***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 A r and omized , placebo-controlled , double-blind trial of the relative effectiveness of glucosamine sulphate and placebo in managing pain in osteoarthritis ( OA ) of the knee . METHODS Eighty patients with OA of the knee were recruited from a rheumatology out-patient clinic and received either glucosamine sulphate 1500 mg daily for 6 months or dummy placebo . The primary outcome measure was patients ' global assessment of pain in the affected knee . RESULTS Area under the curve analysis for the primary outcome measure showed no difference between placebo and glucosamine [ mean difference 0.15 mm , 95 % confidence interval ( CI ) -8.78 to 9.07 ] . The placebo response was 33 % . There was a statistically significant difference between groups in knee flexion ( mean difference 13 degrees , 95 % CI -23.13 to -1.97 ) , but this difference was small and could have been due to measurement error . CONCLUSIONS As a symptom modifier in OA patients with a wide range of pain severities , glucosamine sulphate was no more effective than placebo Objective : To investigate the efficacy of a Mediterranean diet ( MD ) versus an ordinary Western diet for suppression of disease activity in patients with rheumatoid arthritis ( RA ) . Methods : Patients with well controlled , although active RA of at least two years ’ duration , who were receiving stable pharmacological treatment , were invited to participate . All patients were r and omly allocated to the MD or the control diet ( CD ) . To achieve good compliance with prescribed diets all patients were for the first three weeks served the MD or the CD , respectively , for lunch and dinner at the outpatient clinic ’s canteen . Clinical examinations were performed at baseline , and again in the 3rd , 6th , and 12th week . A composite disease activity index ( DAS28 ) , a physical function index ( Health Assessment Question naire ( HAQ ) ) , a health survey of quality of life ( Short Form-36 ( SF-36 ) ) , and the daily consumption of non-steroidal anti-inflammatory drugs were used as primary efficacy variables . Results : From baseline to the end of the study the patients in the MD group ( n=26 ) showed a decrease in DAS28 of 0.56 ( p<0.001 ) , in HAQ of 0.15 ( p=0.020 ) , and in two dimensions of the SF-36 Health Survey : an increase in “ vitality ” of 11.3 ( p=0.018 ) and a decrease in “ compared with one year earlier ” of 0.6 ( p=0.016 ) . For the control patients ( n=25 ) no significant change was seen at the end of the study . This difference between the two treatment groups was notable only in the second half of the trial . Conclusion : The results indicate that patients with RA , by adjusting to a Mediterranean diet , did obtain a reduction in inflammatory activity , an increase in physical function , and improved vitality Background The purpose of the present study was to examine the effectiveness of an anti-inflammatory intervention as a treatment for neuropathic pain following spinal cord injury ( SCI ) . Methods This r and omized , parallel-group , controlled clinical trial ( NCT02099890 ) examined 20 participants with varying levels and severities of SCI , r and omized ( 3:2 ) to either a 12-week anti-inflammatory diet , or control group .  Outcome measures consisted of self-determined indices of pain as assessed using the neuropathic pain question naire ( NPQ ) and markers of inflammation as assessed by various pro- and anti-inflammatory cytokines , as well as the eicosanoids PGE2 and LTB4 . Results A significant group × time interaction was found for sensory pain scores ( p < 0.01 ) . A Mann-Whitney test revealed that the change scores ( 3-month baseline ) were significantly different between groups for IFN-y ( U = 13.0 , p = 0.01 ) , IL-1β ( U = 14.0 , p = 0.01 ) , and IL-2 ( U = 12.0 , p = 0.01 ) . A Friedman test revealed the treatment group had a significant reduction in IFN-y ( x2 = 8.67 , p = 0.01 ) , IL-1β ( x2 = 17.78 , p < 0.01 ) , IL-6 ( x2 = 6.17 , p < 0.05 ) , while the control group showed no significant change in any inflammatory mediator . A stepwise backward elimination multiple regression analysis showed that the change in sensory neuropathic pain was a function of the change in the proinflammatory cytokines IL-2 and IFN-y , as well as the eicosanoid PGE2 ( R = 0.689 , R2 = 0.474 ) . Conclusions Overall , the results of the study demonstrate the efficacy of targeting inflammation as a means of treating neuropathic pain in SCI , with a potential mechanism relating to the reduction in proinflammatory cytokines and PGE2.Trial registration Clinical Trials.gov , Objective . To evaluate the effectiveness of a whole-foods , plant-based diet ( WFPB ) to reduce symptoms of  osteoarthritis  . Methods . Six-week , prospect i ve r and omized open-label study of patients aged 19–70 with osteoarthritis . Participants were r and omized to a WFPB ( intervention ) or continuing current diet ( control ) . Outcomes were assessed by mixed models analysis of participant self-assessed weekly SF-36v2 domain t scores , weekly Patient Global Impression of Change ( PGIC ) scales , and mean weekly Visual Analog Scale ( VAS ) pain assessment . Mixed models analysis also evaluated pre-post change from baseline level for st and ard clinical measures : weight , BMI , body temperature , pulse , and blood pressure . Results . Forty participants were r and omized . Thirty-seven of them , 18 control and 19 intervention , completed the study . The intervention group reported a significantly greater improvement than the control group in SF-36v2 energy/vitality , physical functioning , role physical , and the physical component summary scale . The differences between the intervention and control PGIC scales were statistically significant over time . Intervention group improvement in VAS weekly mean was also significantly greater than that of the control group from week 2 onward . Conclusion . Study results suggest that a whole-foods , plant-based diet significantly improves self-assessed measures of functional status among osteoarthritis patients Background Osteoarthritis ( OA ) is a slowly destructive process that may be influenced by a nutritional mineral balance in the body . Methods This small , double blind , placebo controlled pilot study investigated the impact of treatment with a natural multi-mineral supplement from seaweed ( Aquamin ) on 6 minute walking distance ( 6 MWD ) , range of motion ( ROM ) , and pain and joint mobility measured by the Western Ontario and McMaster Universities ( WOMAC ) Osteoarthritis Index in subjects with moderate to severe OA of the knee during gradual withdrawal of non-steroidal anti-inflammatory drugs ( NSAIDs ) that were being used daily for pain management . Subjects ( n = 29 ) with moderate to severe OA of the knee were r and omised to receive either Aquamin ( 2400 mg/d ) or Placebo for up to 12 weeks . Results Of the 29 subjects initially r and omized , only 22 subjects proceeded to treatment due to 7 subjects not meeting study selection criteria at baseline . Fourteen subjects completed the study and an ITT analysis ( n = 22 ) of the data showed no significant differences in WOMAC scores however , the data did reveal significant improvements in passive and active extension ROM ( 0.83 ° ± 1.54 vs. -1.54 ° ± 2.43 ; difference , 5.2 ° ± 2.2 , p = 0.028 ) and 6 MWD ( 150 ± 48 ft vs. 12.5 ± 31.5 ft ; difference , 136 ± 57 ft , p = 0.03 ) in the Aquamin group compared to the placebo group ; respectively , following a 50 % reduction in NSAID use . The treatments were well tolerated and the adverse event profiles were not significantly different between the groups . Conclusion This small preliminary study suggests Aquamin may increase range of motion and walking distances in subjects with OA of the knee and may allow partial withdrawal of NSAIDs over 12 weeks of treatment . Additional research is needed to confirm these preliminary observations . Trial registration Background and Aims : Patients with fibromyalgia frequently present with symptoms similar to those experienced by patients with gluten-related disorders , raising the possibility that a subgroup of these patients could be experiencing underlying gluten sensitivity . This study aim ed to evaluate the effects of a gluten-free diet ( GFD ) compared with a hypocaloric diet ( HCD ) among patients with fibromyalgia . Methods : Adult patients diagnosed with fibromyalgia were r and omly allocated to receive a GFD or a HCD over a 24-week period . The primary outcome measure was the change in the number of gluten sensitivity symptoms . The following secondary outcomes were evaluated : body mass index , Revised Fibromyalgia Impact Question naire , Pittsburgh Sleep Quality Index , Brief Pain Inventory , Beck Depression Inventory-II , State-Trait Anxiety Inventory , Short-Form Health Survey , Patient Global Impression Scale of Severity , Patient Global Impression Scale of Improvement , and adverse events . Results : Seventy-five subjects were r and omly allocated to receive either a GFD ( n=35 ) or an HCD ( n=40 ) . The least squares mean change in the total number of gluten sensitivity symptoms from baseline did not differ significantly between the GFD and HCD groups ( −2.44±0.40 for the GFD ; −2.10±0.37 for the HCD ; P=0.343 ) . Similarly , the 2 dietary interventions did not differ in any of the remaining measured secondary outcomes . Both dietary interventions were well tolerated . Conclusions : Both dietary interventions were associated with similar beneficial outcomes in reducing gluten sensitivity symptoms and other secondary outcomes . However , despite its specificity , GFD was not superior to HCD in reducing the number of gluten sensitivity symptoms or secondary outcomes Plants are rich natural sources of antioxidants in addition to other nutrients . Interventions and cross sectional studies on subjects consuming uncooked vegan diet called living food ( LF ) have been carried out . We have clarified the efficacy of LF in rheumatoid diseases as an example of a health problem where inflammation is one of the main concerns . LF is an uncooked vegan diet and consists of berries , fruits , vegetables and roots , nuts , germinated seeds and sprouts , i.e. rich sources of carotenoids , vitamins C and E. The subjects eating LF showed highly increased levels of beta and alfa carotenes , lycopen and lutein in their sera . Also the increases of vitamin C and vitamin E ( adjusted to cholesterol ) were statistically significant . As the berry intake was 3-fold compared to controls the intake of polyphenolic compounds like quercetin , myricetin and kaempherol was much higher than in the omnivorous controls . The LF diet is rich in fibre , substrate of lignan production , and the urinary excretion of polyphenols like enterodiol and enterolactone as well as secoisolaricirecinol were much increased in subjects eating LF . The shift of fibromyalgic subjects to LF result ed in a decrease of their joint stiffness and pain as well as an improvement of their self-experienced health . The rheumatoid arthritis patients eating the LF diet also reported similar positive responses and the objective measures supported this finding . The improvement of rheumatoid arthritis was significantly correlated with the day-to-day fluctuation of subjective symptoms . In conclusion the rheumatoid patients subjectively benefited from the vegan diet rich in antioxidants , lactobacilli and fibre , and this was also seen in objective measures Objective : Pain is a common complaint among postmenopausal women . It has been postulated that vascular dysfunction caused by estrogen decline at menopause plays a key role in the initiation and progression of degradative joint disease , namely age-related osteoarthritis . We evaluated whether supplementation with resveratrol , a phytoestrogen , could improve aspects of well-being such as chronic pain that is commonly experienced by postmenopausal women . Methods : A 14-week r and omized , double-blind , placebo-controlled intervention with trans-resveratrol ( 75 mg , twice daily ) was conducted in 80 healthy postmenopausal women . Aspects of well-being , including pain , menopausal symptoms , sleep quality , depressive symptoms , mood states , and quality of life were assessed by Short form-36 at baseline and at the end of treatment . Rating scales were averaged to provide a composite score representing overall well-being . Cerebral vasodilator responsiveness to hypercapnia was also assessed as a surrogate marker for cerebrovascular function . Results : Compared with placebo treatment , there was a significant reduction in pain and an improvement in total well-being after resveratrol supplementation . Both benefits , including measures of quality of life , correlated with improvements in cerebrovascular function . Conclusions : Our preliminary findings indicate potential for resveratrol treatment to reduce chronic pain in age-related osteoarthritis . Resveratrol consumption may also boost perceptions of well-being in postmenopausal women . Further investigation to eluci date underlying mechanisms is warr 
    Output:
    
The meta- analysis found that , overall , nutrition interventions had a significant effect on pain reduction with studies testing an altered overall diet or just one nutrient having the greatest effect .
This review highlights the importance and effectiveness of nutrition interventions for people who experience chronic pain