***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 psychopharmacotherapy of somatoform disorders ( SD ; ICD-10 : F45 ) has been less frequently investigated and is not as well established as in other ( neurotic ) disorders of ICD-10 section F4 , i.e. generalized anxiety disorder ( GAD ; ICD-10 : F41.1 ) . The atypical compound opipramol is very often used to treat SD and GAD in clinical practice in Germany . However , state-of-the-art controlled clinical trials have not yet been performed . OBJECTIVES Two clinical trials were performed with the aim of confirming the efficacy and tolerability of opipramol in SD and GAD . METHODS Both trials were performed as r and omized , double-blind , placebo-controlled , multicenter studies . While the GAD trial was a three-arm study with opipramol ( 200 mg/day ) vs. placebo and alprazolam ( 2 mg/day ) for 28 days , the SD trial was a placebo-controlled two-arm study with a treatment duration of 42 days . Each group consisted of about 100 patients . RESULTS Significant differences ( alpha = 0.05 ) were found for the primary efficacy criteria ( HAMA total score in GAD , HAMA somatic subscore in SD ) and most of the secondary criteria in favor of the active drug therapies . Considerable differences between the psychopathology of SD and GAD were detected . CONCLUSION The well-tolerated anxiolytic opipramol is the first psychotropic drug with proven efficacy in somatoform disorders with effects on symptoms of somatization , anxiety , and depression . The compound is also effective and safe in GAD & NA ; In the double‐blind placebo‐controlled study presented here , the effects were investigated of a low dose of amitriptyline ( 75 mg ) in patients with chronic pain of various origins . The active drug was superior to placebo in reducing pain intensity . The reduction was small . In the second treatment week , the  amitriptyline  treated patients slept longer . No differences between active drug and placebo were found with respect to daily activities or use of analgesics . Based on our data and those of other studies , it is concluded that amitriptyline ( and other antidepressants ) in low doses does have a positive effect on the intensity and some other aspects of chronic pain , but that the effect is modest . It must be kept in mind that chronic pain is a very treatment‐resistant condition . Therefore , even modest positive effects may be worthwhile OBJECTIVE This pilot study explored the efficacy and tolerability of extended-release venlafaxine ( venlafaxine ER ) in anxious and /or depressed patients with multisomatoform disorder ( MSD ) . METHOD This 12-week , multicenter , r and omized , double-blind study evaluated adult primary care out patients with MSD and comorbid major depressive disorder , generalized anxiety disorder , or social anxiety disorder ( DSM-IV criteria ) . The intent-to-treat population included 112 patients ( venlafaxine ER , N = 55 ; placebo , N = 57 ) . The primary efficacy variable was the change in the 15-item Patient Health Question naire ( PHQ-15 ) somatic symptom severity score . Secondary outcomes included the Hamilton Rating Scale for Depression ( HAM-D-17 ) and for Anxiety ( HAM-A ) , Clinical Global Impressions-Severity of Illness ( CGI-S ) and -Improvement ( CGI-I ) scales , McGill Quality of Life Question naire Physical Symptoms Scale ( MQOL-PS ) , and Medical Outcomes Study Short-Form 36-Item question naire ( MOS SF-36 ) . Data were collected from April 2003 to December 2003 . RESULTS The decline by week 12 in PHQ-15 scores was significant ( p < .0001 ) in both groups ; however , the difference between the venlafaxine ER and placebo groups ( -8.3 vs. -6.6 , respectively ) was not ( p = .097 ) . Improvement was greater with venlafaxine ER than placebo on the PHQ-15 pain subscale ( p = .03 ) , SF-36 bodily pain scale ( 26.1 vs. 14.5 , p = .03 ) , MQOL-PS ( -11.7 vs. -6.0 , p = .02 ) , HAM-A psychic anxiety subscale ( p = .02 ) , SF-36 mental component summary ( p = .03 ) , time to response ( 54 vs. 71 days , p = .01 ) , and CGI-I scale ( p = .009 ) . Venlafaxine ER was generally well tolerated . CONCLUSION These results suggest that venlafaxine ER may be effective in relieving some types of somatic physical symptoms , particularly pain , in patients with depression and /or anxiety disorders Abstract Rationale and objective . Preliminary data have shown that St John 's wort might possess some specific efficacy in patients with somatoform complaints . Therefore , the efficacy of the Hypericum extract LI 160 in patients with somatoform disorders should be studied in a double-blind placebo-controlled fashion . Methods . This was a multicentre , r and omised , placebo controlled , 6-week trial comparing the efficacy of LI 160 ( 600 mg/day ) and placebo in 151 out- patients suffering from somatization disorder ( ICD-10 : F45.0 ) , undifferentiated somatoform disorder ( F45.1 ) , or somatoform autonomic dysfunctions ( F45.3 ) . The primary outcome measure was the decrease of the Hamilton Anxiety Scale , subfactor somatic anxiety ( HAMA-SOM ) , during the trial period . Results . LI 160 was superior effective concerning the primary outcome criterion HAMA-SOM [ decrease from 15.39 ( SD 2.68 ) to 6.64 ( 4.32 ) in the Hypericum group and from 15.55 ( 2.94 ) to 11.97 ( 5.58 ) in the placebo group ( statistically significant difference , P=0.001 ) ] . This was corroborated by the result of a statistically significant superior efficacy in the outcome criteria additionally used such as Clinical Global Impression , HAMA-total score , HAMA , subscore psychic anxiety , Hamilton Depression Scale , Self-Report Symptom Inventory 90 items – revised ( SCL-90-R ) , and SCL-90-R , subscore somatic anxiety . The efficacy of LI 160 was preserved after splitting the population in those with mild and those with severe depressive symptoms . Tolerability of LI 160 was excellent . Conclusion . The data from this trial show excellent efficacy and tolerability for LI 160 in somatoform disorders . The efficacy is independent of an existing depressive mood . This is the first study showing the efficacy of a drug in patients with somatisation disorder independent of depressive symptomatology The reduction of pain by two antidepressants , clomipramine and mianserin , was , in this study on 253 patients with chronic idiopathic pain syndrome , found to be not better than a placebo when all patients were compared independently of the classification of pain . The improvement rate was around 40 % after 6 weeks of treatment when using a 50 % or better reduction in pain level . However , in patients who fulfilled a checklist definition of minor to major depression ( 30 % of the total patient material ) clomipramine was superior to mianserin and placebo with an improvement rate of 75 % after 6 weeks . Using pain curves over time as outcome measure in the various clinical pain categories it was found that both mianserin and clomipramine seemed superior to placebo in patients with tension headache , but in patients with low back pain syndrome placebo was superior to the two antidepressants . No difference among the three treatments was found in patients with burning mouth syndrome or in patients with abdominal pain . These differences underline the importance of study ing specific pain syndromes rather than composite groups of patients with idiopathic pain . The clinical significance of these pain curves needs further placebo controlled investigations The effects of domperidone , a peripherally acting dopamine antagonist , were compared with those of placebo in a double-blind r and omized study in 16 patients with idiopathic gastric stasis , chronic symptoms of “ nonulcer dyspepsia ” ( including nausea , vomiting , and abdominal pain ) , and altered gastroduodenal motility . Patients received either domperidone or placebo orally ( 20 mg before meals and at bedtime ) for six weeks . Symptoms were assessed by daily diaries kept by the patients for two weeks while receiving no medication for their gastrointestinal complaints ( baseline ) , and throughout the six-week treatment phase . Studies of gastric emptying of a radiolabeled solid-phase meal were performed at baseline and six weeks after treatment . All patients had  delayed gastric emptying  at baseline , defined as a half-emptying time of more than mean + 1 sd ( from studies of normal controls ) . An 18- to 24-hr recording of gastroduodenal motor function during fasting was also performed at baseline and after six weeks of either domperidone or placebo treatment . After six weeks of treatment , the symptom scores significantly improved in the domperidone group ( P<0.05 ) , but not in the placebo group . Gastroduodenal motor activity was unchanged from baseline recordings after six weeks . Solid-phase gastric emptying also showed no improvement in either the domperidone or placebo group of patients . Although domperidone therapy had no significant effect on motility , it appears to be an effective drug for the treatment of the symptoms of nonulcer dyspepsia Abstract Objectives : To compare the efficacy and tolerability of Hypericum perforatum ( St John 's wort extract ) with imipramine in patients with mild to moderate depression . Design : R and omised , multicentre , double blind , parallel group trial . Setting : 40 outpatient clinics in Germany . Participants : 324 out patients with mild to moderate depression . Intervention : 75 mg imipramine twice daily or 250 mg hypericum extract ZE 117 twice daily for 6 weeks . Main outcome measures : Hamilton depression rating scale , clinical global impression scale , and patient 's global impression scale . Results : Among the 157 participants taking hypericum  mean scores on the Hamilton depression scale decreased from 22.4 at baseline to 12.00 at end point ; among the 167 participants taking  imipramine  they fell from 22.1 to 12.75 . Mean clinical global impression scores at end point were 2.22 out of 7 for the hypericum group and 2.42 for the imipramine group . On the 7 point self assessment s of global improvement completed by participants ( score of 1 indicating “ very much improved ” and 7 indicating “ very much deteriorated ” ) mean scores were 2.44 in the hypericum group and 2.60 in the imipramine group . None of the differences between treatment groups were significant . However , the mean score on the anxiety-somatisation subscale of the Hamilton scale ( 3.79 in the hypericum group and 4.26 in the imipramine group ) indicated a significant advantage for hypericum relative to imipramine .  Mean scores on the 5 point scale used by participants to assess tolerability ( score of 1 indicating excellent tolerability and 5 indicating very poor tolerability ) were better for hypericum ( 1.67 ) than imipramine ( 2.35 ) . Adverse events occurred in 62/157 ( 39 % ) participants taking hypericum and in 105/167 ( 63 % ) taking imipramine . 4 ( 3 % ) participants taking hypericum  withdrew because of adverse events compared with 26 ( 16 % ) taking imipramine . Conclusions : This Hypericum perforatum extract is therapeutically equivalent to imipramine in treating mild to moderate depression , but patients tolerate hypericum better Pain possesses both sensory and affective dimensions , which are highly correlated yet distinct . Comparison of these dimensions within experimental pain setting s has result ed in the construct of relative unpleasantness . Relative unpleasantness is defined as the amount of affective unpleasantness elicited for a given sensory magnitude . The aim of this study was to determine the relationship between affective and sensory components of evoked pain in subjects with fibromyalgia ( FM ) and healthy controls . Here we show that patients with FM unexpectedly display less relative unpleasantness than healthy controls in response to r and om noxious pressure stimuli . Relative unpleasantness was not correlated with distress , anxiety , or depression , which were pronounced in the FM group .  Clinical pain in patients with FM was perceived to be more unpleasant than the evoked pain stimuli . These results are consistent with the concept that chronic pain may reduce the relative unpleasantness of evoked pain sensations BACKGROUND The German National Health Interview and Examination Survey ( GHS ) is the first government m and ated nationwide study to investigate jointly the prevalence of somatic and mental disorders within one study in the general adult population in Germany . This paper reports results from its Mental Health Supplement ( GHS-MHS ) on 4-week 12-month , and selected lifetime prevalence of a broad range of DSM-IV mental disorders , their co-morbidity and correlates in the community . METHODS The sample of the GHS-MHS ( n=4181 ; multistage stratified r and om sample drawn from population registries ; conditional response rate : 87.6 % ) can be regarded as representative for the German population aged 18 - 65 . Diagnoses are based on fully structured computer assisted clinical interviews ( M-CIDI ) , conducted by clinical ly trained interviewers 
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The current review found very low- quality evidence for NGAs and low- quality evidence for NPs being effective in treating somatoform symptoms in adults when compared with placebo .
Furthermore , the significant effects of antidepressant treatment have to be balanced against the relatively high rates of adverse effects .
Adverse effects produced by medication can have amplifying effects on symptom perceptions , particularly in people focusing on somatic symptoms without medical causes .
We can only draw conclusions about short-term efficacy of the pharmacological interventions because no trial included follow-up assessment s. For each of the comparisons where there were available data on acceptability rates  ( NGAs versus placebo , NPs versus placebo , TCAs versus other medication , and antidepressants versus a combination of an antidepressant and an antipsychotic ) , no clear differences between the intervention and comparator were found .