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: The aim of this study was to compare the efficacy of topical piroxicam and EMLA cream on pain control and subsequent inflammation in neodymium : yttrium – aluminum – garnet ( Nd : YAG ) 1,064 nm laser hair removal in female volunteers . Fifty female volunteers were enrolled in this prospect i ve , r and omized , double-blind , clinical study over a 6-month period . Patients were r and omly assigned to receive topical piroxicam as group Piroxicam or EMLA cream as group EMLA . Topical analgesics were applied to the treatment sites for 60 min . The pain scores [ on a visual analog scale ( VAS ) ] and side effects were recorded before the hair removal , during the hair removal , at the end of the hair removal , and 1 h , 2 h and 24 h after the hair removal . Patients ’ characteristics and the treatment setting s of the Nd : YAG 1,064 nm laser were similar in the two groups . The pain scores ( VAS ) were similar , and satisfaction was high in both groups after the hair removal . The number of blanching and erythema episodes were significantly higher in group E than in group P ( P < 0.001 ) . Inflammatory side effects were less frequent in group P than in group E after the procedure ( P < 0.001 ) . This study showed that topical piroxicam and EMLA provided adequate and similar pain relief after Nd : YAG 1,064 nm laser hair removal in female volunteers . Topical piroxicam was associated with fewer inflammatory side effects than was EMLA cream , because of its anti-inflammatory effect after the procedure Background . The C and ela alex and rite and the Coherent diode laser systems come equipped with built‐in skin cooling systems that are design ed to both protect the epidermis , allowing higher fluences , and to alleviate discomfort . Nevertheless , pain can be a significant problem especially with treatment of larger areas . Scatter of the laser beam is reportedly affected by the spot size . It is cl aim ed that larger spot sizes are more effective at identical fluences . Objective . This study evaluated the effectiveness of a topical 5 % lidocaine cream ( ELA‐Max ) to control pain and compared pain levels at identical fluences between the 8 mm and 12 mm spot size of the alex and rite laser and between the alex and rite and diode laser with its 9 mm spot size . Methods . The study was conducted in the axillae of 12 patients . Each axilla was divided in half for side‐by‐side comparison . Half of the right axilla was treated with the alex and rite 8 mm and the other half with the 12 mm spot size at identical fluences . The left axilla was treated at the maximum tolerated fluences with the alex and rite 12 mm spot size and the diode 9 mm spot size . Results . At identical fluences and other parameters , there was significantly more pain with the alex and rite 12 mm spot size than with the alex and rite 8 mm spot size , both with or without topical anesthesia . The alex and rite laser was significantly less painful than the diode laser both with and without topical anesthetic . The difference was most noticeable between the alex and rite 8 mm spot size and the diode 9 mm spot size . Topical 5 % lidocaine anesthesia was effective in reducing pain , though not completely , for both the alex and rite and the diode lasers . Conclusion . Topical 5 % lidocaine cream is a simple and effective method for reducing patient discomfort during laser hair removal procedures , even when a skin cooling device is being used . A larger spot size causes more pain than a smaller spot size at identical fluences . The 800 nm diode laser causes greater discomfort than the 755 nm alex and rite laser BACKGROUND AND OBJECTIVES Cold air cooling is widely used in dermatological laser therapy . We investigated the influence of cold air cooling at different skin temperatures on therapeutic outcome and side effects of pulsed dye laser treatment of facial telangiectasia . STUDY DESIGN / MATERIAL S AND METHODS From September 2002 to February 2003 , 17 patients with previously untreated facial telangiectasia underwent a single treatment session with flash-lamp pulsed dye laser  ( 3.5 J/cm(2 ) , 585 nm , 0.45 milliseconds pulse length , 10 mm beam diameter , Cynosure V ) . The treatment area was divided into three sub- areas : no cooling , cold air cooling to 20 degrees C and to 17 degrees C skin temperature . The skin temperature was monitored by a prototype infrared sensor system which controlled the temperature of the cold air stream ( Cryo5 ) . In a prospect i ve study , we collected data on purpura , pain , clearance , and patient satisfaction on numerical analog scales ( NAS ) from 0 ( meaning " no " ) to 3 ( meaning " high " ) . RESULTS Without cooling , purpura ( 2.53 ) , pain ( 2.41 ) , and clearance ( 2.35 ) were rated medium to high . Cooling to 20 degrees C reduced purpura ( 1.12 ) and pain ( 1.06 ) , whereas the clearance ( 2.12 ) was only slightly affected . Cooling to 17 degrees C reduced purpura ( 0.88 ) and pain ( 0.76 ) even more , the clearance ( 2.06 ) was lowered marginally . Most patients preferred cooling to 20 degrees C skin temperature . CONCLUSION In dermatological laser therapy of facial telangiectasia , the use of cold air cooling can significantly reduce side effects and increase patient satisfaction while only slightly affecting clearance . Cooling to 20 degrees C skin temperature proved to be a well-balanced middle course . For the practical use of cold air cooling , we thus recommend cooling to a level which the patient can tolerate without problems and to try to increase the energy densities BACKGROUND AND OBJECTIVES The use of the long-pulsed 755-nm alex and rite laser has been an effective tool in hair removal . A dynamic cooling device ( DCD ) is commonly used with this laser in order to minimize epidermal damage . No studies have examined how fine changes in DCD duration may affect comfort and epidermal damage during laser hair removal . This study was design ed to determine what effect , changes in the duration of dynamic cooling would have on pain and epidermal damage with laser hair removal ( 755 nm alex and rite ) in patients with darker skin types . STUDY DESIGN / MATERIAL S AND METHODS Ten volunteers with Fitzpatrick skin types III-V were enrolled . A 755-nm alex and rite laser with a pulse duration of 3 milliseconds and equipped with a DCD was used with the 12 mm spot size on matched treatment sites . We compared cryogen spurt duration s of 0 , 20 , 40 , 60 , 80 , and 100 milliseconds on pain and epidermal changes . The spray delay was set at 1 millisecond . Pain rating scales and epidermal changes ( skin sloughing , hyperpigmentation , hypopigmentation and scarring ) were assessed . RESULTS Overall a decrease in pain was seen with increases in spurt duration . A spurt duration of 20 milliseconds was beneficial for pain reduction in all patients . Longer spurt duration s were associated with additional pain relief especially when geographic spacing of pulses was maximized to prevent thermal build-up . In regards to epidermal protection , most patients benefited with shorter cryogen duration s of 20 - 60 milliseconds . There was little advantage with longer spurt duration s. Some patients treated at higher fluences without cooling had no detectable side effects . CONCLUSIONS Increasing DCD spurt duration in laser hair removal provides its strongest benefit in the area of pain reduction , particularly in type V patients . Increasing cryogen spurt duration s above a protective threshold shows no significant benefit in terms of epidermal protection . Changing the spurt duration may not be as important in some patients with darker skin types Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE The goals of this study were to examine agreement and estimate differences in sensitivity between pain assessment scales . DESIGN  Multiple simultaneous pain assessment s by patients in acute pain after oral surgery were used to compare a four-category verbal rating scale ( VRS-4 ) and an 11-point numeric rating scale ( NRS-11 ) with a 100-mm visual analog scale ( VAS ) . The sensitivity of the scales ( i.e. , their ability [ power ] to detect differences between treatments ) was compared in a simulation model by sampling from true pairs of observations using varying treatment differences of predetermined size . RESULTS There was considerable variability in VAS scores within each VRS-4 or NRS-11 category both between patients and for repeated measures from the same patient . Simulation experiments showed that the VAS was systematic ally more powerful than the VRS-4 in all simulations performed . The sensitivity of the VAS and NRS-11 was approximately equal . CONCLUSIONS In this acute pain model , the VRS-4 was less sensitive than the VAS . The simulation results demonstrated similar sensitivity of the NRS-11 and VAS when comparing acute postoperative pain intensity . The choice between the VAS and NRS-11 can thus be based on subjective preferences BACKGROUND A variety of topical anesthetic compounds are available for use prior to minimally or moderately painful cutaneous laser procedures . A novel lidocaine/tetracaine-based peel has recently been developed that is applied to the skin as a cream and , once air dried , is removed as a flexible film that may prove useful in providing adequate dermal anesthesia for dermatologic laser surgery . OBJECTIVE To evaluate the clinical efficacy of a novel topical anesthetic peel preparation for induction of local anesthesia prior to full-face cutaneous laser resurfacing . METHODS A series of 20 patients undergoing full-face single-pass CO2 laser resurfacing were enrolled in a double-blind institutional review board (IRB)-approved study protocol in which two different topical anesthetic products were compared . A 4 cm × 4 cm area of one cheek was r and omized to receive the novel lidocaine/tetracaine-based cream peel ( S-Caine ) while a 4 cm × 4 cm area on the contralateral side received EMLA cream with occlusion for 30 minutes prior to laser treatment . Patients rated the level of pain experienced during laser treatment on each side using a visual analog scale . Independent assessment s of observed discomfort and side effects were recorded RESULTS Pain scores were significantly lower using the novel lidocaine/tetracaine-based cream peel formulation compared with the EMLA cream . Side effects associated with application of the anesthetic peel were limited to mild transient erythema and skin blanching . CONCLUSION A novel topical lidocaine/tetracaine-based cream peel provides safe and effective dermal anesthesia for single-pass CO2 laser skin resurfacing Background : Energy densities utilized in the treatment of pigmented lesions such as solar lentigines with intense pulsed light systems are often limited by pain and post‐treatment erythema and edema . The sensation of pain associated with the treatment is immediate and acute . Application of topical anesthesia is time‐consuming , with only very moderate pain relief . Objective : ( a ) To test pain reduction as well as the reduction of post‐treatment erythema and edema when using pneumatic skin flattening ( PSF ) . This new technology utilizes an evacuation chamber to generate skin compression and activates tactile neural receptors in the skin . The result is an afferent inhibition of pain transmission in the dorsal horn ( the ‘ gate theory ’ ) . ( b ) To test the efficacy of PSF . Methods : Twenty patients were treated for solar lentigines . The patients were treated by three different IPLs . The evaluation of acute pain and post‐treatment erythema and edema was performed on all 20 patients : one to three sites per patient treated with PSF and the same number of control sites without PSF . Identical energies and IPL were applied to both sites on each patient . The pain evaluation was performed on a 10‐level scale modified McGill Pain Question naire . The clinical response to treatment was also evaluated . Results : All 20 patients completed the study and preferred the PSF treatment side over the non‐PSF side . Substantial pain reduction was observed in 19/20 patients ( 95 % ) . The average reduction of pain was by two levels , from very painful to very mild pain . Erythema reductions were observed on 14/18 ( 77 % ) patients and edema reduction on 8/9 ( 88 % ) patients . Treatment efficacy on PSF sites was identical to that of non‐PSF sites . Conclusion : The pneumatic skin flattening ( PSF ) technology considerably reduces pain , erythema and edema in the treatment of solar lentigines by IPLs . Treatment efficacy is preserved . The enhanced safety of PSF enables the increase of energy density and the acceleration of results The purpose of this study was to vali date the changes in acute pain measurement scales that are most strongly associated with a patient-determined indicator of clinical importance . Measures of pain intensity and pain relief are commonly used outcomes in therapeutic clinical trials . Recent studies of the properties of acute pain measures have provided data defining the cut-off points that are best associated with clinical ly important differences . Validation of these findings in another clinical trial data set is important . Data were obtained from the titration phase of a recently conducted r and omized controlled clinical trial of oral transmucosal fentanyl citrate ( OTFC ) , which compared OTFC to immediate release morphine sulfate ( MSIR ) for the treatment 
    Output:
    
agent
In general , active non-invasive anaesthetic methods seemed to provide favourable results compared to placebo or no anaesthesia , and topical anaesthetic drugs and PSF seemed to result in a better pain reduction than skin cooling .
However , the current evidence is insufficient to provide recommendations for daily clinical practice .
Future studies should also evaluate sex differences in pain perception , have uniformity with regard to vali date d pain measurement scales and address clinical ly significant differences in pain reduction besides statistically significant differences
***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: The aim of this study was to compare the efficacy of topical piroxicam and EMLA cream on pain control and subsequent inflammation in neodymium : yttrium – aluminum – garnet ( Nd : YAG ) 1,064 nm laser hair removal in female volunteers . Fifty female volunteers were enrolled in this prospect i ve , r and omized , double-blind , clinical study over a 6-month period . Patients were r and omly assigned to receive topical piroxicam as group Piroxicam or EMLA cream as group EMLA . Topical analgesics were applied to the treatment sites for 60 min . The pain scores [ on a visual analog scale ( VAS ) ] and side effects were recorded before the hair removal , during the hair removal , at the end of the hair removal , and 1 h , 2 h and 24 h after the hair removal . Patients ’ characteristics and the treatment setting s of the Nd : YAG 1,064 nm laser were similar in the two groups . The pain scores ( VAS ) were similar , and satisfaction was high in both groups after the hair removal . The number of blanching and erythema episodes were significantly higher in group E than in group P ( P < 0.001 ) . Inflammatory side effects were less frequent in group P than in group E after the procedure ( P < 0.001 ) . This study showed that topical piroxicam and EMLA provided adequate and similar pain relief after Nd : YAG 1,064 nm laser hair removal in female volunteers . Topical piroxicam was associated with fewer inflammatory side effects than was EMLA cream , because of its anti-inflammatory effect after the procedure Background . The C and ela alex and rite and the Coherent diode laser systems come equipped with built‐in skin cooling systems that are design ed to both protect the epidermis , allowing higher fluences , and to alleviate discomfort . Nevertheless , pain can be a significant problem especially with treatment of larger areas . Scatter of the laser beam is reportedly affected by the spot size . It is cl aim ed that larger spot sizes are more effective at identical fluences . Objective . This study evaluated the effectiveness of a topical 5 % lidocaine cream ( ELA‐Max ) to control pain and compared pain levels at identical fluences between the 8 mm and 12 mm spot size of the alex and rite laser and between the alex and rite and diode laser with its 9 mm spot size . Methods . The study was conducted in the axillae of 12 patients . Each axilla was divided in half for side‐by‐side comparison . Half of the right axilla was treated with the alex and rite 8 mm and the other half with the 12 mm spot size at identical fluences . The left axilla was treated at the maximum tolerated fluences with the alex and rite 12 mm spot size and the diode 9 mm spot size . Results . At identical fluences and other parameters , there was significantly more pain with the alex and rite 12 mm spot size than with the alex and rite 8 mm spot size , both with or without topical anesthesia . The alex and rite laser was significantly less painful than the diode laser both with and without topical anesthetic . The difference was most noticeable between the alex and rite 8 mm spot size and the diode 9 mm spot size . Topical 5 % lidocaine anesthesia was effective in reducing pain , though not completely , for both the alex and rite and the diode lasers . Conclusion . Topical 5 % lidocaine cream is a simple and effective method for reducing patient discomfort during laser hair removal procedures , even when a skin cooling device is being used . A larger spot size causes more pain than a smaller spot size at identical fluences . The 800 nm diode laser causes greater discomfort than the 755 nm alex and rite laser BACKGROUND AND OBJECTIVES Cold air cooling is widely used in dermatological laser therapy . We investigated the influence of cold air cooling at different skin temperatures on therapeutic outcome and side effects of pulsed dye laser treatment of facial telangiectasia . STUDY DESIGN / MATERIAL S AND METHODS From September 2002 to February 2003 , 17 patients with previously untreated facial telangiectasia underwent a single treatment session with flash-lamp pulsed dye laser  ( 3.5 J/cm(2 ) , 585 nm , 0.45 milliseconds pulse length , 10 mm beam diameter , Cynosure V ) . The treatment area was divided into three sub- areas : no cooling , cold air cooling to 20 degrees C and to 17 degrees C skin temperature . The skin temperature was monitored by a prototype infrared sensor system which controlled the temperature of the cold air stream ( Cryo5 ) . In a prospect i ve study , we collected data on purpura , pain , clearance , and patient satisfaction on numerical analog scales ( NAS ) from 0 ( meaning " no " ) to 3 ( meaning " high " ) . RESULTS Without cooling , purpura ( 2.53 ) , pain ( 2.41 ) , and clearance ( 2.35 ) were rated medium to high . Cooling to 20 degrees C reduced purpura ( 1.12 ) and pain ( 1.06 ) , whereas the clearance ( 2.12 ) was only slightly affected . Cooling to 17 degrees C reduced purpura ( 0.88 ) and pain ( 0.76 ) even more , the clearance ( 2.06 ) was lowered marginally . Most patients preferred cooling to 20 degrees C skin temperature . CONCLUSION In dermatological laser therapy of facial telangiectasia , the use of cold air cooling can significantly reduce side effects and increase patient satisfaction while only slightly affecting clearance . Cooling to 20 degrees C skin temperature proved to be a well-balanced middle course . For the practical use of cold air cooling , we thus recommend cooling to a level which the patient can tolerate without problems and to try to increase the energy densities BACKGROUND AND OBJECTIVES The use of the long-pulsed 755-nm alex and rite laser has been an effective tool in hair removal . A dynamic cooling device ( DCD ) is commonly used with this laser in order to minimize epidermal damage . No studies have examined how fine changes in DCD duration may affect comfort and epidermal damage during laser hair removal . This study was design ed to determine what effect , changes in the duration of dynamic cooling would have on pain and epidermal damage with laser hair removal ( 755 nm alex and rite ) in patients with darker skin types . STUDY DESIGN / MATERIAL S AND METHODS Ten volunteers with Fitzpatrick skin types III-V were enrolled . A 755-nm alex and rite laser with a pulse duration of 3 milliseconds and equipped with a DCD was used with the 12 mm spot size on matched treatment sites . We compared cryogen spurt duration s of 0 , 20 , 40 , 60 , 80 , and 100 milliseconds on pain and epidermal changes . The spray delay was set at 1 millisecond . Pain rating scales and epidermal changes ( skin sloughing , hyperpigmentation , hypopigmentation and scarring ) were assessed . RESULTS Overall a decrease in pain was seen with increases in spurt duration . A spurt duration of 20 milliseconds was beneficial for pain reduction in all patients . Longer spurt duration s were associated with additional pain relief especially when geographic spacing of pulses was maximized to prevent thermal build-up . In regards to epidermal protection , most patients benefited with shorter cryogen duration s of 20 - 60 milliseconds . There was little advantage with longer spurt duration s. Some patients treated at higher fluences without cooling had no detectable side effects . CONCLUSIONS Increasing DCD spurt duration in laser hair removal provides its strongest benefit in the area of pain reduction , particularly in type V patients . Increasing cryogen spurt duration s above a protective threshold shows no significant benefit in terms of epidermal protection . Changing the spurt duration may not be as important in some patients with darker skin types Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE The goals of this study were to examine agreement and estimate differences in sensitivity between pain assessment scales . DESIGN  Multiple simultaneous pain assessment s by patients in acute pain after oral surgery were used to compare a four-category verbal rating scale ( VRS-4 ) and an 11-point numeric rating scale ( NRS-11 ) with a 100-mm visual analog scale ( VAS ) . The sensitivity of the scales ( i.e. , their ability [ power ] to detect differences between treatments ) was compared in a simulation model by sampling from true pairs of observations using varying treatment differences of predetermined size . RESULTS There was considerable variability in VAS scores within each VRS-4 or NRS-11 category both between patients and for repeated measures from the same patient . Simulation experiments showed that the VAS was systematic ally more powerful than the VRS-4 in all simulations performed . The sensitivity of the VAS and NRS-11 was approximately equal . CONCLUSIONS In this acute pain model , the VRS-4 was less sensitive than the VAS . The simulation results demonstrated similar sensitivity of the NRS-11 and VAS when comparing acute postoperative pain intensity . The choice between the VAS and NRS-11 can thus be based on subjective preferences BACKGROUND A variety of topical anesthetic compounds are available for use prior to minimally or moderately painful cutaneous laser procedures . A novel lidocaine/tetracaine-based peel has recently been developed that is applied to the skin as a cream and , once air dried , is removed as a flexible film that may prove useful in providing adequate dermal anesthesia for dermatologic laser surgery . OBJECTIVE To evaluate the clinical efficacy of a novel topical anesthetic peel preparation for induction of local anesthesia prior to full-face cutaneous laser resurfacing . METHODS A series of 20 patients undergoing full-face single-pass CO2 laser resurfacing were enrolled in a double-blind institutional review board (IRB)-approved study protocol in which two different topical anesthetic products were compared . A 4 cm × 4 cm area of one cheek was r and omized to receive the novel lidocaine/tetracaine-based cream peel ( S-Caine ) while a 4 cm × 4 cm area on the contralateral side received EMLA cream with occlusion for 30 minutes prior to laser treatment . Patients rated the level of pain experienced during laser treatment on each side using a visual analog scale . Independent assessment s of observed discomfort and side effects were recorded RESULTS Pain scores were significantly lower using the novel lidocaine/tetracaine-based cream peel formulation compared with the EMLA cream . Side effects associated with application of the anesthetic peel were limited to mild transient erythema and skin blanching . CONCLUSION A novel topical lidocaine/tetracaine-based cream peel provides safe and effective dermal anesthesia for single-pass CO2 laser skin resurfacing Background : Energy densities utilized in the treatment of pigmented lesions such as solar lentigines with intense pulsed light systems are often limited by pain and post‐treatment erythema and edema . The sensation of pain associated with the treatment is immediate and acute . Application of topical anesthesia is time‐consuming , with only very moderate pain relief . Objective : ( a ) To test pain reduction as well as the reduction of post‐treatment erythema and edema when using pneumatic skin flattening ( PSF ) . This new technology utilizes an evacuation chamber to generate skin compression and activates tactile neural receptors in the skin . The result is an afferent inhibition of pain transmission in the dorsal horn ( the ‘ gate theory ’ ) . ( b ) To test the efficacy of PSF . Methods : Twenty patients were treated for solar lentigines . The patients were treated by three different IPLs . The evaluation of acute pain and post‐treatment erythema and edema was performed on all 20 patients : one to three sites per patient treated with PSF and the same number of control sites without PSF . Identical energies and IPL were applied to both sites on each patient . The pain evaluation was performed on a 10‐level scale modified McGill Pain Question naire . The clinical response to treatment was also evaluated . Results : All 20 patients completed the study and preferred the PSF treatment side over the non‐PSF side . Substantial pain reduction was observed in 19/20 patients ( 95 % ) . The average reduction of pain was by two levels , from very painful to very mild pain . Erythema reductions were observed on 14/18 ( 77 % ) patients and edema reduction on 8/9 ( 88 % ) patients . Treatment efficacy on PSF sites was identical to that of non‐PSF sites . Conclusion : The pneumatic skin flattening ( PSF ) technology considerably reduces pain , erythema and edema in the treatment of solar lentigines by IPLs . Treatment efficacy is preserved . The enhanced safety of PSF enables the increase of energy density and the acceleration of results The purpose of this study was to vali date the changes in acute pain measurement scales that are most strongly associated with a patient-determined indicator of clinical importance . Measures of pain intensity and pain relief are commonly used outcomes in therapeutic clinical trials . Recent studies of the properties of acute pain measures have provided data defining the cut-off points that are best associated with clinical ly important differences . Validation of these findings in another clinical trial data set is important . Data were obtained from the titration phase of a recently conducted r and omized controlled clinical trial of oral transmucosal fentanyl citrate ( OTFC ) , which compared OTFC to immediate release morphine sulfate ( MSIR ) for the treatment 
    Output:
    