***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 purpose of this study was to evaluate the efficacy of a self-guided CD-ROM program ( “ Headstrong ” ) containing cognitive-behavioral self-management strategies versus an educational CD-ROM program for treating headaches , headache-related disability , and quality of life . Methods Participants were 35 children ages 7–12 years with migraine recruited from one university medical center and two children ’s hospital headache clinics . Participants were r and omly assigned to complete the Headstrong or educational control CD-ROM program over a 4-week period . Data on headache frequency , duration , and severity , migraine-related disability , and quality of life ( QOL ) were obtained at baseline , post-intervention , and 3-months post-intervention . Results At post-intervention , Headstrong result ed in lower severity ( on a 10-point scale ) than the control group by child report ( 5.06 ± 1.50 SD vs. 6.25 ± 1.92 SD , p = 0.03 , ES = 0.7 ) . At 3-months post-intervention , parents reported less migraine-related disability ( on the PedMIDAS ) in the Headstrong group compared to the control group ( 1.36 ± 2.06 SD vs. 5.18 ± 6.40 SD ; p = 0.04 , ES = 0.8 ) . There were no other group differences at post treatment or at 3-months post-intervention . Conclusions When compared to an educational control , Headstrong result ed in lower pain severity at post-treatment and less migraine-related disability at 3-months post-intervention , by child and parent report respectively . Headache frequency and quality of life did not change more for Headstrong versus control . Additional research is needed on the Headstrong Program to increase its efficacy and to test it with a larger sample recruited from multiple centers simultaneously AbrstractThis study was design ed to examine whether brief training in cognitive coping skills would enhance pain coping strategies and alter pain perception in children and adolescents with sickle cell disease ( SCD ) . Forty-nine participants with SCD were r and omly assigned to either a cognitive coping skills condition or a st and ard care control condition . At pre- and posttesting , coping strategies and pain sensitivity using laboratory pain stimulation were measured . Results indicated that , in comparison to the r and omly assigned control condition , brief training in cognitive coping skills result ed in decreased negative thinking and lower pain ratings during low intensity laboratory pain stimulation UNLABELLED While sex differences in pain-related coping have been widely reported , little is known on sex differences in changes in coping following multimodal pain treatment and how these changes relate to treatment outcome . The present prospect i ve study therefore aim ed to investigate sex differences in coping strategies between boys and girls with chronic pain prior to multimodal inpatient treatment  and at 3-month follow-up . Sixty-four boys and 103 girls with various pain disorders were evaluated . Core outcomes ( pain intensity and pain-related disability ) and coping were assessed via vali date d question naires . At admission , boys and girls used similar coping strategies . Three months following treatment , boys and girls decreased passive pain coping and seeking social support while they maintained the degree of positive self-instruction . Girls displayed higher seeking social support than boys and of importance , only for girls , a reduction in seeking social support was related to decreases in pain intensity . In both groups , the changes in coping were related to positive treatment outcome . Results suggest that both groups may benefit from reductions in passive pain coping and seeking social support . The causal quality of this relationship remains to be determined in future studies . Gender-role expectations and family interactions may account for the sex differences demonstrated for seeking social support . PERSPECTIVE Boys and girls with chronic pain show profound similarities in pain-related coping strategies prior and after multimodal pain treatment . The changes in coping are related to positive treatment outcomes . Sex-specific treatment strategies for changing seeking social support may need to be developed and tested for their differential efficacy in boys and girls OBJECTIVE : This study was design ed to develop and to test a home-based , guided imagery treatment protocol , using audio and video recordings , that is easy for health care professionals and patients to use , is inexpensive , and is applicable to a wide range of health care setting s. METHODS : Thirty-four children , 6 to 15 years of age , with a physician diagnosis of functional abdominal pain were assigned r and omly to receive 2 months of st and ard medical care with or without home-based , guided imagery treatment . Children who received only  st and ard medical care initially received guided imagery treatment after 2 months . Children were monitored for 6 months after completion of guided imagery treatment . RESULTS : All treatment material s were reported to be self-explanatory , enjoyable , and easy to underst and and to use . The compliance rate was 98.5 % . In an intention-to-treat analysis , 63.1 % of children in the guided imagery treatment group were treatment responders , compared with 26.7 % in the st and ard medical care – only group ( P = .03 ; number needed to treat : 3 ) . Per- protocol analysis showed similar results ( 73.3 % vs 28.6 % responders ) . When the children in the st and ard medical care group also received guided imagery treatment , 61.5 % became treatment responders . Treatment effects were maintained for 6 months ( 62.5 % responders ) . CONCLUSION : Guided imagery treatment plus medical care was superior to st and ard medical care only for the treatment of abdominal pain , and treatment effects were sustained over a long period OBJECTIVE : This r and omized controlled trial investigated the effectiveness of a 6-session protocol ized cognitive behavior therapy ( CBT ) compared with 6 visits to a pediatrician ( intensive medical care ; IMC ) for the treatment of pediatric functional abdominal pain ( FAP ) . METHODS : One hundred four children aged 7 to 18 were r and omized to CBT or IMC . CBT was delivered primarily by trained master ’s degree students in psychology ; IMC was delivered by pediatricians or pediatric gastroenterologists . Assessment s were performed pretreatment , posttreatment , and at 6- and 12-month follow-up . Primary outcomes were level of abdominal pain ( AP ) as reported on question naires and diaries . Secondary outcomes were other gastrointestinal complaints , functional disability , other somatic complaints , anxiety , depression , and quality of life . RESULTS : Both CBT and IMC result ed in a significant decrease in AP ( P < .001 ) , but no significant difference was found between the treatments in their effectiveness ( P > .05 for all end points ) . According to the question naire-derived data , 1 year after treatment , 60 % of children that received CBT had significantly improved or recovered , versus 56.4 % of children receiving IMC , which did not significantly differ ( P = .47 ) . These percentages were 65.8 % versus 62.8 % according to the diary-derived data , which also did not significantly differ ( P = .14 ) . Additionally , nearly all secondary outcomes improved after treatment . CONCLUSIONS : CBT was equally effective as IMC in reducing AP in children with FAP . More research into the specific working mechanisms of CBT for pediatric FAP is needed Forty-eight adolescents suffering from recurrent tension headache participated in a controlled trial conducted in a high school setting . During the first treatment phase self-help relaxation training was compared with a waiting-list group . Following this phase a pharmacological regimen consisting of a muscle relaxant ( chlormezanone ) and placebo was superimposed on relaxation therapy in a double-blind crossover design . Each treatment phase encompassed a 5-week period . In addition to the evaluation of headache complaints , psychological distress among students  was measured with respect to their experience of somatic complaints , depressive , anxiety and stress symptoms . Although self-help relaxation training significantly decreased the severity and annoyance of adolescents ' headache besides their somatic complaints , the clinical improvement of headache was modest . The addition of chlormezanone did not help those who were nonresponders to self-help relaxation training . Finally , a set of pretreatment variables consisting of baseline headache severity and annoyance , experience of anxiety and daily life stress among adolescents could predict outcome of self-help relaxation therapy A comparison was carried out of the efficacy of psychological and drug treatments for children with migraine . Forty-three children aged between 8 and 16 years ( mean age : 11.3 years ) who suffered from migraine received either progressive relaxation or cephalic vasomotor feedback , both with stress management training , or metoprolol , a beta-blocker . Psychological treatment was administered in ten sessions lasting six weeks and the drug treatment lasted ten weeks . Relaxation and stress management training reduced the headache index ( frequency x intensity of headache episodes ) , more effectively than metoprolol with cephalic vasomotor feedback and stress management training in between . An overall improvement over time was found with regard to frequency and intensity of headache episodes and analgesics intake . When comparing pre- to post-treatment data , children treated with relaxation training improved significantly in headache frequency and intensity , whereas those treated with cephalic vasomotor feedback improved significantly in headache frequency and duration as well as mood . The clinical improvement was stable at an 8-months follow-up This study describes the results of a controlled clinical trial involving 44 7- to 14-year-old children with recurrent abdominal pain who were r and omly allocated to either cognitive-behavioral family intervention ( CBFI ) or st and ard pediatric care ( SPC ) .  Both treatment conditions result ed in significant improvements on measures of pain intensity and pain behavior . However , the children receiving CBFI had a higher rate of complete elimination of pain , lower levels of relapse at 6- and 12-month follow-up , and lower levels of interference with their activities as a result of pain and parents reported a higher level of satisfaction with the treatment than children receiving SPC . After controlling for pretreatment levels of pain , children 's active self-coping and mothers ' caregiving strategies were significant independent predictors of pain behavior at posttreatment Objectives : We evaluated the efficacy of cognitive-behavioral family intervention in the treatment of crises of pain in children with nonorganic recurrent abdominal pain ( RAP ) and the thresholds of pain for 17 body surface areas in these children . Methods : A r and omized clinical trial was undertaken with 32 children between the ages of 5.1 and 13.9 years with nonorganic RAP . A group of 15 patients , aged 9.9 ± 2.2 years ( 11 girls ) , received st and ard pediatric care and cognitive-behavioral family intervention for treatment of pain crises . The control group of 17 children , aged 8.4 ± 2.0 years ( 11 girls ) , received only st and ard pediatric care . These procedures were undertaken by general pediatricians over 4 monthly sessions . An analog visual scale was used to measure the frequency and intensity of the pain crises per month and a mechanical pressure algometer for the measurement of pain threshold . Results : The median frequency of pain crises per month reported by patients at the 3 monthly cognitive-behavioral family intervention sessions was 15 , 5 , 2 and 2 , respectively . In contrast , the median frequency for pain crises per month reported by the control group was 12 , 8 , 10 and 8 , respectively . The difference between the intervention group and the controls was statistically significant for frequency of pain at the second , third and fourth visits . There was no statistical difference for intensity of pain or for measured pain thresholds between the control and the intervention group . Conclusions : The cognitive-behavioral family intervention reduced the frequency of pain crises of children with nonorganic RAP . This successful intervention was carried out by the intervention of general pediatricians OBJECTIVE Juvenile fibromyalgia syndrome ( FMS ) is a chronic musculoskeletal pain disorder in children and adolescents for which there are no evidence -based treatments . The objective of this multisite , single-blind , r and omized clinical trial was to test whether cognitive-behavioral therapy ( CBT ) was superior to fibromyalgia ( FM ) education in reducing functional disability , pain , and symptoms of depression in juvenile FMS . METHODS Participants were 114 adolescents ( ages 11 - 18 years ) with juvenile FMS . After receiving stable medications for 8 weeks , patients were r and omized to either CBT or FM education and received 8 weekly individual sessions with a therapist and 2 booster sessions . Assessment s were conducted at baseline , immediately following the 8-week treatment phase , and at 6-month followup . RESULTS The majority of patients ( 87.7 % ) completed the trial per protocol . Intent-to-treat analyses showed that patients in both groups had significant reductions in functional disability , pain , and symptoms of depression at the end of the study , and CBT was significantly superior to FM education in reducing the primary outcome of functional disability ( mean baseline to end-of-treatment difference between groups 5.39 [ 95 % confidence interval 1.57 , 9.22 ] ) . Reduction in symptoms of depression was clinical ly significant for both groups , with mean scores in the range of normal/nondepressed by the end of the study . Reduction in pain was not clinical ly significant for either group ( < 30 % decrease in pain ) . There were no study -related adverse events . CONCLUSION In this controlled trial , CBT was found to be a safe and effective treatment for reducing functional disability and symptoms of depression in adolescents with juvenile FMS Summary Intensive interdisciplinary pain treatment is effective for highly impaired children with chronic pain in terms of the child 's well‐being and the economic effects . ABSTRACT Pediatric chronic pain , which can result in deleterious effects for the child , bears the risk of aggravation into adulthood . Intensive interdisciplinary pain treatment ( II 
    Output:
    
Treatment gains were consistent across the sexes .