***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: OBJECTIVES To compare the efficacies of dry needling of trigger points ( TrPs ) with and without paraspinal needling in myofascial pain syndrome of elderly patients . DESIGN Single-blinded , r and omized controlled trial . SUBJECTS Forty ( 40 ) subjects , between the ages of 63 and 90 with myofascial pain syndrome of the upper trapezius muscle . INTERVENTIONS Eighteen ( 18 ) subjects were treated with dry needling of all the TrPs only and another 22 with additional paraspinal needling on days 0 , 7 , and 14 . RESULTS At 4-week follow-up the results were as follows : ( 1 ) TrP and paraspinal dry needling result ed in more continuous subjective pain reduction than TrP dry needling only ; ( 2 ) TrP and paraspinal dry needling result ed in significant improvements on the geriatric depression scale but TrP dry needling only did not ; ( 3 ) TrP and paraspinal dry needling result ed in improvements of all the cervical range of motions but TrP dry needling  only did not in extensional cervical range of motion ; and ( 4 ) no cases of gross hemorrhage were noted . CONCLUSIONS TrP and paraspinal dry needling is suggested to be a better method than TrP dry needling only for treating myofascial pain syndrome in elderly patients Myofascial pain associated with myofascial trigger points ( MTrPs ) is a common cause of nonarticular musculoskeletal pain . Although the presence of MTrPs can be determined by soft tissue palpation , little is known about the mechanisms and biochemical milieu associated with persistent muscle pain . A microanalytical system was developed to measure the in vivo biochemical milieu of muscle in near real time at the subnanogram level of concentration . The system includes a microdialysis needle capable of continuously collecting extremely small sample s ( approximately 0.5 microl ) of physiological saline after exposure to the internal tissue milieu across a 105-microm-thick semi-permeable membrane . This membrane is positioned 200 microm from the tip of the needle and permits solutes of < 75 kDa to diffuse across it . Three subjects were selected from each of three groups ( total 9 subjects ) : normal ( no neck pain , no MTrP ) ; latent ( no neck pain , MTrP present ) ; active ( neck pain , MTrP present ) . The microdialysis needle was inserted in a st and ardized location in the upper trapezius muscle . Due to the extremely small sample size collected by the microdialysis system , an established microanalytical laboratory , employing immunoaffinity capillary electrophoresis and capillary electrochromatography , performed analysis of selected analytes . Concentrations of protons , bradykinin , calcitonin gene-related peptide , substance P , tumor necrosis factor-alpha , interleukin-1beta , serotonin , and norepinephrine were found to be significantly higher in the active group than either of the other two groups ( P < 0.01 ) . pH was significantly lower in the active group than the other two groups ( P < 0.03 ) . In conclusion , the described microanalytical technique enables continuous sampling of extremely small quantities of substances directly from soft tissue , with minimal system perturbation and without harmful effects on subjects . The measured levels of analytes can be used to distinguish clinical ly distinct groups Objective The objective of this study was to assess changes in upper trapezius myoelectric activity and pain in patients with nonspecific neck pain after a single session of acupuncture ( ACP ) . Methods A blinded r and omized clinical trial was conducted . Fifteen patients with nonspecific neck pain and 15 healthy participants were enrolled in a r and omized , single‐blinded , crossover study . Each participant was subjected to a single session of ACP and sham acupuncture ( SACP ) .  The electromyography ( EMG ) signal of the upper trapezius muscle was recorded during different step contractions of shoulder elevation force ( 15%‐30 % maximal voluntary contraction ) before and after ACP treatment . Results Significant effects were confirmed after the treatment ( ACP and SACP ) for Numeric Rating Scale scores ( F1,28 = 51.61 ; P < .0001 ) and pain area ( F1,2 = 32.03 ; P < .0001 ) . Significant decreases in the EMG amplitude were identified for the nonspecific neck pain group ( NPG ) ( F1,112 = 26.82 ; P < .0001 ) and the healthy participant group ( HPG ) ( F1,112 = 21.69 ; P < .0001 ) after ACP treatment . No differences were identified between the ACP and SACP treatment protocol s for Numeric Rating Scale score ( NPG : F1,28 = 0.95 ; P = .33 ) , pain area ( NPG : F1,28 = 1.97 ; P = .17 ) , or EMG amplitude ( NPG : F1,112 = 0.47 ; P = .49 ; HPG : F1,112 = 0.75 ; P = .38 ) . Conclusion The effect of ACP at acupoints triple energizer 5 and large intestine 11 triple energizer 5 , or in close proximity , contributes to pain relief among patients with nonspecific neck pain . The electromyographic analysis indicated a greater resistance to muscle fatigue and decrease of activity of the upper trapezius muscle among healthy participants and patients with nonspecific neck pain BACKGROUND Acupuncture is widely used by patients with low back pain , although its effectiveness is unclear . We investigated the efficacy of acupuncture compared with minimal acupuncture and with no acupuncture in patients with chronic low back pain .  METHODS Patients were r and omized to treatment with acupuncture , minimal acupuncture ( superficial needling at nonacupuncture points ) , or a waiting list control . Acupuncture and minimal acupuncture were administered by specialized acupuncture physicians in 30 outpatient centers , and consisted of 12 sessions per patient over 8 weeks . Patients completed st and ardized question naires at baseline and at 8 , 26 , and 52 weeks after r and omization . The primary outcome variable was the change in low back pain intensity from baseline to the end of week 8 , as determined on a visual analog scale ( range , 0 - 100 mm ) . RESULTS A total of 298 patients ( 67.8 % female ; mean + /- SD age , 59 + /- 9 years ) were included . Between baseline and week 8 , pain intensity decreased by a mean + /- SD of 28.7 + /- 30.3 mm in the acupuncture group , 23.6 + /- 31.0 mm in the minimal acupuncture group , and 6.9 + /- 22.0 mm in the waiting list group . The difference for the acupuncture vs minimal acupuncture group was 5.1 mm ( 95 % confidence interval , -3.7 to 13.9 mm ; P = .26 ) , and the difference for the acupuncture vs waiting list group was 21.7 mm ( 95 % confidence interval , 13.9 - 30.0 mm ; P<.001 ) . Also , at 26 ( P=.96 ) and 52 ( P=.61 ) weeks , pain did not differ significantly between the acupuncture and the minimal acupuncture groups . CONCLUSION Acupuncture was more effective in improving pain than no acupuncture treatment in patients with chronic low back pain , whereas there were no significant differences between acupuncture and minimal acupuncture Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more The aim of this study is to investigate if there is a change in oxygen saturation and blood flow in the different parts of the trapezius muscle in office workers with and without trapezius myalgia during a st and ardized computer task .  Twenty right-h and ed office workers participated ; ten were recruited based on pain in the trapezius and ten as matching controls . Subjects performed a combination of typing and mousing tasks for 60 min at a st and ardized workstation .  Muscle tissue oxygenation and blood flow data were collected from the upper trapezius ( UT ) , the middle trapezius ( MT ) and the lower trapezius ( LT ) , both on the left and right side at seven moments ( at baseline and every tenth minute during the 1-h typing task ) by use of the oxygen to see device . In all three parts of the trapezius muscle , the oxygen saturation and blood flow decreased significantly over time in a similar pattern ( p < 0.001 ) . Oxygenation of the left and right UT was significantly higher compared to the other muscle parts ( p < 0.001 ) . Oxygen saturation for the MT was significantly lower in the cases compared to the control group ( p = 0.027 ) . Blood flow of the UT on the right side was significantly lower than the blood flow on the left side ( p = 0.026 ) . The main finding of this study was that 1 h of combined workstation tasks result ed in decreased oxygen saturation and blood flow in all three parts of the trapezius muscle . Future research should focus on the influence of intervention strategies on these parameters A pragmatic , single blind , r and omised , controlled trial was conducted to test the hypothesis that superficial dry needling ( SDN ) together with active stretching is more effective than stretching alone , or no treatment , in deactivating trigger points ( TrPs ) and reducing myofascial pain . Forty patients with musculoskeletal pain , referred by GPs for physiotherapy , fulfilled inclusion / exclusion criteria for active TrPs . Subjects were r and omised into three groups : group 1 ( n=14 ) received  superficial dry needling ( SDN ) and active stretching exercises ( G1 ) ; group 2 ( n=13 ) received stretching exercises alone ( G2 ) ; and group 3 ( n=13 ) were no treatment controls ( G3 ) . During the three-week intervention period for G1 and G2 , the number of treatments varied according to the severity of the condition and subject/clinician availability . Assessment was carried out pre-intervention ( M1 ) , post-intervention ( M2 ) , and at a three-week follow up ( M3 ) . Outcome measures were the Short Form McGill Pain Question naire ( SFMPQ ) and Pressure Pain Threshold ( PPT ) of the primary TrP , using a Fischer algometer . Ninety-one per cent of assessment s were blind to grouping . At M2 there were no significant inter-group differences , but at M3 , G1 demonstrated significantly improved SFMPQ versus G3 ( p=0.043 ) and significantly improved PPT versus G2 ( p=0.011 ) . There were no differences between G2 and G3 . The mean PPT and SFMPQ scores correlated significantly in G1 only , though no significant inter-group differences were demonstrated . Numbers of patients requiring further treatment following the trial were : 6 ( G1 ) ; 12 ( G2 ) ; 9 ( G3 ) . Conclusion : SDN followed by active stretching is more effective than stretching alone in deactivating TrPs ( reducing their sensitivity to pressure ) , and more effective than no treatment in reducing subjective pain . Stretching without prior deactivation may increase TrP sensitivity BACKGROUND Although acupuncture-needle manipulation is an important component of acupuncture therapy , little information is currently available on whether or not specific types of needle manipulation produce different effects on the body . Bidirectional ( back- and -forth ) rotation is one of the most common forms of needle manipulation used in acupuncture practice . OBJECTIVES In this study , we hypothesized that bidirectional acupuncture needle rotation causes dose-dependent active cytoskeletal remodeling in connective tissue fibroblasts similar to that previously demonstrated with unidirectional rotation . INTERVENTIONS Subcutaneous tissue explants from 18 mice were r and omized to varying amounts of bidirectional rotation cycles ( 8 - 64 ) and rotation-cycle amplitude ( 180 degrees -720 degrees ) ex vivo for 30 minutes , followed by tissue fixation , confocal microscopy , and measurement of fibroblast cell body cross-sectional area . RESULTS As with unidirectional rotation , fibroblasts responded to bidirectional rotation with extensive cell spreading and lamellipodia formation . Bidirectional needle rotation had a significant overall effect on fibroblast cell body cross sectional area ( analysis of variance , p < 0.001 ) . The cellular response to bidirectional rotation was nonmonotonic with maximal responses occurring within specific stimulus windows with regard to cycle amplitude and cycle number . CONCLUSIONS These findings demonstrate that subtle differences in acupuncture-needle manipulation techniques can affect cellular responses in mouse subcutaneous connective tissue . Further studies will be needed to determine whether these connective-tissue responses are related to therapeutic effects The principle aim of the present work is the evaluation of the importance of the variable " depth " of needle insertion in the determination of acupuncture 's therapeutic results . A r and omized clinical trial carried out on 44 patients belonging to two groups of 22 each , suffering from shoulder myofascial pain : group A : superficial acupuncture ; group B : deep acupuncture .  All of them subjected to the same model of treatment with 13 needles and the treatment of the most painful 4 trigger points ( TP ) found in the shoulder 's area . In the group A patients , the needles were introduced in the skin at a depth of 2 mm , on the TP . In the group B patients , the needles were placed deeply both in the muscular acupuncture points and in the TP . The treatment was planned 
    Output:
    
Discussion : Statistically significant between-group differences were observed favoring deep needling over superficial .
Both superficial and deep needling result ed in clinical ly meaningful changes in pain scores over time .
However , differences between groups may not be clinical ly meaningful .