 months post-r and omisation . RESULTS Both groups demonstrated a significant improvement in all symptom dimensions and quality of life over 12 months . At 3 months the intervention group had significantly greater improvements in pain , diarrhoea and overall symptom scores ( P<0.05 ) . No significant differences between groups in quality of life were identified . No differences were maintained over time . Intervention patients , however , were significantly less likely to require medication , and the majority described an improvement in their condition . CONCLUSIONS Gut-directed hypnotherapy benefits patients via symptom reduction and reduced medication usage , although the lack of significant difference between groups beyond 3 months prohibits its general introduction without additional evidence . A large trial incorporating robust economic analysis is , therefore , urgently recommended This article both summarizes the previous review s of r and omized , controlled trials of hypnotic analgesia for the treatment of chronic and acute pain in adults , and review s similar trials which have recently been published in the scientific literature . The results indicate that for both chronic and acute pain conditions : ( 1 ) hypnotic analgesia consistently results in greater decreases in a variety of pain outcomes compared to no treatment/st and ard care ; ( 2 ) hypnosis frequently out-performs non-hypnotic interventions ( e.g. education , supportive therapy ) in terms of reductions in pain-related outcomes ; and ( 3 ) hypnosis performs similarly to treatments that contain hypnotic elements ( such as progressive muscle relaxation ) , but is not surpassed in efficacy by these alternative treatments . Factors that may influence the efficacy of hypnotic analgesia interventions are discussed , including , but not limited to , the patient 's level of suggestibility , treatment outcome expectancy , and provider expertise . Based upon this body of literature , suggestions are offered for practitioners who are using , or would like to use , hypnosis for the amelioration of pain problems in their patients or clients We investigated the effectiveness of a special hypnotherapy technique in the treatment of  chronic tension-type headache .  A waitinglist control group was used to control for the changes in headache activity due to the passage of time . The results showed significant reductions in the number of headache days ( p less than 0.05 ) , the number of headache hours ( p less than 0.05 ) and headache intensity ( p less than 0.05 ) . The improvement was confirmed by the subjective evaluation data gathered with the use of a question naire and by a significant reduction in anxiety scores ( p less than 0.01 ) & NA ; The aims of this study were to(a ) investigate the efficacy of autogenic training ( AT ) and cognitive self‐hypnosis training ( CSH ) for the treatment of  chronic headaches  in comparison with a waiting‐list control ( WLC ) condition,(b ) investigate the influence of subject recruitment on treatment outcome ( c ) explore whether the level of hypnotizability is related to therapy outcome . Three different subjects groups ( group 1 , patients ( n = 58 ) who were referred by a neurological outpatient clinic ; group 2 , members ( n = 48 ) of the community who responded to an advertisement in a newspaper ; and group 3 , students ( n = 40 ) who responded to an advertisement in a university newspaper )  were allocated at r and om to a therapy or WLC condition . During treatment , there was a significant reduction in the Headache Index scores of the subjects in contrast with the controls . At post‐treatment and follow‐up almost no significant differences were observed between the 2 treatment conditions or the 3 referral sources regarding the Headache Index , psychological distress ( SCL‐90 ) scores and medication use . Follow‐up measurements indicated that therapeutic improvement was maintained . In both treatment conditions , the high‐hypnotizable subjects achieved a greater reduction in headache pain at post‐treatment and follow‐up than did the low‐hypnotizable subjects . It is concluded that a relatively simple and highly structured relaxation technique for the treatment of  chronic headache subjects may be preferable to more complex cognitive hypnotherapeutic procedures , irrespective of the source of recruitment . The level of hypnotic susceptibility seems to be a subject characteristic which is associated with a more favourable outcome in subjects treated with AT or CSH Abstract Twenty-two patients with multiple sclerosis ( MS ) and chronic pain we recruited into a quasi-experimental trial comparing the effects of self-hypnosis training ( HYP ) with progressive muscle relaxation ( PMR ) on pain intensity and pain interference ; 8 received HYP and the remaining 14 participants were r and omly assigned to receive either HYP or PMR . HYP-condition participants reported significantly greater pre- to postsession as well as pre- to posttreatment decreases in pain and pain interference than PMR-condition participants , and gains were maintained 
    Output:
    
This study demonstrates that hypnotherapy and relaxation techniques are effective in reducing short- and long-term headache activity in migraine sufferers