***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 : This study was design ed to evaluate the short-term efficacy of low-level laser therapy ( LLLT ) for improving pain and function in patients with knee osteoarthritis . Methods : Forty-seven patients with knee osteoarthritis ( 79 knees ) , of both genders , participated in this r and omized controlled double-blind clinical trial . They were r and omly allocated to two groups : laser group with 25 patients ( 41 knees ) and placebo group with 22 patients ( 38 knees ) . LLLT was performed three times a week , totaling nine sessions , using a AsGa 904 nm laser with mean power of 60 mW and beam area of 0.5 cm2 . Nine points were irradiated on the knee , with energy of 3.0 J/point . The placebo group was treated with the same laser device , but with a sealed probe . Evaluations using Lequesne , visual numerical scale ( VNS ) , Timed Up and Go ( TUG ) , goniometry and dynamometry were conducted before the treatment started and after the nine sessions of LLLT . Results : A significant improvement in pain and function was found in all the assessment s applied to the laser group . On comparing the laser group with the placebo group , significant differences were found in the VNS-resting and Lequesne evaluations . Conclusion : Treatment with LLLT improves pain and function over the short term in patients with knee osteoarthritis Twenty patients with chronic low back pain were enrolled in a r and omized double-blind trial to test the efficacy of low-energy laser biostimulation combined with exercise .  Ten patients received low-energy gallium-arsenide laser treatment , and ten received placebo laser treatment .  Both groups were also placed on an active exercise program .  Visual analogue and disability pain scores were assessed pretreatment and one month posttreatment and showed significant ( p less than .02 ) improvements in both groups , but no relative advantage was found for either group . Objective parameters using computerized triaxial measurements of range of motion , isometric torque , and isodynamic velocity were also performed before and after treatment . There were significant improvements in objective parameters in both the laser and placebo groups , but no relative advantage accrued to either group . Under the conditions of this study , low-energy laser stimulation plus exercise did not provide a significant advantage over exercise alone BACKGROUND There is little evidence about the management and course of chronic low back pain in primary care . OBJECTIVES Our aim was to describe the course of chronic low back pain and the performed diagnostic and therapeutic procedures for patients with chronic low back pain in general practice . METHODS Twenty-six GPs involved in the Registration Network Family Practice s participated in this prospect i ve follow-up study . All patients and GPs were asked to complete question naires at baseline and at 4 , 8 and 12 months follow-up . RESULTS The GPs provided information about diagnostic and therapeutic procedures concerning 524 patients with chronic low back pain . Diagnostic tests other than history-taking and physical examination were not frequently used . Medication , mostly NSAIDs , was the most frequently used type of treatment ( 21.6 % ) . The most frequent referrals concerned physiotherapy ( 16.3 % ) and neurology or neurologic surgery ( 6.3 % ) . Information about the course of their chronic low back pain was provided by 368 patients participating in our study . The course of chronic low back pain appeared to be quite stable , as there was only a slight improvement in pain intensity and physical functioning over the 12 months of follow-up . CONCLUSIONS A variety of options for the treatment and referral of chronic low back pain patients is available for and used by GPs . Efforts should be made to establish which diagnostic and therapeutic procedures are the most effective for chronic low back pain Background Non-specific chronic low back pain ( NSCLBP ) is a major health problem . Identification of subgroups and appropriate treatment regimen was proposed as a key priority by the Cochrane Back Review Group . We developed a multimodal treatment ( MMT ) for patients with moderate to severe disability and medium risk of poor outcome .  MMT includes a ) neurophysiological education on the perception of pain to decrease self-limitation due to catastrophizing believes about the nature of NSCLBP , b ) sensory training of the lower trunk because these patients predominantly show poor sensory acuity of the trunk , and c ) motor training to regain definite movement control of the trunk . A pilot study was conducted to investigate the feasibility of MMT , prior to a larger RCT , with focus on patients ’ adherence and the evaluation of short-term effects on pain and disability of MMT when compared to usual physiotherapy . Method We conducted a r and omised controlled trial ( RCT ) in a primary care physiotherapy centre in Switzerl and . Outcome assessment was 12 weeks after baseline . Patients with NSCLBP , considerable disability ( five or more points on the Rol and  and Morris Disability Question naire ( RMDQ ) and medium or high risk of poor outcome on the Keele Start Back Tool ( KSBT ) were r and omly allocated to either MMT or usual physiotherapy treatment ( UPT ) by an independent research assistant . Treatment included up to 16 sessions over 8 to 12 weeks . Both groups were given additional home training of 10 to 30 minutes to be performed five times per week . Adherence to treatment was evaluated in order to assess the feasibility of the treatment . Assessment s were conducted by an independent blinded person . The primary outcome was pain ( NRS 0 - 10 ) and the secondary outcome was disability ( RMDQ ) . Between-group effects with Student ’s t-test or the Mann-Whitney U test and the st and ardized mean difference of the primary outcome were calculated . Results Twenty-eight patients ( 46 % male , mean age 41.5 years ( SD 10.6 ) ) were r and omized to MMT ( n = 14 ) or UPT ( n = 14 ) . Patients ’ adherence to treatment was > 80 % in both groups . Pain reduction ( NRS ; [ 95 % CI ] ) was 2.14 [ 1.0 to 3.5 ] in the MMT and 0.69 [ -2.0 to 2.5 . ] in the UPT . The between-group difference was 1.45 [ 0.0 to 4.0 ] ( p = 0.03 ) , representing a moderate effect size of 0.66 [ -0.1 to 1.5 ] . Reduction in disability on the RMDQ was 6.71 [ 4.2 to 9.3 ] in MMT and 4.69 [ 1.9 to 7.4 ] in UPT , with a non-significant between-group difference of 2.02 [ -1.5 to 5.6 ] ( p = 0.25 ) . The required sample size for a RCT with six months follow-up was estimated at 170 patients . Conclusions MMT was found to be feasible and to significantly reduce pain in the short term when compared with UPT . A future RCT with a six-month follow-up would require approximately 170 patients .Trial registration Current Controlled Trials IS RCT N66262199 . Registered 8 January 2014 Summary of Fritzell P , Hagg O , Wessberg P , Nordwall A , and the Swedish Lumbar Spine Study Group ( 2001 ) : Lumbar fusion versus non-surgical treatment for  chronic low back pain .  A multicenter r and omized controlled trial from the Swedish Lumbar Spine Study Group We conducted a double-blind r and omized placebo-controlled study to investigate the effects of short-term 890-nm light therapy in patients with chronic low back pain in a rehabilitation clinic . Thirty-eight women and 22 men with chronic low back pain ( mean age , 60.3 years ; range , 32–80 years ) received 40-min sessions of hot-pack therapy combined with active or placebo 890-nm light therapy ( wavelength = 890 nm , radiant power output = 6.24 W , power density = 34.7 mW/cm2 for 40 min , total energy = 83.2 J/cm2 ) over the lower back three times weekly for 2 weeks . Participants were assessed before and after treatment by using a range of motion measurements , a visual analog scale evaluation of pain , the Multidimensional Fatigue Inventory , the Biodex Stability System , the Fear-Avoidance Beliefs Question naire , repeated chair-rising times , the Frenchay Activity Index , the Oswestry Disability Question naire ( ODQ ) , and the Osteoarthritis Quality of Life Question naire . The severity of disability based on the ODQ score was used as the primary clinical outcome measurement . Compared to the baseline measurements , participants in the treatment group reported significant reductions in fear-avoidance beliefs regarding physical activity ( P = 0.040 ) and work ( P = 0.007 ) and in the severity of disability ( P = 0.021 ) . Treatment with hot-pack therapy and 890-nm light therapy was associated with reductions in the severity of disability and fear avoidance beliefs in patients with chronic low back pain QUESTION Is low level laser therapy an effective adjuvant intervention for chronic low back pain ? DESIGN R and omised trial with concealed allocation , blinded assessors and intention-to-treat analysis . PARTICIPANTS Sixty-one patients who had low back pain for at least 12 weeks . INTERVENTION One group received laser therapy alone , one received laser therapy and exercise , and the third group received placebo laser therapy and exercise . Laser therapy was performed twice a week for 6 weeks . OUTCOME MEASURES Outcomes were pain severity measured using a 10-cm visual analogue scale , lumbar range of motion measured by the Schober Test and maximum active flexion , extension and lateral flexion , and disability measured with the Oswestry Disability Index on admission to the study , after 6 weeks of intervention , and after another 6 weeks of no intervention . RESULTS There was no greater effect of  laser therapy compared with exercise for any outcome , at either 6 or 12 weeks . There was also no greater effect of laser therapy plus exercise  compared with exercise for any outcome at 6 weeks . However , in the laser therapy plus exercise group pain had reduced by 1.8 cm ( 95 % CI 0.1 to 3.3 , p = 0.03 ) , lumbar range of movement increased by 0.9 cm ( 95 % CI 0.2 to 1.8 , p < 0.01 ) on the Schober Test and by 15 deg ( 95 % CI 5 to 25 , p < 0.01 ) of active flexion , and disability reduced by 9.4 points ( 95 % CI 2.7 to 16.0 , p = 0.03 ) more than in the exercise group at 12 weeks . CONCLUSION In chronic low back pain low level laser therapy combined with exercise is more beneficial than exercise alone in the long term Neuropathic pain ( NP ) is one of the most suffered conditions in medical disciplines . The role of reactive oxygen species ( ROS ) and oxidative stress in the induction of NP was studied by many research ers . Neuropathies lead to medical , social , and economic isolation of the patient , so various therapies were used to treat or reduce it . During the recent years , low-level laser therapy ( LLLT ) has been used in certain areas of medicine and rehabilitation . Chronic constriction injury ( CCI ) is a well-known model for neuropathic pain studies . In order to find the effects of different wavelengths of LLLT on the injured sciatic nerve , the present research was done . Thirty Wistar adult male rats ( 230–320 g ) were used in this study . The animals were r and omly divided into three groups ( n = 10 ) . To induce neuropathic pain for the sciatic nerve , the CCI technique was used . Low-level laser of 660 and 980 nm was used for two consecutive weeks . Thermal and mechanical hyperalgesia was done before and after surgery on days 7 and 14 , respectively . Paw withdrawal thresholds were also evaluated . CCI decreased the pain threshold , whereas both wavelengths of LLLT for 2 weeks increased mechanical and thermal threshold significantly . A comparison of the mechanical and thermal threshold showed a significant difference between the therapeutic effects of the two groups that received LLLT . Based on our findings , the laser with a 660-nm wavelength had better therapeutic effects than the laser with a 980-nm wavelength , so the former one may be used for clinical application in neuropathic cases ; however , it needs more future studies BACKGROUND Interference is an important feature of the waves . When two or more in phase light waves meet , a new and reinforced wave is generated . Shoulder pain is a common clinical problem and laser is one of the treatments frequently used to relieve it . OBJECTIVE To test the safety of interferential laser therapy generated by two independent low level lasers and compare its effectiveness with conventional single laser therapy in the reduction of  shoulder musculoskeletal pain and associated disability . DESIGN R and omised and single-blind controlled clinical trial . SETTING Physiotherapy Unit and Rehabilitation Department of Ramon y Cajal University Hospital ( Madrid ) . PARTICIPANTS 200 patients with shoulder musculoskeletal pain were r and omly assigned in two groups , 100 people each . INTERVENTIONS Group I , experimental ( n=100 ) received interferential laser , placing two probes opposite each other over the shoulder joint . Group II , control ( n=100 ) received conventional laser therapy , using a single probe along with a second inactive dummy probe . Lasers used were GaAlAs diode ( 810 nm , 100 mW ) , in continuous emission . Laser was applied in contact mode through ten sessions , on 5 shoulder 
    Output:
    
Conclusions Our findings indicate that LLLT is an effective method for relieving pain in NSCLBP patients .
However , there is still a lack of evidence supporting its effect on function