***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: In this experiment , we tested for opioid and nonopioid mechanisms of pain control through cognitive means and the relation of opioid involvement to perceived coping efficacy . Subjects were taught cognitive methods of pain control , were administered a placebo , or received no intervention . Their pain tolerance was then measured at periodic intervals after they were administered either a saline solution or naloxone , an opiate antagonist that blocks the effects of endogenous opiates . Training in cognitive control strengthened perceived self-efficacy both to withst and and to reduce pain ; placebo medication enhanced perceived efficacy to withst and pain but not reductive efficacy ; and neither form of perceived self-efficacy changed without any intervention . Regardless of condition , the stronger the perceived self-efficacy to withst and pain , the longer subjects endured mounting pain stimulation . The findings provide evidence that attenuation of the impact of pain stimulation through cognitive control is mediated by both opioid and nonopioid mechanisms . Cognitive copers administered naloxone were less able to tolerate pain stimulation than were their saline counterparts . The stronger the perceived self-efficacy to reduce pain , the greater was the opioid activation . Cognitive copers were also able to achieve some increase in pain tolerance even when opioid mechanisms were blocked by naloxone , which is in keeping with a nonopioid component in cognitive pain control . We found suggestive evidence that placebo medication may also activate some opioid involvement . Because placebos do not impart pain reduction skills , it was perceived self-efficacy to endure pain that predicted degree of opioid activation A comparison was carried out of the efficacy of psychological and drug treatments for children with migraine . Forty-three children aged between 8 and 16 years ( mean age : 11.3 years ) who suffered from migraine received either progressive relaxation or cephalic vasomotor feedback , both with stress management training , or metoprolol , a beta-blocker . Psychological treatment was administered in ten sessions lasting six weeks and the drug treatment lasted ten weeks . Relaxation and stress management training reduced the headache index ( frequency x intensity of headache episodes ) , more effectively than metoprolol with cephalic vasomotor feedback and stress management training in between . An overall improvement over time was found with regard to frequency and intensity of headache episodes and analgesics intake . When comparing pre- to post-treatment data , children treated with relaxation training improved significantly in headache frequency and intensity , whereas those treated with cephalic vasomotor feedback improved significantly in headache frequency and duration as well as mood . The clinical improvement was stable at an 8-months follow-up & NA ; Few controlled clinical trials of psychological interventions for cancer pain relief exist in spite of frequent support for their importance as adjuncts to medical treatment . This study compared oral mucositis pain levels in 4 groups of cancer patients receiving bone marrow transplants ( BMT ) : ( 1 ) treatment as usual control , ( 2 ) therapist support , ( 3 ) relaxation and imagery training , and ( 4 ) training in a package of cognitive‐behavioral coping skills which included relaxation and imagery . A total of 94 patients completed the study which involved two training sessions prior to treatment and twice a week ‘ booster ’ sessions during the first 5 weeks of treatment . Results confirmed our hypothesis that patients who received either relaxation and imagery alone or patients who received the package of cognitive‐behavioral coping skills would report less pain than patients in the other 2 groups . The hypothesis that the cognitive‐behavioral skills package would have an additive effect beyond relaxation and imagery alone was not confirmed . Average visual analogue scale ( VAS ) report of pain within the therapist support group was not significantly lower than the control group ( P = 0.103 ) nor significantly higher than the training groups . Patient reports of relative helpfulness of the interventions for managing pain and nausea matched the results of VAS reports . From these results , we conclude that relaxation and imagery training reduces cancer treatment‐related pain ; adding cognitive‐behavioral skills to the relaxation with imagery does not , on average , further improve pain relief CONTEXT A prior national survey documented the high prevalence and costs of  alternative medicine use in the United States in 1990 . OBJECTIVE To document trends in alternative medicine use in the United States between 1990 and 1997 . DESIGN Nationally representative r and om household telephone surveys using comparable key questions were conducted in 1991 and 1997 measuring utilization in 1990 and 1997 , respectively . PARTICIPANTS A total of 1539 adults in 1991 and 2055 in 1997 . MAIN OUTCOMES MEASURES Prevalence , estimated costs , and disclosure of alternative therapies to physicians . RESULTS Use of at least 1 of 16 alternative therapies during the previous year increased from 33.8 % in 1990 to 42.1 % in 1997 ( P < or = .001 ) . The therapies increasing the most included herbal medicine , massage , megavitamins , self-help groups , folk remedies , energy healing , and homeopathy . The probability of users visiting an alternative medicine practitioner increased from 36.3 % to 46.3 % ( P = .002 ) . In both surveys alternative therapies were used most frequently for chronic conditions , including back problems , anxiety , depression , and headaches . There was no significant change in disclosure rates between the 2 survey years ; 39.8 % of alternative therapies were disclosed to physicians in 1990 vs 38.5 % in 1997 . The percentage of users paying entirely out-of-pocket for services provided by alternative medicine practitioners did not change significantly between 1990 ( 64.0 % ) and 1997 ( 58.3 % ) ( P=.36 ) . Extrapolations to the US population suggest a 47.3 % increase in total visits to alternative medicine practitioners , from 427 million in 1990 to 629 million in 1997 , thereby exceeding total visits to all US primary care physicians . An estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies and /or high-dose vitamins ( 18.4 % of all prescription users ) . Estimated expenditures for alternative medicine professional services increased 45.2 % between 1990 and 1997 and were conservatively estimated at $ 21.2 billion in 1997 , with at least $ 12.2 billion paid out-of-pocket . This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations . Total 1997 out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $ 27.0 billion , which is comparable with the projected 1997 out-of-pocket expenditures for all US physician services . CONCLUSIONS  Alternative medicine use and expenditures increased substantially between 1990 and 1997 , attributable primarily to an increase in the proportion of the population seeking alternative therapies , rather than increased visits per patient OBJECTIVE To examine relationships among changes in self-efficacy and changes in other clinical ly relevant outcome measures . METHOD Subjects ( n = 44 ) were participants in a prospect i ve , r and omized stress-management study followed over 15 months . Outcome measures included self-efficacy , depression , pain , health status , and disease activity . RESULTS Correlational analyses revealed significant associations between changes in self-efficacy ( particularly total self-efficacy ) and changes in selected measures of depression , pain , health status , and disease activity . The observed associations were not due to changes in medication regimen or to nonadherence to the stress-management program . CONCLUSIONS Evidence is provided that induced changes in self-efficacy following a stress-management program were significantly related to other clinical ly important outcome measures OBJECTIVE To assess the effects of hypnotherapy on the first and second stages of labour in a large group of pregnant women . DESIGN A semi- prospect i ve case control study in which women attending antenatal clinics were invited to undergo hypnotherapy . SUBJECTS One hundred twenty-six primigravid women with 300 age matched controls , and 136 parous women having their second baby with 300 age matched controls . Only women who had spontaneous deliveries were included . SETTING Aberdare District Maternity Unit , Mid Glamorgan , Wales . INTERVENTION Six sessions of hypnotherapy given by a trained medical hypnotherapist during pregnancy . OUTCOME MEASURES Analgesic requirements , duration of first and second stages of labour . RESULTS The mean lengths of the first stage of labour in the primigravid women was 6.4 h after hypnosis and 9.3 h in the control group ( P < 0.0001 ) ; the mean lengths of the second stage were 37 min and 50 min , respectively ( P < 0.001 ) . In the parous women the corresponding values were 5.3 h and 6.2 h ( P < 0.01 ) ; and 24 and 22 min ( ns ) . The use of analgesic agents was significantly reduced ( P < 0.001 ) in both hypnotised groups compared with their controls . CONCLUSION In addition to demonstrating the benefits of hypnotherapy , the study gives some insight into the relative proportions of mechanical and psychological components involved in the longer duration of labour in primigravid women The aim of this study was to investigate the role of dispositional optimism ( DO ) as a predictor of health-related quality of life ( HRQL ) in a sample of upper aerodigestive tract cancer ( UADT ) patients . A prospect i ve observational study design was used with a cohort of patients from one centre . DO was evaluated using a French version of the Life Orientation Test ( the FLOT ) translated and vali date d for this study . HRQL was evaluated using the EORTC QLQ-C30 prior to and 3 months following treatment . The association between FLOT ratings and HRQL was evaluated using linear multiple regression analysis and a two-way ANOVA with repeated measures . Baseline data were gathered on 101 subjects and follow-up data on 88 of these . The sample was dichotomized around the median FLOT score creating ‘ optimist ’ and ‘ pessimist ’ groups . Before treatment , optimists reported better role , cognitive and emotional function , less pain and fatigue and a better global rating of HRQL than did pessimists . Following treatment , optimists reported better role and cognitive functioning , less pain and better global HRQL than did pessimists . Pessimists reported a greater deterioration in the role domain following treatment than did optimists . At no point did pessimists rate HRQL better than optimists . The results suggest that optimism is associated with better HRQL in French UADT cancer patients & NA ; Few controlled clinical trials have tested the efficacy of psychological techniques for reducing cancer pain or post‐chemotherapy nausea and emesis . In this study , 67 bone marrow transplant patients with hematological malignancies were r and omly assigned to one of four groups prior to beginning transplantation conditioning : hypnosis training (HYP);cognitive behavioral coping skills training (CB);therapist contact control ( TC ) ; ortreatment as usual ( TAU ; no treatment control ) . Patients completed measures of physical functioning ( Sickness Impact Profile ; SIP ) and psychological functioning ( Brief Symptom Inventory ; BSI ) , which were used as covariates in the analyses . Biodemographic variables included gender , age and a risk variable based on diagnosis and number of remissions or relapses . Patients in the HYP , CB and TC groups met with a clinical psychologist for two pre‐transplant training sessions and ten in‐hospital “ booster ” sessions during the course of transplantation . Forty‐five patients completed the study and provided all covariate data , and 80 % of the time series outcome data . Analyses of the principal study variables indicated that hypnosis was effective in reducing reported oral pain for patients undergoing marrow transplantation . Risk , SIP , and BSI pre‐transplant were found to be effective predictors of inpatient physical symptoms . Nausea , emesis and opioid use did not differ significantly between the treatment groups . The cognitive behavioral intervention , as applied in this study , was not effective in reducing the symptoms measured 24 patients with chronic low back pain were r and omly assigned to three treatment conditions : ( a ) EMG biofeedback , ( b ) relaxation training , and ( c ) a placebo condition . Patients were seen for eight sessions and were evaluated before Session 1 and after Session 8 . Eight analyses of covariance which were adjusted for age and pretest scores were computed on the final scores to find which variables could detect significant difference between treatments . Age was included as a covariate because the differences in age between conditions were significant . Four variables with significant and nearly significant differences were chosen for analysis . The second set of analyses identified the nature of the differences among the three conditions . These included a priori planned comparisons among conditions , and paired t tests . Relaxation-trained subjects were significantly superior to subjects in the placebo condition , in decreasing pain during the function test , increasing relaxation , and decreasing Upper Trapezius EMG . They were superior to EMG Biofeedback training in increasing reported activity . Both Relaxation and EMG trained subjects were able to reduce Upper Trapezius EMG by Session 8 Relaxation-trained subjects showed significant change on eight of the 14 possible comparisons for each treatment condition . EMG biofeedback training showed significant favorable results in only one condition ; the placebo condition showed no significant results . Relaxation training gave better results in reducing EMG and pain , and in increasing relaxation and activity than either EMG biofeedback alone or a placebo condition Chronic low back pain ( CLBP ) presents a problem of massive dimensions . While inpatient approaches have been evaluated , outpatient treatment programs have received relatively little examination . Hypnosis and relaxation are two powerful techniques amenable to outpatient use . Seventeen outpatient subjects suffering from CLBP were assigned to either Self-Hypnosis ( n = 9 ) or Relaxation 
    Output:
    
Based on evidence from r and omized controlled trials and in many cases , systematic review s of the literature , the following recommendations can be made : 1 ) multi-component mind-body approaches that include some combination of stress management , coping skills training , cognitive restructuring and relaxation therapy may be an appropriate adjunctive treatment for chronic low back pain ; 2 ) multimodal mind-body approaches such as cognitive-behavioral therapy , particularly when combined with an educational/informational component , can be an effective adjunct in the management of rheumatoid and osteoarthritis ; 3 ) relaxation and thermal biofeedback may be considered as a treatment for recurrent migraine while relaxation and muscle biofeedback can be an effective adjunct or st and alone therapy for recurrent tension headache ; 4 ) an array of mind-body therapies ( eg , imagery , hypnosis , relaxation ) when employed pre-surgically , can improve recovery time and reduce pain following surgical procedures ; 5 ) mind-body approaches may be considered as adjunctive therapies to help ameliorate pain during invasive medical procedures