***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: We present a double-blind trial in which a pulsed infrared beam was compared with a placebo in the treatment of myofascial pain in the cervical region . The patients were su bmi tted to 12 sessions on alternate days to a total energy dose of 5 J each . At each session , the four most painful muscular trigger points and five bilateral homometameric acupuncture points were irradiated . Those in the placebo group su bmi tted to the same number of sessions following an identical procedure , the only difference being that the laser apparatus was nonoperational . Pain was monitored using the Italian version of the McGill pain question naire and the Scott-Huskisson visual analogue scale . The results show a pain attenuation in the treated group and a statistically significant difference between the two groups of patients , both at the end of therapy and at the 3-month follow-up examination Thirty people with classical or definite rheumatoid arthritis received laser exposure to a Q-switch neodymium laser that operated at 1.06 micrometer with an output of 15 joules/cm2 for 30 nsec . One h and was lased at the proximal interphalangeal ( PIP ) and metacarpal phalangeal ( MCP ) joints , whereas the other h and was sham lased . The patient , physician , and occupational therapy evaluators did not know which h and was being lased . Twenty-one patients noted improvement of both their MCP and PIP joints of both h and s during laser therapy . Twenty-seven noted improvement of their PIP joints and 26 noted improvement of the MCP joints during therapy . Heat , erythema , pain , swelling , and tenderness all improved with time in both h and s , but the lased h and had more significant improvement in erythema and pain . There was also significant improvement in grasp and tip pressure on the lased side . The level of circulating immune complexes as measured by platelet aggregation decreased during lasing . The improvement may be related to laser exposure . The exact role that laser radiation has upon rheumatoid arthritis and its mechanism of action remain to be eluci date I N SPITE of new discoveries and advances in the treatment of rheumatoid arthritis , the most important part of the management of patients with this disease today is the prevention or minimizing of deformity and the maintenance or improvement of function . The numerous remedies that have been promoted for use in arthritis tend to detract from the appreciation of the value of physical treatment in preventing crippling and disability . Hill and Holbrook ’ have estimated that not one patient in 100 is following a proper schedule to protect his joints and maintain function . This is a serious indictment of our medical care programs for patients with rheumatoid arthritis . Whether one agrees with these figures or not , all will agree that a high percentage of patients fail to carry out any program , or go at it halfheartedly , or eventually tend to lose interest in even a carefully planned and effective schedule of treatment . A review of the literature from 1940 to the present offers little information as to the best way to motivate ‘ a patient with a chronic ailment to treat himself over a long period of time . In 1943 , a report from the Mayo Clinic ? gave the results of a survey of arthritis patients chosen at r and om from several thous and clinic patients who had been instructed in home physical therapy .  Of the 346 patients to whom the investigators sent a question naire , 216 responded , and the results showed that 92.7 per cent had started the treatment program and 64.7 per cent had continued treatment for three months or more . There were 96 patients with rheumatoid arthritis in this group ; 63.5 per cent of these were continuing home treatment or else had stopped because their condition had improved . A survey of arthritis patients at University Hospital was recently conducted to help evaluate our program of instruction in home treatment and shed some light on why patients continue or stop their home treatment schedules . Fiftysix patients who had previously been instructed in adequate home programs were personally interviewed . At the time of the interview , 5 patients had stopped their home treatment because of improvement in their condition . Of the remaining 51 patients , 27 were still continuing adequate home treatment programs , but 24 patients who needed physical therapy were not treating themselves adequately Low level laser therapy ( LLLT ) is a relatively new and increasingly popular form of electrotherapy . It is used by physiotherapists in the treatment of a wide variety of conditions including RA despite the lack of scientific evidence to support its efficacy . A r and omized , double-blind and placebo-controlled study was conducted to evaluate the efficacy of LLLT . The patient sample consisted of chronic RA patients with active finger joint synovitis . Forty RA patients with involvement of some or all of MCP or PIP joints were recruited . Following r and om allocation they received either active or placebo laser three times a week for 4 weeks . Measurements were taken prior to entry , after the treatment , 1 month and 3 months at follow-up . The groups were well matched in terms of age , sex , disease duration and severity . Few significant differences were noted in grip strength , duration of morning stiffness , joint tenderness , temperature of inflamed joints , range of movement or pain either within or between groups . Using these irradiation parameters the efficacy of LLLT  is ineffective OBJECTIVES --To define the value of low power laser treatment in small joint rheumatoid arthritis . METHODS --Twenty five women with active disease were recruited . The metacarpophalangeal and proximal interphalangeal joints of one h and were treated with 12 J/cm2 for 30 s with a gallium-aluminium-arsenate laser . The other h and received a sham laser treatment design ed so that neither therapist nor patient could distinguish the active laser from the sham laser . Each patient received 12 treatments over four weeks . The following parameters were measured : pain as assessed by visual analogue scale ; range of joint movements ; grip strength ; duration of early morning stiffness , joint circumference , Jebsen 's h and assessment ; drug usage ; total swollen joint counts ; Arthritis Impact Measurement Scales ; three phase bone scans ; haematological and serological tests . RESULTS --A total of 72 % of patients reported pain relief but this reduction was reported equally in both h and s. No significant changes were seen in other clinical , functional , scintigraphic , or laboratory features . Neither patients nor staff were able to detect which h and was treated with the active laser . CONCLUSION --When this specific laser and dose regimen was used , low power laser treatment had no objective effect on patients with rheumatoid arthritis . It did appear to produce analgesia through a powerful placebo effect OBJECTIVE Musculoskeletal disorders ( MSD ) are a leading cause of morbidity in the population , yet their prominence seems to be insufficiently appreciated . We describe the ranking compared with other major body systems of the prevalence of MSD , including arthritis and rheumatism , and back/neck disorders , as a cause of chronic health problems , longterm disability , restricted activity days , consultation with health professionals , and use of both prescription and nonprescription drugs . METHODS We analyzed data from the 1990 Ontario Health Survey , a stratified r and om sample of the household dwelling population in Ontario , based on 45,650 individuals aged 16 years and over . RESULTS MSD ranked first in prevalence as the cause of chronic health problems , longterm disabilities , and consultations with a health professional and ranked 2nd for restricted activity days and use of both prescription and nonprescription drugs . No other body systems ranked invariably within the top 2 ranks for the morbidity indices examined . Even when compared to other major disease groups , arthritis and rheumatism ranked consistently in the top 3 and back/neck disorders also ranked high . MSD were mentioned as a reason for 40 % of all chronic conditions , 54 % of all longterm disability , 24 % of restricted activity days and almost 20 % of health care utilization . The impact of MSD was even greater in the 65 and over age group . CONCLUSIONS MSD have a major role in the health profile of the population . This high burden of illness should be considered in planning health care services and setting research priorities Low energy laser ( LEL ) is a widely used treatment for a variety of musculoskeletal disorders although convincing documentation of the effect is missing . We have examined the LEL effect on Rheumatoid Arthritis ( RA ) in a double blind placebo controlled study . Twenty-two patients completed the study ( 10 receiving LEL treatment ) according to the protocol . A significant effect on pain score was found due to LEL treatment , but when data were corrected for disease variation the effect disappeared . No effect of LEL could be demonstrated on the other assessed variables : grip strength , morning stiffness , flexibility , erythrocyte sedimentation rate ( ESR ) , C-reactive protein ( CRP ) . In conclusion , we did not find that LEL had any clinical ly relevant effects on RA This study was conducted to examine the effects of helium-neon laser auriculotherapy on experimental pain threshold .  Eighty healthy female and male subjects , aged 18 to 39 years , were assigned r and omly to one of two treatment groups . Subjects in the Experimental Group ( n = 41 ) received laser stimulation , and subjects in the Control Group ( n = 39 ) received sham stimulation to appropriate acupuncture points on the left ear . Experimental pain threshold at the ipsilateral wrist was determined with an electrical stimulus immediately before and after treatment . The mean change ( posttreatment minus pretreatment ) for the Experimental Group was greater than the mean change for the Control Group ( p less than .05 ) . The Experimental Group demonstrated a statistically significant ( p less than .05 ) increase in mean pain threshold after treatment , but the Control Group did not . Results indicate that helium-neon laser auriculotherapy can increase experimental pain threshold and suggest a possible alternative for patients intolerant of transcutaneous electrical nerve stimulation The effect of soft-laser therapy on rheumatoid arthritis was evaluated in 17 patients with symmetrical involvement of the metacarpophalangeal joint of the index . Nine treatments with a He-Ne laser , 6 J/cm2 , were given on the one h and with a sham irradiation of the other . The study was double-blind . The laser therapy gave some pain relief , but no difference in morning stiffness or joint performance was obtained . It is concluded that the laser therapy is of limited value in rheumatoid arthritis 
    Output:
    
LLLT could be considered for short-term treatment for relief of pain and morning stiffness for RA patients , particularly since it has few side-effects .