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: An open-label r and omized pilot study was conducted to evaluate the efficacy and acceptability of 6 months treatment with leuprolide in a 3-monthly versus a monthly i.m . depot injection for the relief of chronic pelvic pain in women with endometriosis . A total of 30 women aged 18 - 38 years were allocated to the 3-monthly depot arm ( n = 15 ) or to the monthly depot arm ( n = 15 ) after laparoscopic diagnosis of pelvic endometriosis .  Mean ( SD ) deep dyspareunia scores according to a 0 - 3 point verbal rating scale decreased from 1.8 ( 0.9 ) at baseline to 1.3 ( 0.7 ) at the end of treatment in the 3-monthly depot group and from 2.1 ( 1.2 ) to 1.3 ( 0.7 ) in the monthly depot group . Corresponding values in non-menstrual pain scores fell from 2.1 ( 0.6 ) to 1.1 ( 0.3 ) , and from 2.1 ( 0.8 ) to 1.2 ( 0.4 ) respectively , without statistically significant differences between the groups . Serum luteinizing hormone ( LH ) and 17 beta-oestradiol concentrations were significantly suppressed at 12 and 24 weeks compared with baseline values , without differences between the groups . The monthly depot caused a slightly more marked inhibition of serum follicle stimulating hormone ( FSH ) levels with respect to the 3-monthly preparation . Mean ( SD ) endometriosis scores at baseline and at 6-month follow-up laparoscopy were respectively 32.8 ( 25.1 ) and 12.2 ( 9.3 ) in the 3-monthly depot group and 29.0 ( 22.7 ) and 13.1 ( 15.3 ) in the monthly depot group ( paired t-test , P < 0.05 ) . Mean percentage decrease in lumbar spine bone mineral density was 5.2 % in the former and 4.9 % in the latter subjects . In the 3-monthly depot group , 13 women grade d the tolerability of their treatment schedule as " good ' compared with seven in the monthly depot group ( chi 2 = 5.40 , P = 0.02 ) Background : Prior study has shown that right paracolic adhesions are found in 90 % of patients with chronic pelvic pain and less frequently in pain-free patients . We set out to determine whether paracolic adhesiolysis will reduce site-specific pain . Methods : This was a prospect i ve , r and omized trial of right paracolic adhesiolysis at the time of diagnostic and operative laparoscopy for chronic pelvic pain . Twenty-five patients with a diagnosis of chronic pelvic pain were r and omized to either undergo or withhold lysis of right paracolic adhesions at the time of operative laparoscopy . Results : Right paracolic adhesions were found in 100 % of our patients . For all subjects , there was a significant reduction of right and left lower quadrant pain ( P<0.001 ) following the operative laparoscopy . Those who underwent right paracolic adhesiolysis had significantly greater right pelvic pain reduction than those who did not ( P=0.014 ) . There was no difference in the reduction of left or mid pelvic pain between the treatment and control groups . Conclusions : Right paracolic adhesiolysis reduces short-term site-specific tenderness in patients with chronic pelvic pain . Patients who would benefit from diagnostic or operative laparoscopy are likely to benefit further from paracolic adhesiolysis OBJECTIVE To compare the efficacy and safety of SC depot medroxyprogesterone acetate ( DMPA-SC 104 ) with that of leuprolide acetate in treatment of endometriosis . DESIGN Phase 3 , multicenter , r and omized , evaluator-blinded , comparator-controlled trial . SETTING Clinical trial sites in Canada and United States . PATIENT(S ) Two hundred seventy-four women with surgically diagnosed endometriosis . INTERVENTION(S ) Intramuscular injections of DMPA-SC ( 104 mg ) or leuprolide acetate ( 11.25 mg ) , given every 3 months for 6 months , with 12 months of posttreatment follow-up . MAIN OUTCOME MEASURE(S ) Reduction in five endometriosis symptoms or signs ( dysmenorrhea , dyspareunia , pelvic pain , pelvic tenderness , pelvic in duration ) ; change in bone mineral density ( BMD ) , hypoestrogenic symptoms , bleeding , and weight . RESULT ( S ) The depot medroxyprogesterone acetate given SC was statistically equivalent to leuprolide in reducing four of five endometriosis symptoms or signs at the end of treatment ( month 6 ) and in reducing all five symptoms after 12 months ' follow-up ( month 18 ) . Patients in the  DMPA-SC 104  group showed significantly less BMD loss than did leuprolide  patients at month 6 , with scores returning to baseline at 12 months ' follow-up . No statistically significant differences in median weight changes were observed between groups . Compared with leuprolide , DMPA-SC 104 was associated with fewer hypoestrogenic symptoms but more irregular bleeding . CONCLUSION ( S ) Efficacy of DMPA-SC 104 was equivalent to that of leuprolide for reducing endometriosis-associated pain , with less impact on BMD and fewer hypoestrogenic side effects but more bleeding The effect of treatment with danazol was evaluated with respect to expectant management after laparoscopic conservative surgery . All patients conservatively operated at laparoscopy for stage III-IV endometriosis from July 1994 to October 1996 were requested to enter the study . Patients who underwent surgery for recurrent endometriosis were excluded from the study , as well as patients who had taken hormonal therapies before laparoscopy . Informed consent was obtained from 77 women who were r and omized after surgery to treatment with danazol 600 mg daily for 3 months ( n = 36 ) or to expectant management ( n = 41 ) . All patients were regularly followed up every 6 months for evaluation of fertility , recurrence of pain symptoms and disease . During the follow-up , six ( 55 % ) of the 11 infertile women allocated to danazol and eight ( 50 % ) of the 16 given no treatment became pregnant ( not significant ) . Moderate/severe pelvic pain recurred during follow-up in seven ( 23 % ) of the 31 women with pelvic pain allocated to the danazol group and nine ( 31 % ) of the 29 allocated to no treatment ; the respective cumulative pain recurrence rates at 12 months were 26 and 34 % ( log rank test , not significant ) . Three women ( 8.3 % ) treated with danazol and six ( 15 % ) who received no treatment had disease recurrence as demonstrated by gynaecological examination and /or pelvic ultrasonography ( not significant ) . Our results do not demonstrate a significant advantage of 3 month danazol therapy after laparoscopic surgery for stage III-IV endometriosis with respect to postoperative expectant management OBJECTIVE There are fundamental differences between the administration of medications and the application of manual procedures , such as those used by chiropractors . The objective of this study was to gather preliminary information on how to address these differences in the design of a multisite , r and omized placebo-controlled trial of chiropractic care for women with chronic pelvic pain ( CPP ) . DESIGN Pilot study for a multisite , r and omized , placebo-controlled clinical trial . SETTING Three chiropractic research clinics in the midwest United States . SUBJECTS Thirty-nine ( 39 ) women with CPP of at least 6 months ' duration , diagnosed by board-certified gynecologists . INTERVENTIONS The active intervention consisted of the chiropractic technique , lumbar spine flexion-distraction , combined with manual Trigger Point Therapy . The placebo intervention consisted of a sham chiropractic procedure performed with an instrument combined with effleurage ( light massage ) . OUTCOME MEASURES The primary outcome measure was the change in the Pain Disability Index ( PDI ) from baseline to the end of treatment ( 6 weeks ) , assessed by group and site . If the change score was in the same direction at all sites , the results were to be combined to estimate treatment effect size . RESULTS Patient characteristics were similar to those of patients with CPP in other studies . Recruitment methods , particularly in respect to the eligibility criteria and screening protocol s , would require modification in order to recruit an adequate sample for the planned r and omized controlled trial . Clinicians followed st and ardized procedures with apparently minimal deviation , patients in both groups were satisfied with their care and blinding appeared to be successful . PDI change scores were not consistent across sites and so results were not combined and overall treatment effect sizes were not estimated . CONCLUSIONS The technical and personnel re sources required to achieve adequate st and ardization of procedures at multiple sites may make a placebo-controlled trial unfeasible , given our current lack of knowledge about the active agent in manual chiropractic procedures Summary BACKGROUND : The aim of this study was to compare the efficacy and side effects of gabapentin , amitriptyline , and their combination in women with chronic pelvic pain . METHODS : In this open-label , prospect i ve , r and omized trial , 56 women with chronic pelvic pain were investigated with a two-year follow-up at the Vienna Medical University Hospital . If pain intensity assessed by a visual analog scale ( VAS ) was 5 or more ( 0 , no pain ; 10 , maximal pain ) , despite analgesic therapy using the nonopioid drug metamizol together with weak opioids , patients were r and omized to receive gabapentin ( n = 20 ) , amitriptyline ( n = 20 ) , or a combination of both drugs ( n = 16 ) . Doses of gabapentin and amitriptyline were increased to maximum daily doses of 3600 mg and 150 mg , respectively , until sufficient pain relief or the occurrence of side effects . VAS and side effects were evaluated before treatment and at 1 , 3 , 6 , 12 and 24 months afterwards . RESULTS : All patients experienced significant pain relief during the observation period . However , after 6 , 12 and 24 months , pain relief was significantly better in patients receiving gabapentin either alone or in combination with amitriptyline than in patients receiving monotherapy with amitriptyline ( gabapentin : 0 months , 7.7 ± 1.5 ; 6 months , 1.6 ± 0.9 ; 12 months , 1.5 ± 0.9 ; 24 months , 1.9 ± 0.9 ; amitriptyline : 0 months , 7.3 ± 1.5 ; 6 months , 2.2 ± 1.6 ; 12 months , 2.2 ± 1.6 ; 24 months ; 3.4 ± 0.9 ; amitriptyline-gabapentin : 0 months , 7.6 ± 0.8 ; 6 months , 1.3 ± 0.9 ; 12 months , 1.7 ± 1.0 ; 24 months , 2.3 ± 0.9 ) . Side effects were lower in the gabapentin group than in the two other groups , the difference reaching statistical significance after three months ( P < 0.05 ) . CONCLUSION : Gabapentin alone or in combination with amitriptyline is better than amitriptyline alone in the treatment of female chronic pelvic pain . ZusammenfassungEINLEITUNG : Gegenst and der Studie war der Vergleich der Wirksamkeit und Verträglichkeit von Gabapentin bzw . Amitriptylin allein mit der Kombination der beiden Medikamente bei chronischen Unterbauchschmerzen ( chronic pelvic pain , CPP ) . METHOD EN : 56 weibliche Patientinnen mit chronischen Unterbauschmerzen wurden bei der prospektiven , r and omisierten Open-label-Studie mit einem 2-jährigem Follow-up an der Schmerzambulanz der Universitätsklinik Wien , Österreich , eingeschlossen . Wenn die Schmerzintensität trotz analgetischer Therapie mit dem Nichtopioid Metamizol und einem schwachen Opioid gemessen auf der visuellen Analogskala ( VAS ) bei 5 oder darüber lag ( 0 , kein Schmerz ; 10 , schlimmster vorstellbarer Schmerz ) , wurden die Patientinnen r and omisiert einem der drei Beh and lungsarme zugeteilt ( Gabapentin , n = 20 ; Amitriptylin , n = 20 , oder beides , n = 16 ) . Die Medikamentengaben von Gabapentin bzw . Amitriptylin wurden auf eine tägliche Dosis von 3600 mg bzw . 150 mg gesteigert , bis eine suffiziente Schmerzerleichterung erreicht war oder unerwünschte Nebenwirkungen auftraten . VAS-Werte wurde vor Beginn der Beh and lung und 1 , 3 , 6 , 12 und 24 Monate danach erhoben . ERGEBNISSE : Alle Patientinnen erfuhren während des Beobachtungszeitraumes eine signifikante Schmerzreduktion . Dennoch war die Schmerzreduktion bei Patientinnen , die Gabapentin allein oder in Kombination mit Amitriptylin erhalten hatten , signifikant höher als unter Monotherapie mit Amitriptylin ( Gabapentin : 0 , 7,7 ± 1,5 ; 6 , 1,6 ± 0,9 ; 12 , 1,5 ± 0 
    Output:
    
agent
RESULTS The instruments most frequently used were single-item VAS and Biberoglu and Behrman pain score , while multidimensional inventories were used in few studies .
The results of clinical studies in CPP are more frequently based on one-dimensional measurements .
***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: An open-label r and omized pilot study was conducted to evaluate the efficacy and acceptability of 6 months treatment with leuprolide in a 3-monthly versus a monthly i.m . depot injection for the relief of chronic pelvic pain in women with endometriosis . A total of 30 women aged 18 - 38 years were allocated to the 3-monthly depot arm ( n = 15 ) or to the monthly depot arm ( n = 15 ) after laparoscopic diagnosis of pelvic endometriosis .  Mean ( SD ) deep dyspareunia scores according to a 0 - 3 point verbal rating scale decreased from 1.8 ( 0.9 ) at baseline to 1.3 ( 0.7 ) at the end of treatment in the 3-monthly depot group and from 2.1 ( 1.2 ) to 1.3 ( 0.7 ) in the monthly depot group . Corresponding values in non-menstrual pain scores fell from 2.1 ( 0.6 ) to 1.1 ( 0.3 ) , and from 2.1 ( 0.8 ) to 1.2 ( 0.4 ) respectively , without statistically significant differences between the groups . Serum luteinizing hormone ( LH ) and 17 beta-oestradiol concentrations were significantly suppressed at 12 and 24 weeks compared with baseline values , without differences between the groups . The monthly depot caused a slightly more marked inhibition of serum follicle stimulating hormone ( FSH ) levels with respect to the 3-monthly preparation . Mean ( SD ) endometriosis scores at baseline and at 6-month follow-up laparoscopy were respectively 32.8 ( 25.1 ) and 12.2 ( 9.3 ) in the 3-monthly depot group and 29.0 ( 22.7 ) and 13.1 ( 15.3 ) in the monthly depot group ( paired t-test , P < 0.05 ) . Mean percentage decrease in lumbar spine bone mineral density was 5.2 % in the former and 4.9 % in the latter subjects . In the 3-monthly depot group , 13 women grade d the tolerability of their treatment schedule as " good ' compared with seven in the monthly depot group ( chi 2 = 5.40 , P = 0.02 ) Background : Prior study has shown that right paracolic adhesions are found in 90 % of patients with chronic pelvic pain and less frequently in pain-free patients . We set out to determine whether paracolic adhesiolysis will reduce site-specific pain . Methods : This was a prospect i ve , r and omized trial of right paracolic adhesiolysis at the time of diagnostic and operative laparoscopy for chronic pelvic pain . Twenty-five patients with a diagnosis of chronic pelvic pain were r and omized to either undergo or withhold lysis of right paracolic adhesions at the time of operative laparoscopy . Results : Right paracolic adhesions were found in 100 % of our patients . For all subjects , there was a significant reduction of right and left lower quadrant pain ( P<0.001 ) following the operative laparoscopy . Those who underwent right paracolic adhesiolysis had significantly greater right pelvic pain reduction than those who did not ( P=0.014 ) . There was no difference in the reduction of left or mid pelvic pain between the treatment and control groups . Conclusions : Right paracolic adhesiolysis reduces short-term site-specific tenderness in patients with chronic pelvic pain . Patients who would benefit from diagnostic or operative laparoscopy are likely to benefit further from paracolic adhesiolysis OBJECTIVE To compare the efficacy and safety of SC depot medroxyprogesterone acetate ( DMPA-SC 104 ) with that of leuprolide acetate in treatment of endometriosis . DESIGN Phase 3 , multicenter , r and omized , evaluator-blinded , comparator-controlled trial . SETTING Clinical trial sites in Canada and United States . PATIENT(S ) Two hundred seventy-four women with surgically diagnosed endometriosis . INTERVENTION(S ) Intramuscular injections of DMPA-SC ( 104 mg ) or leuprolide acetate ( 11.25 mg ) , given every 3 months for 6 months , with 12 months of posttreatment follow-up . MAIN OUTCOME MEASURE(S ) Reduction in five endometriosis symptoms or signs ( dysmenorrhea , dyspareunia , pelvic pain , pelvic tenderness , pelvic in duration ) ; change in bone mineral density ( BMD ) , hypoestrogenic symptoms , bleeding , and weight . RESULT ( S ) The depot medroxyprogesterone acetate given SC was statistically equivalent to leuprolide in reducing four of five endometriosis symptoms or signs at the end of treatment ( month 6 ) and in reducing all five symptoms after 12 months ' follow-up ( month 18 ) . Patients in the  DMPA-SC 104  group showed significantly less BMD loss than did leuprolide  patients at month 6 , with scores returning to baseline at 12 months ' follow-up . No statistically significant differences in median weight changes were observed between groups . Compared with leuprolide , DMPA-SC 104 was associated with fewer hypoestrogenic symptoms but more irregular bleeding . CONCLUSION ( S ) Efficacy of DMPA-SC 104 was equivalent to that of leuprolide for reducing endometriosis-associated pain , with less impact on BMD and fewer hypoestrogenic side effects but more bleeding The effect of treatment with danazol was evaluated with respect to expectant management after laparoscopic conservative surgery . All patients conservatively operated at laparoscopy for stage III-IV endometriosis from July 1994 to October 1996 were requested to enter the study . Patients who underwent surgery for recurrent endometriosis were excluded from the study , as well as patients who had taken hormonal therapies before laparoscopy . Informed consent was obtained from 77 women who were r and omized after surgery to treatment with danazol 600 mg daily for 3 months ( n = 36 ) or to expectant management ( n = 41 ) . All patients were regularly followed up every 6 months for evaluation of fertility , recurrence of pain symptoms and disease . During the follow-up , six ( 55 % ) of the 11 infertile women allocated to danazol and eight ( 50 % ) of the 16 given no treatment became pregnant ( not significant ) . Moderate/severe pelvic pain recurred during follow-up in seven ( 23 % ) of the 31 women with pelvic pain allocated to the danazol group and nine ( 31 % ) of the 29 allocated to no treatment ; the respective cumulative pain recurrence rates at 12 months were 26 and 34 % ( log rank test , not significant ) . Three women ( 8.3 % ) treated with danazol and six ( 15 % ) who received no treatment had disease recurrence as demonstrated by gynaecological examination and /or pelvic ultrasonography ( not significant ) . Our results do not demonstrate a significant advantage of 3 month danazol therapy after laparoscopic surgery for stage III-IV endometriosis with respect to postoperative expectant management OBJECTIVE There are fundamental differences between the administration of medications and the application of manual procedures , such as those used by chiropractors . The objective of this study was to gather preliminary information on how to address these differences in the design of a multisite , r and omized placebo-controlled trial of chiropractic care for women with chronic pelvic pain ( CPP ) . DESIGN Pilot study for a multisite , r and omized , placebo-controlled clinical trial . SETTING Three chiropractic research clinics in the midwest United States . SUBJECTS Thirty-nine ( 39 ) women with CPP of at least 6 months ' duration , diagnosed by board-certified gynecologists . INTERVENTIONS The active intervention consisted of the chiropractic technique , lumbar spine flexion-distraction , combined with manual Trigger Point Therapy . The placebo intervention consisted of a sham chiropractic procedure performed with an instrument combined with effleurage ( light massage ) . OUTCOME MEASURES The primary outcome measure was the change in the Pain Disability Index ( PDI ) from baseline to the end of treatment ( 6 weeks ) , assessed by group and site . If the change score was in the same direction at all sites , the results were to be combined to estimate treatment effect size . RESULTS Patient characteristics were similar to those of patients with CPP in other studies . Recruitment methods , particularly in respect to the eligibility criteria and screening protocol s , would require modification in order to recruit an adequate sample for the planned r and omized controlled trial . Clinicians followed st and ardized procedures with apparently minimal deviation , patients in both groups were satisfied with their care and blinding appeared to be successful . PDI change scores were not consistent across sites and so results were not combined and overall treatment effect sizes were not estimated . CONCLUSIONS The technical and personnel re sources required to achieve adequate st and ardization of procedures at multiple sites may make a placebo-controlled trial unfeasible , given our current lack of knowledge about the active agent in manual chiropractic procedures Summary BACKGROUND : The aim of this study was to compare the efficacy and side effects of gabapentin , amitriptyline , and their combination in women with chronic pelvic pain . METHODS : In this open-label , prospect i ve , r and omized trial , 56 women with chronic pelvic pain were investigated with a two-year follow-up at the Vienna Medical University Hospital . If pain intensity assessed by a visual analog scale ( VAS ) was 5 or more ( 0 , no pain ; 10 , maximal pain ) , despite analgesic therapy using the nonopioid drug metamizol together with weak opioids , patients were r and omized to receive gabapentin ( n = 20 ) , amitriptyline ( n = 20 ) , or a combination of both drugs ( n = 16 ) . Doses of gabapentin and amitriptyline were increased to maximum daily doses of 3600 mg and 150 mg , respectively , until sufficient pain relief or the occurrence of side effects . VAS and side effects were evaluated before treatment and at 1 , 3 , 6 , 12 and 24 months afterwards . RESULTS : All patients experienced significant pain relief during the observation period . However , after 6 , 12 and 24 months , pain relief was significantly better in patients receiving gabapentin either alone or in combination with amitriptyline than in patients receiving monotherapy with amitriptyline ( gabapentin : 0 months , 7.7 ± 1.5 ; 6 months , 1.6 ± 0.9 ; 12 months , 1.5 ± 0.9 ; 24 months , 1.9 ± 0.9 ; amitriptyline : 0 months , 7.3 ± 1.5 ; 6 months , 2.2 ± 1.6 ; 12 months , 2.2 ± 1.6 ; 24 months ; 3.4 ± 0.9 ; amitriptyline-gabapentin : 0 months , 7.6 ± 0.8 ; 6 months , 1.3 ± 0.9 ; 12 months , 1.7 ± 1.0 ; 24 months , 2.3 ± 0.9 ) . Side effects were lower in the gabapentin group than in the two other groups , the difference reaching statistical significance after three months ( P < 0.05 ) . CONCLUSION : Gabapentin alone or in combination with amitriptyline is better than amitriptyline alone in the treatment of female chronic pelvic pain . ZusammenfassungEINLEITUNG : Gegenst and der Studie war der Vergleich der Wirksamkeit und Verträglichkeit von Gabapentin bzw . Amitriptylin allein mit der Kombination der beiden Medikamente bei chronischen Unterbauchschmerzen ( chronic pelvic pain , CPP ) . METHOD EN : 56 weibliche Patientinnen mit chronischen Unterbauschmerzen wurden bei der prospektiven , r and omisierten Open-label-Studie mit einem 2-jährigem Follow-up an der Schmerzambulanz der Universitätsklinik Wien , Österreich , eingeschlossen . Wenn die Schmerzintensität trotz analgetischer Therapie mit dem Nichtopioid Metamizol und einem schwachen Opioid gemessen auf der visuellen Analogskala ( VAS ) bei 5 oder darüber lag ( 0 , kein Schmerz ; 10 , schlimmster vorstellbarer Schmerz ) , wurden die Patientinnen r and omisiert einem der drei Beh and lungsarme zugeteilt ( Gabapentin , n = 20 ; Amitriptylin , n = 20 , oder beides , n = 16 ) . Die Medikamentengaben von Gabapentin bzw . Amitriptylin wurden auf eine tägliche Dosis von 3600 mg bzw . 150 mg gesteigert , bis eine suffiziente Schmerzerleichterung erreicht war oder unerwünschte Nebenwirkungen auftraten . VAS-Werte wurde vor Beginn der Beh and lung und 1 , 3 , 6 , 12 und 24 Monate danach erhoben . ERGEBNISSE : Alle Patientinnen erfuhren während des Beobachtungszeitraumes eine signifikante Schmerzreduktion . Dennoch war die Schmerzreduktion bei Patientinnen , die Gabapentin allein oder in Kombination mit Amitriptylin erhalten hatten , signifikant höher als unter Monotherapie mit Amitriptylin ( Gabapentin : 0 , 7,7 ± 1,5 ; 6 , 1,6 ± 0,9 ; 12 , 1,5 ± 0 
    Output:
    