***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: 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 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 To assess the efficacy of electromyographic biofeedback , relaxation-response training and pain behavior management as a treatment for  pediatric migraine  , we studied 18 children between the ages of eight and 12 years ( mean = 10 X 1 ) in a prospect i ve , r and omized , controlled investigation . Six patients received all three treatment procedures , six received relaxation-response training and pain behavior management , and the remaining six constituted a waiting-list control group . All patients kept a record of their headaches for the 15-week study period and then for four weeks one year later . Following four weeks of baseline , the treatment groups completed nine one-hour treatment sessions in 11 weeks . Both treatment groups experienced a significant reduction in headache symptoms and were significantly improved compared to the waiting-list control group by the end of treatment . The treatment groups did not differ from each other in any of these comparisons . The reduction in headache symptoms in the treatment groups was maintained one year after treatment ended . These results suggest that relaxation-response training , with or without biofeedback training , combined with pain behavior management , is an effective alternative treatment for pediatric migraine 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 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 & NA ; Little is known about the epidemiology of pain in children . We studied the prevalence of pain in Dutch children aged from 0 to 18 years in the open population , and the relationship with age , gender and pain parameters . A r and om sample of 1300 children aged 0–3 years was taken from the register of population in Rotterdam , The Netherl and s. In the Rotterdam area , 27 primary schools and 14 secondary schools were selected to obtain a representative sample of 5336 children aged 4–18 years . Depending on the age of the child , a question naire was either mailed to the parents ( 0–3 years ) or distributed at school ( 4–18 years ) . Of 6636 children surveyed , 5424 ( 82 % ) responded ; response rates ranged from 64 to 92 % , depending on the subject age and who completed the question naire . Of the respondents , 54 % had experienced pain within the previous 3 months . Overall , a quarter of the respondents reported chronic pain ( recurrent or continuous pain for more than 3 months ) . The prevalence of chronic pain increased with age , and was significantly higher for girls ( P<0.001 ) . In girls , a marked increase occurred in reporting chronic pain between 12 and 14 years of age . The most common types of pain in children were limb pain , headache and abdominal pain . Half of the respondents who had experienced pain reported to have multiple pain , and one‐third of the chronic pain sufferers experienced frequent and intense pain . These multiple pains and severe pains were more often reported by girls ( P<0.001 ) . The intensity of pain was higher in the case of chronic pain ( P<0.001 ) and multiple pains ( P<0.001 ) , and for chronic pain the intensity was higher for girls ( P<0.001 ) . These findings indicate that chronic pain is a common complaint in childhood and adolescence . In particular , the high prevalence of severe chronic pain and multiple pain in girls aged 12 years and over calls for follow‐up investigations documenting the various bio‐psycho‐social factors related to this pain OBJECTIVE AND DESIGN Using a r and omized design with a waiting list control condition , we assessed the effectiveness of an abbreviated cognitive therapy group program for  headaches in children 7 to 12 years of age . In the treatment condition , small groups of five to eight children were taught relaxation , distraction , visualization , and stress management skills in two 90-minute sessions . Parent groups , seen concurrently , review ed the children 's program and addressed parenting strategies . The waiting list control groups were treated 5 weeks later . Thirty-six children meeting inclusion criteria were included in the study ; complete data were available for 29 participants ( mean age , 9.4 years ; 66 % female ) . DEPENDENT MEASURES We obtained children 's ratings of headache frequency , intensity , duration , and five other variables in a diary kept for 3 weeks before and 3 weeks after treatment . Parent measures were collected once before treatment and once at 3-month follow-up . RESULTS CHILD RATINGS : The control condition showed a significant reduction in children 's self-rated headache frequency , while the treatment condition did not . On all other self-reported variables , there were no significant differences between the control and treatment conditions . Two participants in each condition achieved a 50 % or greater reduction in a self-rating headache index . RESULTS PARENT RATINGS : Follow-up ratings , obtained over the telephone from parents after the children in both conditions had been treated , indicated that the children in both conditions had experienced reduced intensity , frequency , and duration of headaches and that 82 % of the children were using the techniques taught in the program . Fourteen children achieved a 50 % or greater reduction in a headache index based on parent ratings . CONCLUSIONS Although parents were very positive about the effectiveness of the program , the results for children 's self-ratings do not support the use of this highly abbreviated treatment method Compared the efficacy of a school-based , nurse-administered relaxation training intervention to a no-treatment control condition for children ( 10 - 15 years old ) with chronic tension-type headache  and the outcome at posttreatment and a 6-month follow-up . The study was conducted in a controlled between-group design including 26 schoolchildren who were r and omly assigned to the two treatment conditions . Results showed that headache activity in the children treated with relaxation training was significantly more reduced than among those in the no-treatment control group at posttreatment as well as the 6-month follow-up . At these evaluations , 69 % and 73 % of the pupils , respectively , treated with relaxation had achieved a clinical ly significant headache improvement ( at least a 50 % improvement ) as compared to 8 % and 27 % of the pupils , respectively , in the no-treatment control group . Thus , a school-based , nurse-administered relaxation training program seems to be a viable treatment approach for children with chronic tension-type headaches Using a controlled group outcome design , skin temperature biofeedback with autogenic training and autogenic training only was compared to a waiting list as a treatment for childhood headache . Thirty children with migraine headaches , ages 7 to 18 years were r and omly assigned to one of the three conditions . Statistical analyses of headache activity indicated that children in the treatment groups improved in headache frequency and duration but not intensity as compared to the waiting list control group . These findings were consistent through a 6 month follow-up . In terms of clinical improvement , 80 % of the biofeedback group , 50 % of the autogenics group , and none of the waiting list control group were symptom-free . These findings were discussed in relation to past childhood headache studies and implication s for current treatment of children with headaches In a prospect i ve study we compared propranolol , placebo , and self-hypnosis in the treatment of juvenile classic migraine . Children aged 6 to 12 years with classic migraine who had no previous specific treatment were r and omized into propranolol ( at 3 mg/kg/d ) or placebo groups for a 3-month period and then crossed over for 3 months . After this 6-month period , each child was taught self-hypnosis and used it for 3 months . Twenty-eight patients completed the entire study . The mean number of headaches per child for 3 months during the placebo period was 13.3 compared with 14.9 during the propranolol period and 5.8 during the self-hypnosis period . Statistical analysis showed a significant association between decrease in headache frequency and self-hypnosis training ( P = .045 ) . There was no significant change in subjective or objective measures of headache severity with either therapy This study compared the relative efficacy of a therapist-assisted relaxation treatment programme with a self-help approach and a self-monitoring condition in the treatment of  chronic headaches in adolescents within a school setting . The subjects were 46 high school students , 16 - 18 years of age , who were r and omly assigned to the three treatment conditions . The results indicated that the self-help approach was as effective as the therapist-assisted relaxation condition in reducing the students ' headache , and that these findings were maintained at a 5-month follow-up evaluation . The results suggest that the self-help relaxation procedure is a potential low-cost alternative treatment to a more traditional therapist-based intervention condition The effect of teacher-presented Progressive Relaxation Training ( PRT ) on headaches , fear of failure and school problems was studied in school students . During ten physical education lessons , students received either PRT ( n = 110 ) or placebo training ( n = 92 ) . The effect of the training was investigated in students who indicated the presence of headaches in a pre-training diary . No significant differences were found between both training groups regarding headache frequency , duration and intensity and the psychological variables . On the basis of these and previous findings , it is recommended to present PRT to fairly small groups of self-selected subjects instead of complete classes An experimental study was conducted on 33 adolescent students with various types of chronic headaches ( tension and combined tension and migraine headaches ) , all treated in a school setting . After a 4-week baseline period during which the subjects rated their headache activity , they were r and omly assigned to a 9-session relaxation training programme or to an information-contact condition , both contrasted with an untreated self- registration group . Relaxation therapy alone led to significant improvement in headache activity , particularly in reduction of the frequency of complaints which still was significantly reduced at a 6-month follow-up evaluation . The effects obtained in the information-contact condition were comparable to those in the self- registration group , both achieving only minor improvements after treatment or at the follow-up assessment . The majority of students in the relaxation treatment , however , was much improved , attaining more than 50 % reduction in headache activity . The findings in the present study are consistent with results from similar treatment outcome studies , reported on adult population s with chronic headaches 
    Output:
    
The odds-ratio for a 50 % reduction in pain was 9.62 and the number needed to treat was 2.32 , indicating that the psychological treatments examined are effective in reducing the pain of headache .