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: Background Placebo treatment can significantly influence subjective symptoms . However , it is widely believed that response to placebo requires concealment or deception . We tested whether open-label placebo ( non-deceptive and non-concealed administration ) is superior to a no-treatment control with matched patient-provider interactions in the treatment of irritable bowel syndrome ( IBS ) . Methods Two-group , r and omized , controlled three week trial ( August 2009-April 2010 ) conducted at a single academic center , involving 80 primarily female ( 70 % ) patients , mean age 47±18 with IBS diagnosed by Rome III criteria and with a score ≥150 on the IBS Symptom Severity Scale ( IBS-SSS ) . Patients were r and omized to either open-label placebo pills presented as “ placebo pills made of an inert substance , like sugar pills , that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes ” or no-treatment controls with the same quality of interaction with providers . The primary outcome was IBS Global Improvement Scale ( IBS-GIS ) . Secondary measures were IBS Symptom Severity Scale ( IBS-SSS ) , IBS Adequate Relief ( IBS-AR ) and IBS Quality of Life ( IBS-QoL ) . Findings Open-label placebo produced significantly higher mean ( ±SD ) global improvement scores ( IBS-GIS ) at both 11-day midpoint ( 5.2±1.0 vs. 4.0±1.1 , p<.001 ) and at 21-day endpoint ( 5.0±1.5 vs. 3.9±1.3 , p = .002 ) . Significant results were also observed at both time points for reduced symptom severity ( IBS-SSS , p = .008 and p = .03 ) and adequate relief ( IBS-AR , p = .02 and p = .03 ) ; and a trend favoring open-label placebo was observed for quality of life ( IBS-QoL ) at the 21-day endpoint ( p = .08 ) . Conclusion Placebos administered without deception may be an effective treatment for IBS . Further research is warranted in IBS , and perhaps other conditions , to eluci date whether physicians can benefit patients using placebos consistent with informed consent . Trial Registration Clinical Trials.gov BACKGROUND To our knowledge , verum acupuncture has never been directly compared with sham acupuncture and guideline -based conventional therapy in patients with chronic low back pain . METHODS A patient- and observer-blinded r and omized controlled trial conducted in Germany involving 340 outpatient practice s , including 1162 patients aged 18 to 86 years ( mean + /- SD age , 50 + /- 15 years ) with a history of chronic low back pain for a mean of 8 years . Patients underwent ten 30-minute sessions , generally 2 sessions per week , of verum acupuncture ( n = 387 ) according to principles of traditional Chinese medicine ; sham acupuncture ( n = 387 ) consisting of superficial needling at nonacupuncture points ; or conventional therapy , a combination of drugs , physical therapy , and exercise ( n = 388 ) . Five additional sessions were offered to patients who had a partial response to treatment ( 10%-50 % reduction in pain intensity ) . Primary outcome was response after 6 months , defined as 33 % improvement or better on 3 pain-related items on the Von Korff Chronic Pain Grade Scale question naire or 12 % improvement or better on the back-specific Hanover Functional Ability Question naire . Patients who were unblinded or had recourse to other than permitted concomitant therapies during follow-up were classified as nonresponders regardless of symptom improvement . RESULTS At 6 months , response rate was 47.6 % in the verum acupuncture group , 44.2 % in the sham acupuncture group , and 27.4 % in the conventional therapy group . Differences among groups were as follows : verum vs sham , 3.4 % ( 95 % confidence interval , -3.7 % to 10.3 % ; P = .39 ) ; verum vs conventional therapy , 20.2 % ( 95 % confidence interval , 13.4 % to 26.7 % ; P < .001 ) ; and sham vs conventional therapy , 16.8 % ( 95 % confidence interval , 10.1 % to 23.4 % ; P < .001 . CONCLUSIONS Low back pain improved after acupuncture treatment for at least 6 months . Effectiveness of acupuncture , either verum or sham , was almost twice that of conventional therapy BACKGROUND Acupuncture stimulates points on the body , influencing the perception of myofascial pain or altering physiologic functions . OBJECTIVE The aim was to evaluate the effect of electroacupuncture ( EAC ) and acupuncture ( AC ) for myofascial pain of the upper trapezius and cervical range of motion , using SHAM acupuncture as control . METHOD Sixty women presenting at least one trigger point at the upper trapezius and local or referred pain for more than six months were r and omized into EAC , AC , and SHAM groups .  Eight sessions were scheduled and a follow-up was conducted after 28 days . The Visual Analog Scale assessed the intensity of local and general pain . A fleximeter assessed cervical movements . Data were analyzed using paired t or Wilcoxon 's tests , ANOVA or Friedman or Kruskal-Wallis tests and Pearson 's correlation ( α=0.05 ) . RESULTS There was reduction in general pain in the EAC and AC groups after eight sessions ( P<0.001 ) . A significant decrease in pain intensity occurred for the right trapezius in all groups and for the left trapezius in the EAC and AC groups . Intergroup comparisons showed improvement in general pain in the EAC and AC groups and in local pain intensity in the EAC group ( P<0.05 ) , which showed an increase in left rotation ( P=0.049 ) . The AC group showed increases in inclination ( P=0.005 ) sustained until follow-up and rotation to the right ( P=0.032 ) . CONCLUSION EAC and AC were effective in reducing the pain intensity compared with SHAM . EAC was better than AC for local pain relief . These treatments can assist in increasing cervical range of motion , albeit subtly BACKGROUND Musculoskeletal disorders have been identified globally as the second most common healthcare problem for ' years lived with disability ' , and of these shoulder conditions are amongst the most common , frequently associated with substantial pain and morbidity . Exercise and acupuncture are often provided as initial treatments for musculoskeletal shoulder conditions but their clinical effectiveness is uncertain . This study compared group exercise with group exercise plus either acupuncture or electro-acupuncture in patients with subacromial pain syndrome . METHODS Two hundred and twenty-seven participants were recruited to a three-arm parallel-group r and omized clinical trial . The primary outcome measure was the Oxford Shoulder Score . Follow-up was post treatment , and at 6 and 12 months . Between-group differences ( two comparisons : the exercise group versus each of the acupuncture groups ) were analysed at 6 months . A similar comparison across all follow-up time points was also conducted . Data were analysed on intention-to-treat principles with imputation of missing values . RESULTS Treatment groups were similar at baseline , and all treatment groups demonstrated an improvement over time . Between-group estimates at 6 months were , however , small and non-significant , for both of the comparisons . The analyses across all follow-up time points yielded similar conclusions . There was a high rate of missing values ( 22 % for the Oxford Shoulder Score ) . A sensitivity analysis using complete data gave similar conclusions to the analysis with missing values imputed . CONCLUSIONS In the current investigation , neither acupuncture nor electro-acupuncture were found to be more beneficial than exercise alone in the treatment of subacromial pain syndrome . These findings may support clinicians with treatment planning . SIGNIFICANCE Shoulder pain is common and associated with substantial morbidity . Acupuncture is a popular treatment for shoulder pain . The findings suggest that acupuncture and electro-acupuncture offer no additional benefit over exercise in the treatment of shoulder pain of musculoskeletal origin Objective The aim of this study was to evaluate the effects of acupuncture treatment on serum levels of serotonin and substance P ( SP ) as well as on clinical parameters in patients with fibromyalgia ( FM ) . Methods This is a r and omized controlled clinical trial . Seventy-five women with FM were r and omized into one of three kinds of acupuncture treatment : real acupuncture group ( AcG ) , sham acupuncture group ( ShG ) , and simulated acupuncture group ( SiG ) . Treatments were applied semiweekly for four weeks . The serum levels of serotonin and SP were evaluated before and after the eight sessions . Patients were clinical ly assessed by visual analog scale ( VAS ) , the number of tender points ( NTP ) , Fibromyalgia Impact Question naire ( FIQ ) , Beck Depression Inventory ( BDI ) , and Nottingham Health Profile ( NHP ) at baseline , after the last treatment , and one and three months after completion of all treatments . Results Serum serotonin values increased significantly after treatment in AcG and ShG ( P < 0.001 and P < 0.01 , respectively ) . The increase in the AcG was also different from both of the other groups ( P < 0.01 ) . While SP levels decreased in the AcG , they increased in the SiG ( P = 0.001 ) . In the AcG , significant improvements were found in almost all clinical outcomes after treatment . These usually continued for three months . In the ShG , there were also significant changes on the NTP , VAS , FIQ , and BDI scores after treatment . Improvements on the NTP and FIQ scores lasted for three months . In the SiG , significant improvements were found only in the NTP , VAS , and BDI scores after treatment . Conclusions Acupuncture , rather than sham or placebo acupuncture , may lead to long-term improvements on clinical outcomes and pain neuromediator values . Changes in serum serotonin and SP levels may be a valuable explanation for acupuncture mechanisms in FM treatment OBJECTIVE The aim of this manuscript is to determine and to compare the efficacy of real acupuncture with sham acupuncture on fibromyalgia ( FM ) treatment . METHODS 50 women with FM were r and omized into 2 groups to receive either true acupuncture or sham acupuncture . Subjects were evaluated with VAS ( at night , at rest , during activity ) , SF-36 , Fibromyalgia Impact Question naire ( FIQ ) , Beck Depression scale ( BDI ) , Fatigue Severity Scale ( FSS ) at baseline , 1 month and 2 months after the 1st session . Patients in both groups received 3 sessions in the 1st week , 2 sessions/week during 2 weeks and 1 session/week in the following 5 weeks ( totally 12 sessions ) . RESULTS 25 subjects with a mean age of 47,28±7,86 years were enrolled in true acupuncture group and 25 subjects with a mean age of 43,60±8,18 years were enrolled in sham acupuncture group . Both groups improved significantly in all parameters 1 month after the 1st session and this improvement persisted 2 months after the 1st session ( p<0,05 ) . However , real acupuncture group had better scores than sham acupuncture score in terms of all VAS scores , BDI and FIQ scores either 1 or 2 months after the 1st session ( all p<0,05 ) . CONCLUSION Acupuncture significantly improved pain and symptoms of FM . Although sham effect was important , real acupuncture treatment seems to be effective in treatment of FM & NA ; Acupuncture is widely used by patients with neck pain , but there is a lack of information about its effectiveness in routine medical care . The aim was to investigate the effectiveness of acupuncture in addition to routine care in patients with chronic neck pain compared to treatment with routine care alone . We performed a r and omized controlled multicentre trial plus non‐r and omized cohort in general practice s in Germany . 14,161 patients with chronic neck pain ( duration > 6 months ) . Patients were r and omly allocated to an acupuncture group or a control group receiving no acupuncture . Patients in the acupuncture group received up to 15 acupuncture sessions over three months . Patients who did not consent to r and omization received acupuncture treatment . All subjects were allowed to receive usual medical care in addition to study treatment . Neck pain and disability ( NPAD Scale by Wheeler ) after three months . Of 14,161 patients ( mean age 50.9 ± 13.1 years , 68 % female ) 1880 were r and omized to acupuncture and 1886 to control , and 10,395 included into the non‐r and omized acupuncture group . At three months , neck pain and disability improved by 16.2 ( SE : 0.4 ) to 38.3 ( SE : 0.4 ) ; and by 3.9 ( SE : 0.4 ) to 50.5 ( SE : 0.4 ) , difference 12.3 ( p < 0.001 ) in the acupuncture and control group , respectively . Treatment success was essentially maintained through six months . Non‐r and omized patients had more severe symptoms at baseline and showed higher neck pain and disability improvement compared to r and omized patients . Treatment with acupuncture added to routine care in  patients with chronic neck pain  was associated with improvements in neck pain and disability compared to treatment with routine care alone BACKGROUND Acupuncture is widely used by patients with chronic pain although there is little evidence of 
    Output:
    
agent
***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: Background Placebo treatment can significantly influence subjective symptoms . However , it is widely believed that response to placebo requires concealment or deception . We tested whether open-label placebo ( non-deceptive and non-concealed administration ) is superior to a no-treatment control with matched patient-provider interactions in the treatment of irritable bowel syndrome ( IBS ) . Methods Two-group , r and omized , controlled three week trial ( August 2009-April 2010 ) conducted at a single academic center , involving 80 primarily female ( 70 % ) patients , mean age 47±18 with IBS diagnosed by Rome III criteria and with a score ≥150 on the IBS Symptom Severity Scale ( IBS-SSS ) . Patients were r and omized to either open-label placebo pills presented as “ placebo pills made of an inert substance , like sugar pills , that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes ” or no-treatment controls with the same quality of interaction with providers . The primary outcome was IBS Global Improvement Scale ( IBS-GIS ) . Secondary measures were IBS Symptom Severity Scale ( IBS-SSS ) , IBS Adequate Relief ( IBS-AR ) and IBS Quality of Life ( IBS-QoL ) . Findings Open-label placebo produced significantly higher mean ( ±SD ) global improvement scores ( IBS-GIS ) at both 11-day midpoint ( 5.2±1.0 vs. 4.0±1.1 , p<.001 ) and at 21-day endpoint ( 5.0±1.5 vs. 3.9±1.3 , p = .002 ) . Significant results were also observed at both time points for reduced symptom severity ( IBS-SSS , p = .008 and p = .03 ) and adequate relief ( IBS-AR , p = .02 and p = .03 ) ; and a trend favoring open-label placebo was observed for quality of life ( IBS-QoL ) at the 21-day endpoint ( p = .08 ) . Conclusion Placebos administered without deception may be an effective treatment for IBS . Further research is warranted in IBS , and perhaps other conditions , to eluci date whether physicians can benefit patients using placebos consistent with informed consent . Trial Registration Clinical Trials.gov BACKGROUND To our knowledge , verum acupuncture has never been directly compared with sham acupuncture and guideline -based conventional therapy in patients with chronic low back pain . METHODS A patient- and observer-blinded r and omized controlled trial conducted in Germany involving 340 outpatient practice s , including 1162 patients aged 18 to 86 years ( mean + /- SD age , 50 + /- 15 years ) with a history of chronic low back pain for a mean of 8 years . Patients underwent ten 30-minute sessions , generally 2 sessions per week , of verum acupuncture ( n = 387 ) according to principles of traditional Chinese medicine ; sham acupuncture ( n = 387 ) consisting of superficial needling at nonacupuncture points ; or conventional therapy , a combination of drugs , physical therapy , and exercise ( n = 388 ) . Five additional sessions were offered to patients who had a partial response to treatment ( 10%-50 % reduction in pain intensity ) . Primary outcome was response after 6 months , defined as 33 % improvement or better on 3 pain-related items on the Von Korff Chronic Pain Grade Scale question naire or 12 % improvement or better on the back-specific Hanover Functional Ability Question naire . Patients who were unblinded or had recourse to other than permitted concomitant therapies during follow-up were classified as nonresponders regardless of symptom improvement . RESULTS At 6 months , response rate was 47.6 % in the verum acupuncture group , 44.2 % in the sham acupuncture group , and 27.4 % in the conventional therapy group . Differences among groups were as follows : verum vs sham , 3.4 % ( 95 % confidence interval , -3.7 % to 10.3 % ; P = .39 ) ; verum vs conventional therapy , 20.2 % ( 95 % confidence interval , 13.4 % to 26.7 % ; P < .001 ) ; and sham vs conventional therapy , 16.8 % ( 95 % confidence interval , 10.1 % to 23.4 % ; P < .001 . CONCLUSIONS Low back pain improved after acupuncture treatment for at least 6 months . Effectiveness of acupuncture , either verum or sham , was almost twice that of conventional therapy BACKGROUND Acupuncture stimulates points on the body , influencing the perception of myofascial pain or altering physiologic functions . OBJECTIVE The aim was to evaluate the effect of electroacupuncture ( EAC ) and acupuncture ( AC ) for myofascial pain of the upper trapezius and cervical range of motion , using SHAM acupuncture as control . METHOD Sixty women presenting at least one trigger point at the upper trapezius and local or referred pain for more than six months were r and omized into EAC , AC , and SHAM groups .  Eight sessions were scheduled and a follow-up was conducted after 28 days . The Visual Analog Scale assessed the intensity of local and general pain . A fleximeter assessed cervical movements . Data were analyzed using paired t or Wilcoxon 's tests , ANOVA or Friedman or Kruskal-Wallis tests and Pearson 's correlation ( α=0.05 ) . RESULTS There was reduction in general pain in the EAC and AC groups after eight sessions ( P<0.001 ) . A significant decrease in pain intensity occurred for the right trapezius in all groups and for the left trapezius in the EAC and AC groups . Intergroup comparisons showed improvement in general pain in the EAC and AC groups and in local pain intensity in the EAC group ( P<0.05 ) , which showed an increase in left rotation ( P=0.049 ) . The AC group showed increases in inclination ( P=0.005 ) sustained until follow-up and rotation to the right ( P=0.032 ) . CONCLUSION EAC and AC were effective in reducing the pain intensity compared with SHAM . EAC was better than AC for local pain relief . These treatments can assist in increasing cervical range of motion , albeit subtly BACKGROUND Musculoskeletal disorders have been identified globally as the second most common healthcare problem for ' years lived with disability ' , and of these shoulder conditions are amongst the most common , frequently associated with substantial pain and morbidity . Exercise and acupuncture are often provided as initial treatments for musculoskeletal shoulder conditions but their clinical effectiveness is uncertain . This study compared group exercise with group exercise plus either acupuncture or electro-acupuncture in patients with subacromial pain syndrome . METHODS Two hundred and twenty-seven participants were recruited to a three-arm parallel-group r and omized clinical trial . The primary outcome measure was the Oxford Shoulder Score . Follow-up was post treatment , and at 6 and 12 months . Between-group differences ( two comparisons : the exercise group versus each of the acupuncture groups ) were analysed at 6 months . A similar comparison across all follow-up time points was also conducted . Data were analysed on intention-to-treat principles with imputation of missing values . RESULTS Treatment groups were similar at baseline , and all treatment groups demonstrated an improvement over time . Between-group estimates at 6 months were , however , small and non-significant , for both of the comparisons . The analyses across all follow-up time points yielded similar conclusions . There was a high rate of missing values ( 22 % for the Oxford Shoulder Score ) . A sensitivity analysis using complete data gave similar conclusions to the analysis with missing values imputed . CONCLUSIONS In the current investigation , neither acupuncture nor electro-acupuncture were found to be more beneficial than exercise alone in the treatment of subacromial pain syndrome . These findings may support clinicians with treatment planning . SIGNIFICANCE Shoulder pain is common and associated with substantial morbidity . Acupuncture is a popular treatment for shoulder pain . The findings suggest that acupuncture and electro-acupuncture offer no additional benefit over exercise in the treatment of shoulder pain of musculoskeletal origin Objective The aim of this study was to evaluate the effects of acupuncture treatment on serum levels of serotonin and substance P ( SP ) as well as on clinical parameters in patients with fibromyalgia ( FM ) . Methods This is a r and omized controlled clinical trial . Seventy-five women with FM were r and omized into one of three kinds of acupuncture treatment : real acupuncture group ( AcG ) , sham acupuncture group ( ShG ) , and simulated acupuncture group ( SiG ) . Treatments were applied semiweekly for four weeks . The serum levels of serotonin and SP were evaluated before and after the eight sessions . Patients were clinical ly assessed by visual analog scale ( VAS ) , the number of tender points ( NTP ) , Fibromyalgia Impact Question naire ( FIQ ) , Beck Depression Inventory ( BDI ) , and Nottingham Health Profile ( NHP ) at baseline , after the last treatment , and one and three months after completion of all treatments . Results Serum serotonin values increased significantly after treatment in AcG and ShG ( P < 0.001 and P < 0.01 , respectively ) . The increase in the AcG was also different from both of the other groups ( P < 0.01 ) . While SP levels decreased in the AcG , they increased in the SiG ( P = 0.001 ) . In the AcG , significant improvements were found in almost all clinical outcomes after treatment . These usually continued for three months . In the ShG , there were also significant changes on the NTP , VAS , FIQ , and BDI scores after treatment . Improvements on the NTP and FIQ scores lasted for three months . In the SiG , significant improvements were found only in the NTP , VAS , and BDI scores after treatment . Conclusions Acupuncture , rather than sham or placebo acupuncture , may lead to long-term improvements on clinical outcomes and pain neuromediator values . Changes in serum serotonin and SP levels may be a valuable explanation for acupuncture mechanisms in FM treatment OBJECTIVE The aim of this manuscript is to determine and to compare the efficacy of real acupuncture with sham acupuncture on fibromyalgia ( FM ) treatment . METHODS 50 women with FM were r and omized into 2 groups to receive either true acupuncture or sham acupuncture . Subjects were evaluated with VAS ( at night , at rest , during activity ) , SF-36 , Fibromyalgia Impact Question naire ( FIQ ) , Beck Depression scale ( BDI ) , Fatigue Severity Scale ( FSS ) at baseline , 1 month and 2 months after the 1st session . Patients in both groups received 3 sessions in the 1st week , 2 sessions/week during 2 weeks and 1 session/week in the following 5 weeks ( totally 12 sessions ) . RESULTS 25 subjects with a mean age of 47,28±7,86 years were enrolled in true acupuncture group and 25 subjects with a mean age of 43,60±8,18 years were enrolled in sham acupuncture group . Both groups improved significantly in all parameters 1 month after the 1st session and this improvement persisted 2 months after the 1st session ( p<0,05 ) . However , real acupuncture group had better scores than sham acupuncture score in terms of all VAS scores , BDI and FIQ scores either 1 or 2 months after the 1st session ( all p<0,05 ) . CONCLUSION Acupuncture significantly improved pain and symptoms of FM . Although sham effect was important , real acupuncture treatment seems to be effective in treatment of FM & NA ; Acupuncture is widely used by patients with neck pain , but there is a lack of information about its effectiveness in routine medical care . The aim was to investigate the effectiveness of acupuncture in addition to routine care in patients with chronic neck pain compared to treatment with routine care alone . We performed a r and omized controlled multicentre trial plus non‐r and omized cohort in general practice s in Germany . 14,161 patients with chronic neck pain ( duration > 6 months ) . Patients were r and omly allocated to an acupuncture group or a control group receiving no acupuncture . Patients in the acupuncture group received up to 15 acupuncture sessions over three months . Patients who did not consent to r and omization received acupuncture treatment . All subjects were allowed to receive usual medical care in addition to study treatment . Neck pain and disability ( NPAD Scale by Wheeler ) after three months . Of 14,161 patients ( mean age 50.9 ± 13.1 years , 68 % female ) 1880 were r and omized to acupuncture and 1886 to control , and 10,395 included into the non‐r and omized acupuncture group . At three months , neck pain and disability improved by 16.2 ( SE : 0.4 ) to 38.3 ( SE : 0.4 ) ; and by 3.9 ( SE : 0.4 ) to 50.5 ( SE : 0.4 ) , difference 12.3 ( p < 0.001 ) in the acupuncture and control group , respectively . Treatment success was essentially maintained through six months . Non‐r and omized patients had more severe symptoms at baseline and showed higher neck pain and disability improvement compared to r and omized patients . Treatment with acupuncture added to routine care in  patients with chronic neck pain  was associated with improvements in neck pain and disability compared to treatment with routine care alone BACKGROUND Acupuncture is widely used by patients with chronic pain although there is little evidence of 
    Output:
    