***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 To assess the efficacy and safety of a copper-salicylate gel in osteoarthritis of the hip and knee . DESIGN R and omised , double-blind , placebo-controlled study . SETTING Rheumatology Clinic of St Vincent 's Hospital , Sydney , New South Wales ( a tertiary referral hospital ) , June 1993 to October 1994 . PATIENTS 116 patients with pain associated with osteoarthritis of the hip and /or knee ( diagnosed by criteria of the European League against Rheumatism ) , drawn from patients attending the Clinic or self-referred after newspaper advertisements . INTERVENTION Copper-salicylate or placebo gel ( 1.5 g ) applied twice daily to the forearm for four weeks . OUTCOME MEASURES Self- assessment of pain before the trial and after two and four weeks of treatment ; patient and investigator assessment s of efficacy ; additional analgesia required ; adverse reactions ; and withdrawal rates . RESULTS Pain scores at rest and on movement decreased in both the copper-salicylate and placebo groups by 13%-20 % . There was no significant difference between the two groups for decrease in pain score , patient and investigator efficacy ratings , number of patients requiring paracetamol for extra analgesia ( active , 77 % ; placebo , 71 % ) and average dose of paracetamol ( active , 555 mg/day ; placebo , 600 mg/day ) . Significantly more patients in the copper-salicylate group reported adverse reactions ( 83 % versus 52 % of the placebo group ) , most commonly skin reactions , and withdrew from the trial because of these reactions ( 17 % versus 1.7 % of the placebo group ) . CONCLUSION Copper-salicylate gel applied to the forearm was no better than placebo gel as pain relief for patients with osteoarthritis of the hip or knee , but produced significantly more skin rashes Objective : To determine the clinical effects of the treatment of lumbar disc herniation with herbal magnetic corsets . Design : A r and omized control trial . Setting : The outpatient and inpatient departments of the Rehabilitation Center of the West China Hospital . Patients : Sixty patients with clinical ly diagnosed lumbar disc herniation were included in the study . Interventions : Both groups received lumbar traction , medium frequency electrotherapy and massage , whereas the experimental group wore herbal magnetic corsets in addition . Main outcome measures : Pain and lumbar function were assessed before treatment and at one week , two weeks and four weeks after intervention . Results : Both groups reported improvements in pain and lumbar function after treatment ( P 0.05 or P 0.001 ) . However , the experimental group reported gradually increasing relief over time leading to a better curative effect than observed in the control group ( P 0.05 for visual analogue scale or P 0.001 for lumbar function ) . Conclusion : Herbal magnetic corsets can facilitate the reduction of pain caused by lumbar disc herniation and can improve lumbar function . This is a safe and effective non-operative therapeutic option for treatment of lumbar disc herniation Abstract  Variability  in patients ' response to interventions in pain and other clinical setting s is large . Many explanations such as trial methods , environment or culture have been proposed , but this paper sets out to show that the main cause of the variability may be r and om chance , and that if trials are small their estimate of magnitude of effect may be incorrect , simply because of the r and om play of chance . This is highly relevant to the questions of ‘ How large do trials have to be for statistical accuracy ? ’ and ‘ How large do trials have to be for their results to be clinical ly valid ? ’ The true underlying control event rate ( CER ) and experimental event rate ( EER ) were determined from single‐dose acute pain analgesic trials in over 5000 patients . Trial group size required to obtain statistically significant and clinical ly relevant ( 0.95 probability of number‐needed‐to‐treat within ±0.5 of its true value ) results were computed using these values . Ten thous and trials using these CER and EER values were simulated using varying group sizes to investigate the variation due to r and om chance alone . Most common analgesics have EERs in the range 0.4–0.6 and CER of about 0.19 . With such efficacy , to have a 90 % chance of obtaining a statistically significant result in the correct direction requires group sizes in the range 30–60 . For clinical relevance nearly 500 patients are required in each group . Only with an extremely effective drug ( EER>0.8 ) will we be reasonably sure of obtaining a clinical ly relevant NNT with commonly used group sizes of around 40 patients per treatment arm . The simulated trials showed substantial variation in CER and EER , with the probability of obtaining the correct values improving as group size increased . We contend that much of the variability in control and experimental event rates is due to r and om chance alone . Single small trials are unlikely to be correct . If we want to be sure of getting correct ( clinical ly relevant ) results in clinical trials we must study more patients . Credible estimates of clinical efficacy are only likely to come from large trials or from pooling multiple trials of conventional ( small ) size Enelbin-Rheuma-ointment and a reference ointment were compared with regard to effectiveness in a double-blind trial in 100 patients with gonarthrosis , osteoarthrosis of the spine and humeroscapular periarthropathy . Both ointments showed good results regarding spontaneous pain , pain on pressure and motion , reduction of mobility , swelling and muscular tension . The success of treatment was statistically significantly better in the Enelbin-Rheuma-ointment treated patients Abstract This r and omized , double-blind study was design ed to evaluate the effectiveness of the topical cream Theraflex-TMJ ( NaBob/Rx , San Mateo , CA ) in patients with masseter muscle pain and temporom and ibular joint ( TMJ ) pain . Fifty-two subjects ( 5 males and 47 females ) were instructed to apply a cream over the afflicted masseter muscle(s ) or over the jaw joint(s ) twice daily for two weeks . Theraflex-TMJ cream was used by the experimental group , while a placebo cream was used by the control group . The means of pain ratings were calculated prior to the application of the cream ( baseline ) , after ten days of tx ( period 1 ) , and 15 days of tx ( period 2 ) days of treatment and five days after stopping the treatment ( follow-up ) . There was a significant decrease in reported pain levels from baseline in the experimental group for period 1 ( p<0.01 ) , period 2 ( p<0.001 ) , and follow-up ( p<0.01 ) . For the control group , no significant differences were found between the different time periods ( p>0.05 ) . There was evidence of minor side effects such as skin irritation and /or burning on the site of the application in two subjects in the experimental as well as two subjects in the control groups . The data strongly suggest that Theraflex-TMJ topical cream is safe and effective for reducing pain in the masseter muscle and the temporom and ibular joint BACKGROUND An occlusive patch formulation containing 10 % methyl salicylate and 3 % l-menthol was recently approved by the US Food and Drug Administration for the treatment of mild to moderate pain . Despite widespread use of counterirritants , including methyl salicylate and menthol , for topical pain relief , published efficacy and safety data regarding the use of the agents alone or in combination are limited . OBJECTIVE The goal of this study was to determine the efficacy and safety profile of a patch containing 10 % methyl salicylate and 3 % l-menthol compared with a placebo patch in adult patients with mild to moderate muscle strain . METHODS Eligible patients were men or women aged > or=18 years with a clinical diagnosis of mild to moderate muscle strain . Patients were r and omly assigned to receive either 1 active patch or 1 placebo patch applied to the skin at the affected area ( ie , shoulder , upper back , upper arm , neck , calf , thigh , forearm , abdomen ) . Pain intensity was assessed on a 100-mm visual analog scale while at rest and with movement for 12 hours after patch application . The primary efficacy end point was the summed pain intensity difference score through 8 hours ( SPID8 ) with movement . Analyses included use of descriptive statistics and an ANOVA model . Safety data , including adverse events , and secondary efficacy end points were also evaluated . RESULTS A total of 208 patients ( 104 men , 104 women ; age range , 18 - 78 years ) were r and omized to 1 of 2 study groups ( 105 in the active-patch group [ mean age , 37.3 years ] , 103 in the placebo-patch group [ mean age , 38.1 years ] ) . The primary efficacy analysis ( SPID8 with movement ) indicated that patients receiving the active patch experienced significantly greater pain relief ( approximately 40 % ) than those patients receiving a placebo patch ( mean [ SD ] , 182.6 [ 131.2 ] vs 130.1 [ 144.1 ] ; P = 0.005 ) . Analysis of the per- protocol population also found significantly more relief ( P = 0.024 ) in the active-patch group ( 176.2 [ 131.4 ] ; n = 92 ) versus the placebo-patch group ( 130.2 [ 144.0 ] ; n = 96 ) . Statistical analysis of secondary efficacy measures supported the primary end-point results . The number of patients experiencing any type of adverse event was comparable between study groups ( active patch , 6.7 % [ 7 events ] ; placebo patch , 5.8 % [ 6 events ] ) . No serious adverse events were reported during the study . CONCLUSION A single , 8-hour application of a patch containing methyl salicylate and l-menthol provided significant relief of pain associated with mild to moderate muscle strain in these adult patients compared with patients receiving a placebo patch Twenty-five patients with symptomatic osteoarthritis ( OA ) of the knee were treated topically for one week with either 10 % trolamine salicylate cream or placebo cream in a r and omized double-blind crossover study . No significant difference was found in subjective or objective measures of pain relief between the treatment and control groups . Eight patients preferred " active " test cream , six preferred placebo , and 11 had no preference . No side effects were reported . Topically applied 10 % trolamine salicylate cream did not relieve the pain of OA of the knee any more than did placebo Forty patients with acute mechanical low-back pain were treated in a double-blind manner with either Rado-Salil ® or placebo for 14 days . Statistically significant improvements in spontaneous pain , muscular contracture and in both the patient 's and physician 's opinions occurred by day 3 . These improvements persisted at day 14 and , in addition , there were statistically significant improvements in the finger – floor distance and the degree of lumbar extension . Treatment with Rado-Salil ® also allowed significant reduction in the use of oral analgesics . Only a few localized transient side-effects , requiring no specific treatment , were observed In a r and omised , placebo-controlled , double-blind study with parallel group comparison , the efficacy and tolerability of topical treatment with a mucopolysaccharide polysulphate/salicylic acid cream was investigated in 156 patients with acute sprains of the knee or ankle joint . There was a more rapid reduction in pain on movement ( the main parameter ) in the active drug group compared with the placebo group . On day 9 after r and omisation the difference was highly significant . There were no adverse events in the active drug group & NA ; A data base of r and omised  clinical trials ( RCTs ) in pain research published from 1950 to 1990 was created following an extensive literature search . By applying a refined MEDLINE search strategy from 1966 to 1990 and by h and ‐ search ing more than 1 000 000 pages of a total of 40 biomedical journals published during the period 1950–1990 , more than 8000 RCTs were identified . The RCTs were published in more than 800 journals and over 85 % appeared between 1976 and 1990 . If the trend of the last 15 years persists , a total of more than 15 000 RCTs will be published in pain relief by the year 2000 . A detailed description of methods to ensure efficient use of re sources during the identification , retrieval and management of the information in pain relief and other fields is given . Emphasis is made on the importance of refining MEDLINE search strategies , on the use of volunteers to h and ‐ search journals and on careful monitoring of each of the steps of the process . The potential uses of the data base to guide clinical and research decisions are discussed Acute low back pain is a very common condition in Western industrialised countries . In most cases analgesics or topical medications are prescribed at first encounter with the general practitioner ( GP ) . The aim of this study was to investigate whether the homeopathic gel Spiroflor SRL gel ( SRL ) is equally effective and better tolerated than Cremor Capsici Compositus FNA ( CCC ) in patients with acute low back pain . A multi-centre , r and omised , double-blind , controlled clinical trial was conducted in the practice s of 19 GPs in the districts of Bristol and Manchester , UK . One hundred and sixty-one subjects suffering from acute low back pain were treated for one week either with SRL or with CCC .  Pain was scored on a 100 mm visual analogue scale ( VAS ) . Main efficacy parameter VAS reduction was compared between treatments . Evaluation of safety was primarily based on the number of subjects with adverse events ( AEs ) , withdrawals due to an AE and adverse drug 
    Output:
    
In both categories there were a number of factors might have influenced the results but sensitivity analysis was limited because of the small number of studies and participants .For both acute and chronic painful conditions any evidence of efficacy came from the older , smaller studies , while the larger , more recent studies showed no effect .
The evidence does not support the use of topical rubefacients containing salicylates for acute injuries or chronic conditions .
They seem to be relatively well tolerated in the short-term , based on limited data .
The amount and quality of the available data mean that uncertainty remains about the effects of salicylate-containing rubefacients