***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: OBJECTIVE To compare the efficacy and safety of celecoxib , a cyclooxygenase-2 ( COX-2 ) inhibitor , with those of naproxen , a nonsteroidal anti-inflammatory drug ( NSAID ) , and placebo in the treatment of osteoarthritis of the knee . METHODS In this multicenter , r and omized , double-blind , placebo-controlled trial , 1003 patients with symptomatic osteoarthritis of the knee were r and omly assigned to receive celecoxib at doses of 50 , 100 , or 200 mg twice a day ; naproxen , 500 mg twice a day ; or placebo for 12 weeks . Patients were evaluated with st and ard measures of efficacy 2 to 7 days after discontinuing previous NSAID or analgesic therapy and after 2 , 6 , and 12 weeks of treatment with the study drug . RESULTS Celecoxib treatment led to significant improvement in the signs and symptoms of osteoarthritis as determined by all efficacy measures . Significant pain relief occurred within 2 days of the initiation of treatment , and maximum anti-inflammatory and analgesic activity , evident within 2 weeks , was sustained throughout the 12-week study . All celecoxib doses were efficacious compared with placebo , although the 50-mg twice-daily dosage regimen was minimally effective . The higher doses of celecoxib ( 100 and 200 mg twice a day ) were similarly efficacious , and the magnitude of improvement observed with these dosing regimens was comparable to that seen with naproxen at a dose of 500 mg twice a day . All doses of celecoxib and naproxen were well tolerated . CONCLUSION COX-2 inhibition with celecoxib is an effective approach for the treatment of osteoarthritis , as seen by clinical improvement in signs and symptoms comparable to treatment with naproxen In this report of a double-blind placebo-controlled trial of  steroid injections for supraspinatus tendonitis , there was no statistical difference in the improvement in pain score between the two groups at 2 and 8 weeks of follow-up or in analgesic consumption . This trial casts further doubt on the efficacy of such treatment in soft tissue lesions around the shoulder Between 1986 and 1995 , we treated with foraminal injection of local anaesthetic and steroids  30 patients with severe lumbar radiculopathy secondary to foraminal and extraforaminal disc herniation which had not resolved with rest and non-steroidal anti-inflammatory agents .  They were assessed prospect ively using st and ardised forms as well as the Low Back Outcome Score , and were review ed at an average of 3.4 years ( 1 to 10 ) after injection by an independent observer ( BKW ) . Relief of symptoms was obtained in 27 immediately after injection . Three subsequently relapsed , requiring operation , and two were lost to long-term follow-up . Thus 22 of the 28 patients available for long-term follow-up had considerable and sustained relief from their symptoms . Before the onset of symptoms 17 were in employment and , after injection , 13  resumed work , all but two in the same job . The average score before injection was 25 out of a possible 75 points . At follow-up , the overall average score was 54 , and in those who had obtained relief of symptoms it had improved to a mean of 61 . Based on these findings we recommend foraminal injection of local anaesthetic and steroids as the primary treatment for patients with severe radiculopathy secondary to foraminal or extraforaminal herniation of a lumbar disc BACKGROUND Chronic pain in the cervical zygapophyseal joints is a common problem after a whiplash injury . Treatment with intraarticular injections of corticosteroid preparations has been advocated , but the value of this approach has not been established . We compared the efficacy of a depot injection of a corticosteroid preparation with the efficacy of an injection of a local anesthetic agent in patients with painful cervical zygapophyseal joints . METHODS Sixteen men and 25 women with pain in one or more cervical zygapophyseal joints after automobile accidents ( mean age , 43 years ; median duration of pain , 39 months ) were r and omly assigned to receive an intraarticular injection of either bupivacaine ( 0.5 percent ) or betamethasone ( 5.7 mg ) under double-blind conditions . The patients were followed by means of regular telephone contact and clinic visits until they reported a return to a level of pain equivalent to 50 percent of the preinjection level . The time from treatment to a 50 percent return of pain was compared in the two groups with the use of a survival analysis . RESULTS Less than half the patients reported relief of pain for more than one week , and less than one in five patients reported relief for more than one month , irrespective of the treatment received . The median time to a return of 50 percent of the preinjection level of pain was 3 days in the 21 patients in the corticosteroid group and 3.5 days in the 20 patients in the local-anesthetic group ( P = 0.42 ) . CONCLUSIONS Intraarticular injection of betamethasone is not effective therapy for pain in the cervical zygapophyseal joints after a whiplash injury The management of sciatica due to lumbar nerve root compromise remains controversial , probably because few well-controlled studies of conservative management have been performed . This preliminary study assesses the efficacy of epidural injections of 80 mg triamcinolone acetonide plus 0.5 % procaine hydrochloride in saline , administered via the caudal route , in a double-blind , placebo controlled trial with 1 year follow-up . Twenty-three patients were entered into the study : 12 received treatment and 11 placebo .  The active group showed significant pain relief ( P=0.02 ) and a significant increase in mobility ( P=0.01 ) at 4 weeks , which result ed in improved quality of life ( P=0.02 ) . At 1 year , subjective and objective measures improved in both groups . The improvement was greater in the actively treated group , but only the objective assessment ( straight leg raise ) was statistically significant BACKGROUND Although epidural corticosteroid injections are commonly used for sciatica , their efficacy has not been established . METHODS In a r and omized , double-blind trial , we administered up to three epidural injections of methylprednisolone acetate ( 80 mg in 8 ml of isotonic saline ) or isotonic saline ( 1 ml ) to 158 patients with sciatica due to a herniated nucleus pulposus . All patients had Oswestry disability scores higher than 20 ( on a scale of 1 to 100 , with scores of 20 or less indicating minimal disability , and higher scores greater disability ) . RESULTS At three weeks , the Oswestry score had improved by a mean of -8.0 in the methylprednisolone group and -5.5 in the placebo group ( 95 percent confidence interval for the difference , -7.1 to 2.2 ) . Differences in improvements between the groups were not significant , except for improvements in the finger-to-floor distance ( P=0.006 ) and sensory deficits ( P=0.03 ) , which were greater in the methylprednisolone group . After six weeks , the only significant difference was the improvement in leg pain , which was greater in the methylprednisolone group ( P=0.03 ) . After three months , there were no significant differences between the groups . The Oswestry score had improved by a mean of -17.3 in the methylprednisolone group and -15.4 in the placebo group ( 95 percent confidence interval for the difference , -9.3 to 5.4 ) . At 12 months , the cumulative probability of back surgery was 25.8 percent in the methylprednisolone group and 24.8 percent in the placebo group ( P=0.90 ) . CONCLUSIONS Although epidural injections of methylprednisolone may afford short-term improvement in leg pain and sensory deficits in patients with sciatica due to a herniated nucleus pulposus , this treatment offers no significant functional benefit , nor does it reduce the need for surgery Fifty-five patients with shoulder pain due to rotator cuff tendinitis of less than 12 weeks ' duration were r and omized to receive either 40 mg methylprednisolone and lignocaine or lignocaine alone . No statistically significant difference could be discerned between the two groups during 12 weeks of follow-up BACKGROUND The optimal short-term , symptomatic therapy for osteoarthritis of the knee has not been fully determined . Accordingly , we compared the efficacy of a nonsteroidal antiinflammatory drug , ibuprofen , given in either an antiinflammatory dose ( high dose ) or an analgesic dose ( low dose ) , with that of acetaminophen , a pure analgesic . METHODS In a r and omized , double-blind trial , 184 patients with chronic knee pain due to osteoarthritis were given either 2400 or 1200 mg of ibuprofen per day or 4000 mg of acetaminophen per day . They were evaluated after a washout period of three to seven days before the beginning of the study , and again after four weeks of treatment . The major measures of outcome included scores on the pain and disability scales of the Stanford Health Assessment Question naire ( range of possible scores , 0 to 3 ) , scores on the visual-analogue scales for pain at rest and pain while walking , the time needed to walk 50 ft ( 15 m ) , and the physician 's global assessment of the patient 's arthritis . RESULTS Seventy-eight percent of the patients completed four weeks of therapy . No significant differences were noted among the three treatment groups with respect to failure to complete the trial because of noncompliance or adverse events . All three groups had improvement in all major outcome variables , and the groups did not differ significantly in the magnitude of improvement in most variables . The mean improvement ( change ) in the scores on the pain scale of the Health Assessment Question naire was 0.33 with acetaminophen ( 95 percent confidence interval , 0.14 to 0.52 ) , 0.30 with the low dose of ibuprofen ( 95 percent confidence interval , 0.09 to 0.51 ) , and 0.35 with the high dose of ibuprofen ( 95 percent confidence interval , 0.13 to 0.57 ) . Side effects were minor and similar in all three groups . CONCLUSIONS In short-term , symptomatic treatment of osteoarthritis of the knee , the efficacy of acetaminophen was similar to that of ibuprofen , whether the latter was administered in an analgesic or an antiinflammatory dose OBJECTIVE Spontaneous chronic widespread pain in combination with hyperalgesia to pressure stimuli is the hallmark of fibromyalgia ( FM ) . We tested whether muscular hyperalgesia can exist in a muscle without spontaneous pain , which could indicate a generalized hyperexcitability of the nociceptive system in patients with FM . METHODS Twelve women with FM and 12 age matched female controls participated in this blind study . Patients had no spontaneous pain in the anterior tibial ( AT ) muscle . The  pressure pain threshold  was tested on the AT muscle . The pain threshold to electrical single and repeated stimulations of the skin and of the right AT muscle was assessed . Pain was evoked in the left AT muscle by infusion of sterile hypertonic saline ( 5.7 % , 2.8 ml over 480 s ) . The saline induced muscle pain intensity and duration were assessed by continuous recordings on an electronic visual analog scale ( VAS ) , and the distribution of pain was assessed on drawings . The sequence of electrical sensibility tests and the infusion of hypertonic saline was r and omized . RESULTS Pressure pain thresholds were lower ( p < 0.02 ) in patients with FM compared to controls . Thresholds for pain evoked by electrical stimulation at the skin were not significantly different in the 2 groups . The pain threshold to repeated intramuscular stimulation was significantly ( p = 0.02 ) lower for the patients with FM compared to the control group , indicating that the temporal nociceptive summation was more pronounced in patients with FM . This is an indication of central sensitization ( hyperexcitability ) . Infusion of hypertonic saline evoked muscle pain with a longer duration ( p = 0.01 ) in patients with FM , and referred pain that spread to a larger area ( p = 0.002 ) than in controls . This is an indication of central hyperexcitability . CONCLUSION There is a state of central hyperexcitability in the nociceptive system in FM . This hyperexcitability can be revealed by excitation of intramuscular nociceptors in a muscle with no spontaneous pain Four treatment regimens for patients with specified combinations of low back pain and sciatica were evaluated . The largest group studied had low back pain with limited straight-leg raising ( SLR ) and in them the beneficial effect of manipulation in hastening pain relief was highly significant . In similar patients without limitation of SLR , the effect was of borderline significance . In all the other groups , treated patients also recovered more quickly than their controls . Traction , for patients with low back pain and sciatica , and epidural injections when a root palsy was present also produced some significant pain relief . The effect of sclerosants for back pain was less clear OBJECTIVE To compare the relative safety and efficacy of naproxen and acetaminophen in the treatment of osteoarthritis ( OA ) of the knee . The major outcome measures were radiographic progression and withdrawal from the trial due to 
    Output:
    
RESULTS Epidural steroids may offer limited , short-term benefit for sciatica .
Local injections of steroids are either ineffective or provide short-lasting benefits .
Nonsteroidal anti-inflammatory drugs and opioids reduce pain , but the effect size is modest .
The literature does not support convincingly the use of antidepressants .
Certain muscle relaxants may be useful in the treatment of back pain .
Hyaluronic acid , neutraceutical agents , avocado-soybean unsaponifiable agents , oxaceprol and diacerein may be effective in the treatment of osteoarthritis , but the information regarding these new agents does not allow wholesale endorsement of these substances .
The effectiveness of the currently available drugs in the treatment of musculoskeletal pain conditions is disappointing .