human
***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: & NA ; The large inter‐individual variability in the magnitude of analgesia in response to opioids and the high prevalence of adverse events associated with their use underline the clinical importance of being able to predict who will or will not respond to opioid treatment . The present study used both static and dynamic quantitative sensory testing ( QST ) on 40 healthy volunteers in order to test whether this methodology can predict the analgesic effects of oral oxycodone , as compared to a placebo , on latency to onset , pain intensity , and tolerance to the cold pressor test ( CPT ) . Static QST consisted of measuring heat and cold pain thresholds . Dynamic QST included measurements of the magnitude of the diffuse noxious inhibitory control (DNIC)‐like effect and of temporal summation ( TS ) . Results showed that oxycodone , but not the placebo , significantly elevated the latency and tolerance to cold pain and significantly reduced pain intensity . The static QST results showed that heat pain thresholds predicted the magnitude of reduction in pain intensity in response to oxycodone treatment ( F(1,22 ) = 5.63 , p = 0.027 , R2 = 0.17 ) . The dynamic QST results showed that TS predicted the effect of oxycodone on the tolerance to CPT ( F(1,38 ) = 9.11 , p = 0.005 , R2 = 0.17 ) . These results suggest that both static and dynamic QST have the potential to be useful in the prediction of the response to opioid treatment Summary Pain responses to 2 types of preoperative heat stimuli were not independent clinical ly relevant predictors for postoperative pain after total knee arthroplasty . ABSTRACT It has been estimated that up to 54 % of the variance in postoperative pain experience may be predicted with preoperative pain responses to experimental stimuli , with suprathreshold heat pain as the most consistent test modality . This study aim ed to explore whether 2 heat test paradigms could predict postoperative pain  after total knee arthroplasty ( TKA ) . Patients scheduled for elective , unilateral , primary TKA under spinal anesthesia were consecutively included in this prospect i ve , observational study . Perioperative analgesia was st and ardized for all patients . Outcomes were postoperative pain during walk : from 6 to 24 hours ( primary ) , from postoperative day ( POD ) 1 to 7 ( secondary ) , and from POD 14 to 30 ( tertiary ) . Two preoperative tonic heat stimuli with 47 ° C were used ; short ( 5 seconds ) and long ( 7 minutes ) stimulation upon which patients rated their pain response on an electronic visual analog scale . Multivariate stepwise linear and logistic regressions analyses were carried out , including 8 potential preoperative explanatory variables ( among these anxiety , depression , preoperative pain , and pain catastrophizing ) to assess pain response to preoperative heat pain stimulation as an independent predictor for postoperative pain . A total of 100 patients were included , and 3 were later excluded . A weak correlation [ rho ( 95 % confidence interval ) ; P value ] was observed between pain from POD 1 to 7 and pain response to short [ rho = 0.25(0.04 to 0.44 ) ; P = .02 ] and to long [ rho = 0.27 ( 0.07 to 0.46 ) ; P = .01 ] heat pain stimulation . However , these positive correlations were not supported by the linear and logistic regression analyses , in which only anxiety , preoperative pain , and pain catastrophizing were significant explanatory variables ( but with low R‐squares ; 0.05 to 0.08 ) . Pain responses to 2 types of preoperative heat stimuli were not independent clinical ly relevant predictors for postoperative pain after TKA Several lines of evidence suggest that mental motor imagery is subserved by the same cognitive operations and brain structures that underlie action . Additionally , motor imagery is informed by the anticipated sensory consequences of action , including pain . We reasoned that motor imagery could provide a useful measure of  chronic leg or foot pain . Forty subjects with leg pain ( 19 bilateral , 11 right , and 10 left leg pain ) , 42 subjects with chronic pain not involving the legs , and 38 controls were shown 12 different line drawings of the right or left foot and asked to indicate which foot was depicted . Previous work suggests that subjects perform this task by mentally rotating their foot to match the visually presented stimulus . All groups of subjects were slower and less accurate with stimuli that required a greater degree of mental rotation of their foot . Subjects with leg pain were both slower and less accurate than normal and pain control subjects in responding to drawings of a painful extremity . Furthermore , subjects with leg pain exhibited a significantly greater decrement in performance for stimuli that required larger amplitude mental rotations . These data suggest that motor imagery may provide important insights into the nature of the pain experience Purpose Pressure algometry ( PA ) may provide an objective and st and ardised tool in assessing palpation pain over the tibia . The purpose of this study was to analyse the intra-rater repeatability of PA and to determine whether tibial tenderness in healthy runners differ from runners with medial tibial stress syndrome ( MTSS ) . Methods Pressure algometry was performed on 20 asymptomatic runners ( 40 legs ) and 9 MTSS patients ( 14 symptomatic legs ) at st and ardised locations along the medial border of the tibia . Intra-rater reliability was assessed in 10 r and omly selected asymptomatic runners through repeated measurements 2 weeks later . Results Intra-rater reliability was moderate to excellent ( ICC 0.53–0.90 ) in asymptomatic runners . Pain pressure threshold ( PPT ) was significantly reduced at 2/9–5/9 of the distance from the medial malleolus to the medial tibial condyle ( p = 0.002–0.022 ) . There was evidence of a statistically significant association between both height and weight , and PPT from the 3/9 ( r = 0.416 , p = 0.008 ) to 7/9 ( r = 0.334 , p = 0.035 ) and 3/9 ( r = 0.448 , p = 0.004 ) to 6/9 ( r = 0.337 , p = 0.034 ) area , respectively . In both MTSS patients and healthy runners , there was evidence of lower PPT in females compared to males ( p = 0.0001–0.049 ) and a negative association between age and PPT ( p = 0.001–0.033 ) . MTSS patients had significantly lower PPT at the 3/9 site ( p = 0.048 ) compared to asymptomatic runners . Conclusion Pain pressure threshold algometry can be incorporated into MTSS clinical assessment to objective ly assess pain and monitor progress . The presence of reduced medial tibial PPT in asymptomatic runners suggests that clinicians may not need to await resolution of medial tibia tenderness before allowing return to sport in MTSS patients .Level of evidence III OBJECTIVE To evaluate the interobserver reproducibility of the assessment of severity of complaints , grip strength , and pressure pain threshold in patients with lateral epicondylitis in primary care . DESIGN Two physiotherapists assessed independently , and in r and omized order , the severity of complaints scored on an 11-point numeric rating scale , pain-free grip strength , maximum grip strength , and pressure pain threshold . SETTING Primary care center in the Netherl and s. PARTICIPANTS Fifty patients were assessed by both physiotherapists . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Intraclass correlation coefficients ( ICCs ) and 95 % confidence intervals ( CIs ) were calculated to assess interobserver reliability . The Bl and and Altman method was used to assess interobserver agreement , which included calculation of the mean difference between the observers ( d ) , the 95 % CI for d , the st and ard deviation of the differences , and the 95 % limits of agreement . Finally , the smallest detectable difference ( SDD ) was calculated . RESULTS The ICC for the severity of complaints was.90 . The ICCs for the pain-free grip strength and maximum grip strength were.97 and .98 , respectively . The pressure pain threshold showed a lower reliability ( ICC=.77 ) . The interobserver agreement for all outcome measures was good , but systematic differences in assessment between the physiotherapists were found for the maximum grip strength and pressure pain threshold . For pressure pain threshold , the SDD was clearly larger than the predefined acceptable difference of 10 % of the total range of measurement . CONCLUSIONS The interobserver reliability of severity of complaints and grip strength was excellent , whereas the pressure pain threshold showed unsatisfactory reliability . Grip strength and overall assessment of the severity of complaints are useful and reliable measures for the assessment of lateral epicondylitis . Pain-free grip strength , in particular , is relatively easy to perform and has been shown to be associated with other measures of functional disability in patients with lateral epicondylitis . We , therefore , recommend the use of pain-free grip strength in both research and clinical practice Physiotherapists frequently use manipulative therapy techniques to treat dysfunction and pain result ing from ankle sprain . This study investigated whether a Mulligan 's mobilization with movement ( MWM ) technique improves talocrural dorsiflexion , a major impairment following ankle sprain , and relieves pain in subacute population s. Fourteen subjects with subacute grade II lateral ankle sprains served as their own control in a repeated measures , double-blind r and omized controlled trial that measured the initial effects of the MWM treatment on weight bearing dorsiflexion and pressure and thermal pain threshold . The subacute ankle sprain group studied displayed deficits in dorsiflexion and local pressure pain threshold in the symptomatic ankle . Significant improvements in dorsiflexion occurred initially post-MWM ( F(2,26 ) = 7.82 , P = 0.002 ) , but no significant changes in pressure or thermal pain threshold were observed after the treatment condition . Results indicate that the MWM treatment for ankle dorsiflexion has a mechanical rather than hypoalgesic effect in subacute ankle sprains . The mechanism by which this occurs requires investigation if we are to better underst and the role of manipulative therapy in ankle sprain management Background : Predictors of outcome in lateral epicondylalgia , which is mainly characterized as a mechanical hyperalgesia , are largely limited to sociodemographic and symptomatic factors . Quantitative sensory testing is used to study altered pain processing in various chronic pain conditions and may be of prognostic relevance . Methods : The predictive capacity of early measures of physical and psychological impairment on pain and disability and mechanical hyperalgesia , were examined using data from 41 patients assigned to placebo in a prospect i ve r and omized controlled trial of unilateral lateral epicondylalgia .  Quantitative sensory testing ( pressure , cold pain thresholds ) , motor function ( pain-free grip ) , and psychological factors ( Tampa Scale of Kinesiophobia , Hospital Anxiety and Depression Scale ) were measured at baseline . The outcome measures were the Patient-rated Tennis Elbow Evaluation ( PRTEE ) scale and pressure pain threshold ( PPT ) measured by digital algometry at the affected elbow . Backward stepwise linear regression was used to predict PRTEE and PPT scores at 2 and 12 months . Results : Cold pain threshold was the only consistent predictor for both PRTEE ( P<0.034 ) and PPT ( P<0.048 ) . Initial PRTEE was the strongest single predictor of PRTEE at 2 months , whereas female sex was the strongest single predictor of PPT ( P<0.002 ) . At 1 year , final models explained 9 % to 52 % of the variability in pain and disability and mechanical hyperalgesia , respectively . Discussion : Early assessment of cold pain threshold could be a useful clinical tool to help identify patients at risk of poorer outcomes and might provide direction for future research into mechanism-based treatment approaches for these patients AIMS The coadministration of subantinociceptive doses of oxycodone with morphine has recently been shown to result in a synergistic antinociceptive effect in rats . The present study was aim ed to investigate the possibility that coadministration of morphine and oxycodone can produce a similar synergistic effect in humans exposed to an experimental model of cold pressor test ( CPT ) . METHODS The enriched enrollment design was used to exclude ' stoic ' and ' placebo responders ' in a single-blind fashion . ' Nonstoic ' , placebo ' nonresponder ' female volunteers ( n = 30 ) were r and omly assigned to receive 0.5 mg kg(-1 ) oral morphine sulphate , 0.5 mg kg(-1 ) oral oxycodone hydrochloride , and the combination of 0.25 mg kg(-1 ) morphine sulphate with 0.25 mg kg(-1 ) oxycodone hydrochloride , 1 week apart from each other , in a double-blind crossover design . Latency to pain onset ( threshold ) , pain intensity ( VAS ) , and pain tolerance ( time until removal of the h and from the water ) were measured six times over a 3-h period , subsequent to the administration of each medication , and were used to assess their antinociceptive effect . RESULTS The combination produced a significantly higher effect on latency to pain onset than that of morphine alone [ difference in mean postbaseline value 2.2 ; 95 % confidence interval ( CI ) 0.48 , 3.9 ; P = 0.01 ] but the effect was nonsignificantly smaller that that of oxycodone alone . Similarly , the effect of the combination on pain tolerance was significantly larger than that of morphine alone ( combination difference 8.4 ; 95 % CI 2.5 , 14.3 ; P = 0.007 ) , whereas oxycodone alone 
    Output:
    
agent
The level of evidence for PMPs varied across different test procedures in different types of PJP .
H and -held pressure algometry is the only test procedure that showed moderate positive evidence of intrarater reliability , agreement , and responsiveness , simultaneously , when it was investigated in patients with chronic knee osteoarthritis .
***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: & NA ; The large inter‐individual variability in the magnitude of analgesia in response to opioids and the high prevalence of adverse events associated with their use underline the clinical importance of being able to predict who will or will not respond to opioid treatment . The present study used both static and dynamic quantitative sensory testing ( QST ) on 40 healthy volunteers in order to test whether this methodology can predict the analgesic effects of oral oxycodone , as compared to a placebo , on latency to onset , pain intensity , and tolerance to the cold pressor test ( CPT ) . Static QST consisted of measuring heat and cold pain thresholds . Dynamic QST included measurements of the magnitude of the diffuse noxious inhibitory control (DNIC)‐like effect and of temporal summation ( TS ) . Results showed that oxycodone , but not the placebo , significantly elevated the latency and tolerance to cold pain and significantly reduced pain intensity . The static QST results showed that heat pain thresholds predicted the magnitude of reduction in pain intensity in response to oxycodone treatment ( F(1,22 ) = 5.63 , p = 0.027 , R2 = 0.17 ) . The dynamic QST results showed that TS predicted the effect of oxycodone on the tolerance to CPT ( F(1,38 ) = 9.11 , p = 0.005 , R2 = 0.17 ) . These results suggest that both static and dynamic QST have the potential to be useful in the prediction of the response to opioid treatment Summary Pain responses to 2 types of preoperative heat stimuli were not independent clinical ly relevant predictors for postoperative pain after total knee arthroplasty . ABSTRACT It has been estimated that up to 54 % of the variance in postoperative pain experience may be predicted with preoperative pain responses to experimental stimuli , with suprathreshold heat pain as the most consistent test modality . This study aim ed to explore whether 2 heat test paradigms could predict postoperative pain  after total knee arthroplasty ( TKA ) . Patients scheduled for elective , unilateral , primary TKA under spinal anesthesia were consecutively included in this prospect i ve , observational study . Perioperative analgesia was st and ardized for all patients . Outcomes were postoperative pain during walk : from 6 to 24 hours ( primary ) , from postoperative day ( POD ) 1 to 7 ( secondary ) , and from POD 14 to 30 ( tertiary ) . Two preoperative tonic heat stimuli with 47 ° C were used ; short ( 5 seconds ) and long ( 7 minutes ) stimulation upon which patients rated their pain response on an electronic visual analog scale . Multivariate stepwise linear and logistic regressions analyses were carried out , including 8 potential preoperative explanatory variables ( among these anxiety , depression , preoperative pain , and pain catastrophizing ) to assess pain response to preoperative heat pain stimulation as an independent predictor for postoperative pain . A total of 100 patients were included , and 3 were later excluded . A weak correlation [ rho ( 95 % confidence interval ) ; P value ] was observed between pain from POD 1 to 7 and pain response to short [ rho = 0.25(0.04 to 0.44 ) ; P = .02 ] and to long [ rho = 0.27 ( 0.07 to 0.46 ) ; P = .01 ] heat pain stimulation . However , these positive correlations were not supported by the linear and logistic regression analyses , in which only anxiety , preoperative pain , and pain catastrophizing were significant explanatory variables ( but with low R‐squares ; 0.05 to 0.08 ) . Pain responses to 2 types of preoperative heat stimuli were not independent clinical ly relevant predictors for postoperative pain after TKA Several lines of evidence suggest that mental motor imagery is subserved by the same cognitive operations and brain structures that underlie action . Additionally , motor imagery is informed by the anticipated sensory consequences of action , including pain . We reasoned that motor imagery could provide a useful measure of  chronic leg or foot pain . Forty subjects with leg pain ( 19 bilateral , 11 right , and 10 left leg pain ) , 42 subjects with chronic pain not involving the legs , and 38 controls were shown 12 different line drawings of the right or left foot and asked to indicate which foot was depicted . Previous work suggests that subjects perform this task by mentally rotating their foot to match the visually presented stimulus . All groups of subjects were slower and less accurate with stimuli that required a greater degree of mental rotation of their foot . Subjects with leg pain were both slower and less accurate than normal and pain control subjects in responding to drawings of a painful extremity . Furthermore , subjects with leg pain exhibited a significantly greater decrement in performance for stimuli that required larger amplitude mental rotations . These data suggest that motor imagery may provide important insights into the nature of the pain experience Purpose Pressure algometry ( PA ) may provide an objective and st and ardised tool in assessing palpation pain over the tibia . The purpose of this study was to analyse the intra-rater repeatability of PA and to determine whether tibial tenderness in healthy runners differ from runners with medial tibial stress syndrome ( MTSS ) . Methods Pressure algometry was performed on 20 asymptomatic runners ( 40 legs ) and 9 MTSS patients ( 14 symptomatic legs ) at st and ardised locations along the medial border of the tibia . Intra-rater reliability was assessed in 10 r and omly selected asymptomatic runners through repeated measurements 2 weeks later . Results Intra-rater reliability was moderate to excellent ( ICC 0.53–0.90 ) in asymptomatic runners . Pain pressure threshold ( PPT ) was significantly reduced at 2/9–5/9 of the distance from the medial malleolus to the medial tibial condyle ( p = 0.002–0.022 ) . There was evidence of a statistically significant association between both height and weight , and PPT from the 3/9 ( r = 0.416 , p = 0.008 ) to 7/9 ( r = 0.334 , p = 0.035 ) and 3/9 ( r = 0.448 , p = 0.004 ) to 6/9 ( r = 0.337 , p = 0.034 ) area , respectively . In both MTSS patients and healthy runners , there was evidence of lower PPT in females compared to males ( p = 0.0001–0.049 ) and a negative association between age and PPT ( p = 0.001–0.033 ) . MTSS patients had significantly lower PPT at the 3/9 site ( p = 0.048 ) compared to asymptomatic runners . Conclusion Pain pressure threshold algometry can be incorporated into MTSS clinical assessment to objective ly assess pain and monitor progress . The presence of reduced medial tibial PPT in asymptomatic runners suggests that clinicians may not need to await resolution of medial tibia tenderness before allowing return to sport in MTSS patients .Level of evidence III OBJECTIVE To evaluate the interobserver reproducibility of the assessment of severity of complaints , grip strength , and pressure pain threshold in patients with lateral epicondylitis in primary care . DESIGN Two physiotherapists assessed independently , and in r and omized order , the severity of complaints scored on an 11-point numeric rating scale , pain-free grip strength , maximum grip strength , and pressure pain threshold . SETTING Primary care center in the Netherl and s. PARTICIPANTS Fifty patients were assessed by both physiotherapists . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Intraclass correlation coefficients ( ICCs ) and 95 % confidence intervals ( CIs ) were calculated to assess interobserver reliability . The Bl and and Altman method was used to assess interobserver agreement , which included calculation of the mean difference between the observers ( d ) , the 95 % CI for d , the st and ard deviation of the differences , and the 95 % limits of agreement . Finally , the smallest detectable difference ( SDD ) was calculated . RESULTS The ICC for the severity of complaints was.90 . The ICCs for the pain-free grip strength and maximum grip strength were.97 and .98 , respectively . The pressure pain threshold showed a lower reliability ( ICC=.77 ) . The interobserver agreement for all outcome measures was good , but systematic differences in assessment between the physiotherapists were found for the maximum grip strength and pressure pain threshold . For pressure pain threshold , the SDD was clearly larger than the predefined acceptable difference of 10 % of the total range of measurement . CONCLUSIONS The interobserver reliability of severity of complaints and grip strength was excellent , whereas the pressure pain threshold showed unsatisfactory reliability . Grip strength and overall assessment of the severity of complaints are useful and reliable measures for the assessment of lateral epicondylitis . Pain-free grip strength , in particular , is relatively easy to perform and has been shown to be associated with other measures of functional disability in patients with lateral epicondylitis . We , therefore , recommend the use of pain-free grip strength in both research and clinical practice Physiotherapists frequently use manipulative therapy techniques to treat dysfunction and pain result ing from ankle sprain . This study investigated whether a Mulligan 's mobilization with movement ( MWM ) technique improves talocrural dorsiflexion , a major impairment following ankle sprain , and relieves pain in subacute population s. Fourteen subjects with subacute grade II lateral ankle sprains served as their own control in a repeated measures , double-blind r and omized controlled trial that measured the initial effects of the MWM treatment on weight bearing dorsiflexion and pressure and thermal pain threshold . The subacute ankle sprain group studied displayed deficits in dorsiflexion and local pressure pain threshold in the symptomatic ankle . Significant improvements in dorsiflexion occurred initially post-MWM ( F(2,26 ) = 7.82 , P = 0.002 ) , but no significant changes in pressure or thermal pain threshold were observed after the treatment condition . Results indicate that the MWM treatment for ankle dorsiflexion has a mechanical rather than hypoalgesic effect in subacute ankle sprains . The mechanism by which this occurs requires investigation if we are to better underst and the role of manipulative therapy in ankle sprain management Background : Predictors of outcome in lateral epicondylalgia , which is mainly characterized as a mechanical hyperalgesia , are largely limited to sociodemographic and symptomatic factors . Quantitative sensory testing is used to study altered pain processing in various chronic pain conditions and may be of prognostic relevance . Methods : The predictive capacity of early measures of physical and psychological impairment on pain and disability and mechanical hyperalgesia , were examined using data from 41 patients assigned to placebo in a prospect i ve r and omized controlled trial of unilateral lateral epicondylalgia .  Quantitative sensory testing ( pressure , cold pain thresholds ) , motor function ( pain-free grip ) , and psychological factors ( Tampa Scale of Kinesiophobia , Hospital Anxiety and Depression Scale ) were measured at baseline . The outcome measures were the Patient-rated Tennis Elbow Evaluation ( PRTEE ) scale and pressure pain threshold ( PPT ) measured by digital algometry at the affected elbow . Backward stepwise linear regression was used to predict PRTEE and PPT scores at 2 and 12 months . Results : Cold pain threshold was the only consistent predictor for both PRTEE ( P<0.034 ) and PPT ( P<0.048 ) . Initial PRTEE was the strongest single predictor of PRTEE at 2 months , whereas female sex was the strongest single predictor of PPT ( P<0.002 ) . At 1 year , final models explained 9 % to 52 % of the variability in pain and disability and mechanical hyperalgesia , respectively . Discussion : Early assessment of cold pain threshold could be a useful clinical tool to help identify patients at risk of poorer outcomes and might provide direction for future research into mechanism-based treatment approaches for these patients AIMS The coadministration of subantinociceptive doses of oxycodone with morphine has recently been shown to result in a synergistic antinociceptive effect in rats . The present study was aim ed to investigate the possibility that coadministration of morphine and oxycodone can produce a similar synergistic effect in humans exposed to an experimental model of cold pressor test ( CPT ) . METHODS The enriched enrollment design was used to exclude ' stoic ' and ' placebo responders ' in a single-blind fashion . ' Nonstoic ' , placebo ' nonresponder ' female volunteers ( n = 30 ) were r and omly assigned to receive 0.5 mg kg(-1 ) oral morphine sulphate , 0.5 mg kg(-1 ) oral oxycodone hydrochloride , and the combination of 0.25 mg kg(-1 ) morphine sulphate with 0.25 mg kg(-1 ) oxycodone hydrochloride , 1 week apart from each other , in a double-blind crossover design . Latency to pain onset ( threshold ) , pain intensity ( VAS ) , and pain tolerance ( time until removal of the h and from the water ) were measured six times over a 3-h period , subsequent to the administration of each medication , and were used to assess their antinociceptive effect . RESULTS The combination produced a significantly higher effect on latency to pain onset than that of morphine alone [ difference in mean postbaseline value 2.2 ; 95 % confidence interval ( CI ) 0.48 , 3.9 ; P = 0.01 ] but the effect was nonsignificantly smaller that that of oxycodone alone . Similarly , the effect of the combination on pain tolerance was significantly larger than that of morphine alone ( combination difference 8.4 ; 95 % CI 2.5 , 14.3 ; P = 0.007 ) , whereas oxycodone alone 
    Output:
    