***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: Summary Use of the Chronic Pain Management Program was associated with significant decreases in pain‐related , functional , and mental health outcomes and an increase in pain knowledge . Abstract Internet‐based educational and therapeutic programs ( e‐health applications ) are becoming increasingly popular for a variety of psychological and physical disorders . We tested the efficacy of an online Chronic Pain Management Program , a comprehensive , fully self‐directed and self‐paced system that integrates social networking features and self‐management tools into an interactive learning environment . Of 305 adult participants ( 196 women , 109 men ) , a total of 162 individuals with chronic pain were r and omly assigned unsupervised access to the program  for approximately 6 weeks ; 143 were assigned to the wait‐listed control group with treatment as usual .  A comprehensive assessment was administered before the study and approximately 7 and 14 weeks thereafter . All recruitment , data collection , and participant involvement took place online . Participation was fully self‐paced , permitting the evaluation of program effectiveness under real‐world conditions . Intent‐to‐treat analysis that used linear growth models was used as the primary analytic tool . Results indicated that program utilization was associated with significant decreases in pain severity , pain‐related interference and emotional burden , perceived disability , catastrophizing , and pain‐induced fear . Further , program use led to significant declines in depression , anxiety , and stress . Finally , as compared to the wait‐listed control group , the experimental group displayed a significant increase in knowledge about the principles of chronic pain and its management . Study limitations are considered , including the recognition that not all persons with chronic pain are necessarily good c and i date s for self‐initiated , self‐paced , interactive learning Background Chronic low back pain is a common chronic condition whose treatment success can be improved by active involvement of patients . Patient involvement can be fostered by web-based applications combining health information with decision support or behaviour change support . These so-called Interactive Health Communication Applications ( IHCAs ) can reach great numbers of patients at low financial cost and provide information and support at the time , place and learning speed patients prefer . However , high attrition often seems to decrease the effects of web-based interventions . Tailoring content and tone of IHCAs to the individual patient ́s needs might improve usage and therefore effectiveness . This study aims to evaluate a tailored IHCA for people with chronic low back pain combining health information with decision support and behaviour change support . Methods / Design The tailored IHCA will be tested regarding effectiveness and usage against a st and ard website with identical content in a single-blinded r and omized trial with a parallel design . The IHCA contains information on chronic low back pain and its treatment options including health behaviour change recommendations . In the intervention group the content is delivered in dialogue form , tailored to relevant patient characteristics ( health literacy , coping style ) . In the control group there is no tailoring , a st and ard web-page is used for presenting the content . Participants are unaware of group assignment . Eligibility criteria are age ≥ 18 years , self- reported chronic low back pain , and Internet access . To detect the expected small effect ( Cohen ’s d = 0.2 ) , the sample aims to include 414 patients , with assessment s at baseline , directly after the first on-page visit , and at 3-month follow-up using online self-report question naires . It is expected that the tailored IHCA has larger effects on knowledge and patient empowerment ( primary outcomes ) compared to a st and ard website . Secondary outcomes are website usage , preparation for decision making , and decisional conflict . Discussion IHCAs can be a suitable way to promote knowledge about chronic low back pain and self-management competencies . Results of the study can increase the knowledge on how to develop IHCAs which are more useful and effective for people suffering from chronic low back pain . Trial registration International Clinical Trials Registry BACKGROUND Chronic pain is recognised as an important problem in the community but our underst and ing of the epidemiology of chronic pain remains limited . We undertook a study design ed to quantify and describe the prevalence and distribution of chronic pain in the community . METHODS A r and om sample of 5036 patients , aged 25 and over , was drawn from 29 general practice s in the Grampian region of the UK and surveyed by a postal self-completion question naire . The question naire included case-screening questions , a question on the cause of the pain , the chronic pain grade question naire , the level of expressed needs question naire , and sociodemographic questions . FINDINGS 3605 question naires were returned completed . 1817 ( 50.4 % ) of patients self reported chronic pain , equivalent to 46.5 % of the general population . 576 reported back pain and 570 reported arthritis ; these were the most common complaints and accounted for a third of all complaints . Backward stepwise logistic-regression modelling identified age , sex , housing tenure , and employment status as significant predictors of the presence of chronic pain in the community . 703 ( 48.7 % ) individuals with chronic pain had the least severe grade of pain , and 228 ( 15.8 % ) the most severe grade . Of those who reported chronic pain , 312 ( 17.2 % ) reported no expressed need , and 509 ( 28.0 % ) reported the highest expressed need . INTERPRETATION Chronic pain is a major problem in the community and certain groups within the population are more likely to have chronic pain . A detailed underst and ing of the epidemiology of chronic pain is essential for efficient management of chronic pain in primary care Background Temporom and ibular disorders ( TMDs ) are by far the most predominant condition affecting the temporom and ibular joint ( TMJ ) , however many patients have mild self-limiting symptoms and should not be referred for specialist care . The aim of this pilot study was to develop a simple , cost-effective management programme for TMDs using CD-ROM . 41 patients ( age 18–70 ) participated in this study , patients were divided into three groups : the 1st group were involved in an attention placebo CD-ROM ( contain anatomical information about the temporom and ibular system ) , the 2nd group received information on CD-ROM design ed to increase their control and self efficacy , while the 3rd group received the same programme of the 2nd group added to it an introduction to self-relaxing techniques followed by audio tape of progressive muscle relaxation exercises . Each of the groups was asked to complete a number of question naires on the day of initial consultation and six weeks afterwards . Results The two experimental groups ( 2nd & 3rd ) were equally effective in reducing pain , disability and distress , and both were more effective than the attention placebo group ( 1st ) , however the experimental groups appeared to have improved at follow-up relative to the placebo-group in terms of disability , pain and depressed mood . Conclusion This pilot study demonstrates the feasibility and acceptability of the design . A full , r and omized , controlled trial is required to confirm the efficacy of the interventions developed here BACKGROUND The authors conducted a clinical trial to compare the effectiveness of an education program with that of an occlusal splint in treating myofascial pain of the jaw muscles across a short period . METHOD The authors assigned 44 patients r and omly to two treatment groups ; 41 patients completed the study . The first group ( four male , 19 female ; mean [ st and ard deviation { SD } ] age , 31.4 [ 14.0 ] years ) received information regarding the nature of temporom and ibular disorder ( TMD ) and self-care measures , whereas the second group ( five male , 13 female ; mean [ SD ] age , 31.1 [ 8.8 ] years ) received an  occlusal splint . One of the authors evaluated each patient every three weeks during a three-month treatment period . Treatment outcomes included pain-free maximal mouth opening , spontaneous muscle pain , pain during chewing and headache . RESULTS After three months , changes in spontaneous muscle pain differed significantly between the education and occlusal splint groups ( P = .034 ; effect size = 0.33 ) . Changes in pain-free maximal mouth opening did not differ significantly between groups ( P = .528 ; effect size = 0.20 ) . Changes of headache and pain on chewing did not differ significantly between groups ( P ≥ .550 , effect size ≤ 0.10 ) . CONCLUSIONS During a short period , education was slightly more effective than an occlusal splint delivered without education in reducing spontaneous muscle pain in patients with TMD .  Pain-free mouth opening , headache and pain during chewing were not significantly different between the two treatments Objectives : Cognitive-behavioral pain management programs typically achieve improvements in pain cognitions , disability , and physical performance . However , it is not known whether the neurophysiology education component of such programs contributes to these outcomes . In chronic low back pain patients , we investigated the effect of neurophysiology education on cognitions , disability , and physical performance . Methods : This study was a blinded r and omized controlled trial . Individual education sessions on neurophysiology of pain ( experimental group ) and back anatomy and physiology ( control group ) were conducted by trained physical therapist educators . Cognitions were evaluated using the  Survey of Pain Attitudes ( revised ) ( SOPA(R ) ) , and the  Pain Catastrophizing Scale ( PCS ) . Behavioral measures included the Rol and Morris Disability Question naire ( RMDQ ) , and 3 physical performance tasks ; ( 1 ) straight leg raise ( SLR ) , ( 2 ) forward bending range , and ( 3 ) an abdominal “ drawing-in ” task , which provides a measure of voluntary activation of the deep abdominal muscles . Method ological checks evaluated non-specific effects of intervention . Results : There was a significant treatment effect on the SOPA(R ) , PCS , SLR , and forward bending . There was a statistically significant effect on RMDQ ; however , the size of this effect was small and probably not clinical ly meaningful . Discussion : Education about pain neurophysiology changes pain cognitions and physical performance but is insufficient by itself to obtain a change in perceived disability . The results suggest that pain neurophysiology education , but not back school type education , should be included in a wider pain management approach OBJECTIVE To determine whether an interactive self-management Website for people with chronic back pain would significantly improve emotional management , coping , self-efficacy to manage pain , pain levels , and physical functioning compared with st and ard text-based material s. DESIGN The study utilized a pretest-posttest r and omized controlled design comparing Website ( painACTION-Back Pain ) and control ( text-based material ) conditions at baseline and at 1- , 3 , and 6-month follow-ups . PARTICIPANTS Two hundred and nine people with chronic back pain were recruited through dissemination of study information online and at a pain treatment clinic . The 6-month follow-up rates for the Website and control groups were 73 % and 84 % , respectively . MEASUREMENTS Measures were based on the recommendations of the Initiative on Methods , Measurement , and Pain Assessment in Clinical Trials and included measures of pain intensity , physical functioning , emotional functioning , coping , self-efficacy , fear-avoidance , perceived improvement with treatment , self-efficacy , and catastrophizing . RESULTS Compared with controls , painACTION-Back Pain participants reported significantly : 1 ) lower stress ; 2 ) increased coping self-statements ; and 3 ) greater use of social support . Comparisons between groups suggested clinical ly significant differences in current pain intensity , depression , anxiety , stress , and global ratings of improvement . Among participants recruited online , those using the Website reported significantly : 1 ) lower " worst " pain ; 2 ) lower " average " pain ; and 3 ) increased coping self-statements , compared with controls . Participants recruited through the pain clinic evidence d no such differences . CONCLUSIONS An online self-management program for people with chronic back pain can lead to improvements in stress , coping , and social support , and produce clinical ly significant differences in pain , depression , anxiety , and global rates of improvement AIMS To carry out a r and omized clinical trial ( RCT ) contrasting usual conservative treatment of TMD by clinical TMD specialists with a structured self-care intervention , targeted to clinic cases independent of TMD physical diagnosis , who were reporting minimal levels of psychosocial dysfunction ; the intervention was delivered by dental hygienists in lieu of usual treatment . METHODS The Research Diagnostic Criteria for Temporom and ibular Disorders ( RDC/TMD ) was used to target subjects who exhibited minimal TMD-related psychosocial interference . Criteria for study inclusion were : ( 1 ) self-report of facial and /or masticatory muscle pain discomfort for which usual care was prescribed by the clinic TMD specialist ; ( 2 ) RDC/TMD Axis II grade d scale of chronic pain ( GCP ) score of 0 , I , or II-Low . ( 3 ) Age 18 to 70 years . RESULTS On 1-year follow-up , while both groups showed improvement in all clinical and self-report categories measured , patients in the tailored self-care treatment program compared to usual TMD treatment showed significantly ; ( a ) decreased TMD pain , ( b ) decreased pain-related interference in activity ; ( c ) reduced number of masticatory muscles painful ; ( d ) fewer additional visits for TMD treatment . Groups were comparable with regard to measures of vertical range of motion . The self-care program was associated with consistent , but non-statistically significant , trends towards lower levels of depression and somatization . Ability to cope with TMD , knowledge concerning TMD and patient satisfaction was significantly enhanced for the self-care group . No participating patients experienced physical or personal adverse effects during the 1-year post-treatment follow-up period . CONCLUSION Use of RDC/TMD psychosocial assessment criteria can contribute to successful clinical decision-making for the management of TMD Because back pain is a widespread and costly condition that tends to recur , treatment must focus on both the amelioration of acute symptoms and prevention over the long term . This paper reports a longitudinal evaluation of a program from a community hospital that emphas 
    Output:
    
From that limited evidence , the only support for this type of education is for PNE , though it is insufficiently strong to recommend conclusively that PNE should be delivered as a st and -alone intervention .
It therefore remains sensible to recommend that education be delivered in conjunction with other pain management approaches as we can not confidently conclude that education alone is effective in reducing pain intensity or related disability in chronic pain in adults