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: Forty-five individuals with long-st and ing facial pain or headache of muscular origin were r and omly allocated into three groups . The first group was treated with acupuncture , the second group received an occlusal splint , and the third group served as controls . Both acupuncture and occlusal splint therapy significantly reduced subjective symptoms and clinical signs from the stomatognathic system . No differences between these two groups were found with regard to treatment effects . It is concluded that acupuncture is an alternative method to conventional stomatognathic treatment for individuals with craniom and ibular disorders of muscular origin One of the challenges of acupuncture research is design ing appropriate control groups . To address this problem , after surgical third molar extraction s 19 patients were r and omly assigned to an acupuncture group ( n = 11 ) or a placebo acupuncture group ( n = 8) . The length of time for reaching moderate pain and pain intensity after oral surgery were recorded by st and ard patient self-report . The results indicated that subjects treated with acupuncture reported longer pain-free duration times ( mean , 181 versus 71 minutes ; p < or = 0.046 ) and experienced less pain intensity than those who received placebo acupuncture . This study provides a model for an acupuncture control that could examine the placebo effect in clinical acupuncture research In patients with myofascial pain , painful trigger points are often treated using dry needling and local anesthetic injections . However , the therapeutic effect of these treatments has been poorly quantified , and the mechanism underlying the effect is poorly understood . In a r and omized , double-blind , double-placebo clinical trial , a pressure algometer was used to measure pain-pressure thresholds in the masseter and temporalis muscles of 30 subjects aged 23 to 53 years with myofascial pain in the jaws , before and after a series of dry needling treatments , local anesthetic injections , and simulated dry needling and local anesthetic treatments ( treatment group A : Procaine + simulated dry needling ; treatment group B : dry needling + simulated local anesthetic ; control group C : simulated local anesthetic + simulated dry needling ) . Subjects rated pain intensity and unpleasantness using visual analogue scales , and the data were analyzed using analysis of variance . Pain pressure thresholds increased slightly after treatment , irrespective of the treatment modality . Pain intensity and unpleasantness scores decreased significantly at the end of treatment in all groups . There were no statistically significant between-group differences in pain pressure thresholds and visual analogue scale scores at the end of treatment . The findings suggest that the general improvement in pain symptoms was the result of nonspecific , placebo-related factors rather than a true treatment effect . Thus , the therapeutic value of dry needling and Procaine in the management of myofascial pain in the jaw muscles is question able Abstract Objective To investigate the effectiveness of acupuncture compared with minimal acupuncture and with no acupuncture in patients with tension-type headache . Design Three armed r and omised controlled multicentre trial . Setting 28 outpatient centres in Germany . Participants 270 patients ( 74 % women , mean age 43 ( SD 13 ) years ) with episodic or chronic tension-type headache . Interventions Acupuncture , minimal acupuncture ( superficial needling at non-acupuncture points ) , or waiting list control . Acupuncture and minimal acupuncture were administered by specialised physicians and consisted of 12 sessions per patient over eight weeks . Main outcome measure Difference in numbers of days with headache between the four weeks before r and omisation and weeks 9 - 12 after r and omisation , as recorded by participants in headache diaries . Results The number of days with headache decreased by 7.2 ( SD 6.5 ) days in the acupuncture group compared with 6.6 ( SD 6.0 ) days in the minimal acupuncture group and 1.5 ( SD 3.7 ) days in the waiting list group ( difference : acupuncture v minimal acupuncture , 0.6 days , 95 % confidence interval -1.5 to 2.6 days , P = 0.58 ; acupuncture v waiting list , 5.7 days , 3.9 to 7.5 days , P < 0.001 ) . The proportion of responders ( at least 50 % reduction in days with headache ) was 46 % in the acupuncture group , 35 % in the minimal acupuncture group , and 4 % in the waiting list group . Conclusions The acupuncture intervention investigated in this trial was more effective than no treatment but not significantly more effective than minimal acupuncture for the treatment of tension-type headache . Trial registration number IS RCT N9737659 One hundred and ten patients , 23 males and 87 females , participated in a comparative study of the effect of acupuncture and occlusal splint therapy .  All the patients exhibited signs and symptoms of craniom and ibular disorders ( CMD ) and had had pain for more than six months . The participants were r and omly assigned to three groups ; acupuncture treatment , occlusal splint therapy or control . The patients were evaluated before and immediately after treatment/control time . Ten different subjective and /or clinical assessment variables were used in the evaluation of the treatment effects . Both acupuncture and occlusal splint therapy  reduced the symptoms as compared with the control group in which the symptoms remained essentially unchanged . In this short-term study , acupuncture gave better subjective results ( p < 0.001 ) than the occlusal splint therapy Abstract The myofascial trigger point ( MTrP ) is the hallmark physical finding of the myofascial pain syndrome ( MPS ) . The MTrP itself is characterized by distinctive physical features that include a tender point in a taut b and of muscle , a local twitch response ( LTR ) to mechanical stimulation , a pain referral pattern characteristic of trigger points of specific areas in each muscle , and the reproduction of the patient 's usual pain . No prior study has demonstrated that these physical features are reproducible among different examiners , thereby establishing the reliability of the physical examination in the diagnosis of the MPS . This paper reports an initial attempt to establish the interrater reliability of the trigger point examination that failed , and a second study by the same examiners that included a training period and that successfully established interrater reliability in the diagnosis of the MTrP. The study also showed that the interrater reliability of different features varies , the LTR being the most difficult , and that the interrater reliability of the identification of MTrP features among different muscles also varies CONTEXT Acupuncture is widely used to prevent migraine attacks , but the available evidence of its benefit is scarce . OBJECTIVE To investigate the effectiveness of acupuncture compared with sham acupuncture and with no acupuncture in patients with migraine . DESIGN , SETTING , AND PATIENTS Three-group , r and omized , controlled trial ( April 2002-January 2003 ) involving 302 patients ( 88 % women ) , mean ( SD ) age of 43 ( 11 ) years , with migraine headaches , based on International Headache Society criteria . Patients were treated at 18 outpatient centers in Germany . INTERVENTIONS Acupuncture , sham acupuncture , or waiting list control . Acupuncture and sham acupuncture were administered by specialized physicians and consisted of 12 sessions per patient over 8 weeks . Patients completed headache diaries from 4 weeks before to 12 weeks after r and omization and from week 21 to 24 after r and omization . MAIN OUTCOME MEASURES Difference in headache days of moderate or severe intensity between the 4 weeks before and weeks 9 to 12 after r and omization . RESULTS Between baseline and weeks 9 to 12 , the mean ( SD ) number of days with headache of moderate or severe intensity decreased by 2.2 ( 2.7 ) days from a baseline of 5.2 ( 2.5 ) days in the acupuncture group compared with a decrease to 2.2 ( 2.7 ) days from a baseline of 5.0 ( 2.4 ) days in the sham acupuncture group , and by 0.8 ( 2.0 ) days from a baseline if 5.4 ( 3.0 ) days in the waiting list group . No difference was detected between the acupuncture and the sham acupuncture groups ( 0.0 days , 95 % confidence interval , -0.7 to 0.7 days ; P = .96 ) while there was a difference between the acupuncture group compared with the waiting list group ( 1.4 days ; 95 % confidence interval ; 0.8 - 2.1 days ; P<.001 ) . The proportion of responders ( reduction in headache days by at least 50 % ) was 51 % in the acupuncture group , 53 % in the sham acupuncture group , and 15 % in the waiting list group . CONCLUSION Acupuncture was no more effective than sham acupuncture in reducing migraine headaches although both interventions were more effective than a waiting list control OBJECTIVE To search for a better therapy for temporom and ibular joint dysfunction syndrome . METHODS Two hundred and ten cases of temporom and ibular joint dysfunction syndrome were r and omly divided into a treatment group , a control group I and a control group II , 70 cases in each group . The treatment group were treated with warming needle moxibustion plus exercise , with Hegu ( LI 4 ) , Xiaguan ( ST 7 ) , Yifeng ( TE 17 ) and so on selected , in combination with opening and closing the mouth ; the control group I were treated with simple filiform needle needling , and the control group II with local blocking therapy . The therapeutic effects of the 3 groups were compared . RESULTS The total effective rate was 94.3 % in the treatment group , 87.1 % in the control group I and 85.7 % in the control group II with a significant difference among the 3 groups , the treatment group being better than the two control groups ( P < 0.05 ) . CONCLUSION Warming needle moxibustion plus exercise has a good therapeutic effect on temporom and ibular joint dysfunction syndrome A modified double-blind evaluation of naloxone reversibility of dental analgesia produced by auricular electrical stimulation ( AES ) was examined in 40 subjects assigned r and omly to one of four groups :  AES followed by saline ( AS ) , AES followed by naloxone ( AN ) , placebo AES followed by saline ( PS ) , and placebo AES followed by naloxone ( PN ) . Dental pain threshold was tested using a h and -held dental pulp tester . A second investigator administered the true or placebo AES using an electrical stimulator . A third investigator injected intravenously saline or naloxone . The subjects and investigators 1 and 3 were blind to all treatment conditions . A repeated measures analysis of variance revealed a significant difference among the four groups . The AES groups exhibited a statistically significant 18 % elevation of pain threshold , whereas the two placebo stimulation groups ( PS and PN ) remained essentially unchanged . The mean pain threshold increased to more than 23 % for group AS , but fell to less than 12 % for the subjects in group AN , who were given naloxone . These findings indicate a small but significant elevation of pain threshold by AES , an effect partially blocked by naloxone , suggesting an endogenous opioid system as one mechanism for AES analgesia Summary CONTEXT : Patients with disorders of the stomatognathic system describe pain and clicking phenomena as primary symptoms . Rapid improvement of the pain is required to ensure and maintain adequate patient compliance . OBJECTIVE : The study was intended to assess the effects of acupuncture in patients with temporom and ibular disorders as compared to placebo therapy ( sham laser ) ; the primary target parameter was the subjective pain sensation . DESIGN : R and omized , placebo-controlled trial . PATIENTS AND METHODS : 23 patients were enrolled and r and omly assigned to one of the two groups . One group received acupuncture treatment according to the very-point technique , the other group received sham laser treatment . The following observer-blinded findings were evaluated before and after treatment : subjective pain , mouth opening , and muscular tenderness and pain on pressure . In addition , m and ibular joint movement pathways were recorded using electronic axiography . OUTCOMES : Improvements in pain scores ( scale , 0–100 ) in the acupuncture group ( 19.1 ± 11.9 ) were significant ( p = 0.03 ) versus those in the placebo group ( 6.2 ± 14.8 ) . Mouth opening showed an insignificant trend towards improvement ( p > 0.1 ) in the acupuncture ( 5.0 ± 6.2 mm ) versus the placebo group ( 1.0 ± 4.7 mm ) , differences in tenderness and pain on pressure in neck and masticatory muscles were significant ( p < 0,05 ) for most of the muscles having shown pretreatment tenderness or pain . The axiographic tracings were assessed for quality , symmetry and curve characteristics . Recordings of the opening and closing movement in the acupuncture group showed an increased frequency of improvements of curve characteristics as compared to the placebo group . The acupuncture group also showed an increased frequency of improvement in protrusion and retrusion movements , though no statistical significance could be obtained . CONCLUSION : On the basis of the results of the present study , acupuncture may be recommended as acute treatment of craniom and ibular disorders , but studies with larger numbers of patients as well as about long-term treatment outcomes should be conducted . ZusammenfassungEINFÜHRUNG : Patienten mit Störungen des stomatognathen Systems beschreiben als Hauptsymptome Schmerzen und Knackphänomene . Eine rasche Besserung des Schmerzes soll eine gute Patientencompliance sicherstellen . 
    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: Forty-five individuals with long-st and ing facial pain or headache of muscular origin were r and omly allocated into three groups . The first group was treated with acupuncture , the second group received an occlusal splint , and the third group served as controls . Both acupuncture and occlusal splint therapy significantly reduced subjective symptoms and clinical signs from the stomatognathic system . No differences between these two groups were found with regard to treatment effects . It is concluded that acupuncture is an alternative method to conventional stomatognathic treatment for individuals with craniom and ibular disorders of muscular origin One of the challenges of acupuncture research is design ing appropriate control groups . To address this problem , after surgical third molar extraction s 19 patients were r and omly assigned to an acupuncture group ( n = 11 ) or a placebo acupuncture group ( n = 8) . The length of time for reaching moderate pain and pain intensity after oral surgery were recorded by st and ard patient self-report . The results indicated that subjects treated with acupuncture reported longer pain-free duration times ( mean , 181 versus 71 minutes ; p < or = 0.046 ) and experienced less pain intensity than those who received placebo acupuncture . This study provides a model for an acupuncture control that could examine the placebo effect in clinical acupuncture research In patients with myofascial pain , painful trigger points are often treated using dry needling and local anesthetic injections . However , the therapeutic effect of these treatments has been poorly quantified , and the mechanism underlying the effect is poorly understood . In a r and omized , double-blind , double-placebo clinical trial , a pressure algometer was used to measure pain-pressure thresholds in the masseter and temporalis muscles of 30 subjects aged 23 to 53 years with myofascial pain in the jaws , before and after a series of dry needling treatments , local anesthetic injections , and simulated dry needling and local anesthetic treatments ( treatment group A : Procaine + simulated dry needling ; treatment group B : dry needling + simulated local anesthetic ; control group C : simulated local anesthetic + simulated dry needling ) . Subjects rated pain intensity and unpleasantness using visual analogue scales , and the data were analyzed using analysis of variance . Pain pressure thresholds increased slightly after treatment , irrespective of the treatment modality . Pain intensity and unpleasantness scores decreased significantly at the end of treatment in all groups . There were no statistically significant between-group differences in pain pressure thresholds and visual analogue scale scores at the end of treatment . The findings suggest that the general improvement in pain symptoms was the result of nonspecific , placebo-related factors rather than a true treatment effect . Thus , the therapeutic value of dry needling and Procaine in the management of myofascial pain in the jaw muscles is question able Abstract Objective To investigate the effectiveness of acupuncture compared with minimal acupuncture and with no acupuncture in patients with tension-type headache . Design Three armed r and omised controlled multicentre trial . Setting 28 outpatient centres in Germany . Participants 270 patients ( 74 % women , mean age 43 ( SD 13 ) years ) with episodic or chronic tension-type headache . Interventions Acupuncture , minimal acupuncture ( superficial needling at non-acupuncture points ) , or waiting list control . Acupuncture and minimal acupuncture were administered by specialised physicians and consisted of 12 sessions per patient over eight weeks . Main outcome measure Difference in numbers of days with headache between the four weeks before r and omisation and weeks 9 - 12 after r and omisation , as recorded by participants in headache diaries . Results The number of days with headache decreased by 7.2 ( SD 6.5 ) days in the acupuncture group compared with 6.6 ( SD 6.0 ) days in the minimal acupuncture group and 1.5 ( SD 3.7 ) days in the waiting list group ( difference : acupuncture v minimal acupuncture , 0.6 days , 95 % confidence interval -1.5 to 2.6 days , P = 0.58 ; acupuncture v waiting list , 5.7 days , 3.9 to 7.5 days , P < 0.001 ) . The proportion of responders ( at least 50 % reduction in days with headache ) was 46 % in the acupuncture group , 35 % in the minimal acupuncture group , and 4 % in the waiting list group . Conclusions The acupuncture intervention investigated in this trial was more effective than no treatment but not significantly more effective than minimal acupuncture for the treatment of tension-type headache . Trial registration number IS RCT N9737659 One hundred and ten patients , 23 males and 87 females , participated in a comparative study of the effect of acupuncture and occlusal splint therapy .  All the patients exhibited signs and symptoms of craniom and ibular disorders ( CMD ) and had had pain for more than six months . The participants were r and omly assigned to three groups ; acupuncture treatment , occlusal splint therapy or control . The patients were evaluated before and immediately after treatment/control time . Ten different subjective and /or clinical assessment variables were used in the evaluation of the treatment effects . Both acupuncture and occlusal splint therapy  reduced the symptoms as compared with the control group in which the symptoms remained essentially unchanged . In this short-term study , acupuncture gave better subjective results ( p < 0.001 ) than the occlusal splint therapy Abstract The myofascial trigger point ( MTrP ) is the hallmark physical finding of the myofascial pain syndrome ( MPS ) . The MTrP itself is characterized by distinctive physical features that include a tender point in a taut b and of muscle , a local twitch response ( LTR ) to mechanical stimulation , a pain referral pattern characteristic of trigger points of specific areas in each muscle , and the reproduction of the patient 's usual pain . No prior study has demonstrated that these physical features are reproducible among different examiners , thereby establishing the reliability of the physical examination in the diagnosis of the MPS . This paper reports an initial attempt to establish the interrater reliability of the trigger point examination that failed , and a second study by the same examiners that included a training period and that successfully established interrater reliability in the diagnosis of the MTrP. The study also showed that the interrater reliability of different features varies , the LTR being the most difficult , and that the interrater reliability of the identification of MTrP features among different muscles also varies CONTEXT Acupuncture is widely used to prevent migraine attacks , but the available evidence of its benefit is scarce . OBJECTIVE To investigate the effectiveness of acupuncture compared with sham acupuncture and with no acupuncture in patients with migraine . DESIGN , SETTING , AND PATIENTS Three-group , r and omized , controlled trial ( April 2002-January 2003 ) involving 302 patients ( 88 % women ) , mean ( SD ) age of 43 ( 11 ) years , with migraine headaches , based on International Headache Society criteria . Patients were treated at 18 outpatient centers in Germany . INTERVENTIONS Acupuncture , sham acupuncture , or waiting list control . Acupuncture and sham acupuncture were administered by specialized physicians and consisted of 12 sessions per patient over 8 weeks . Patients completed headache diaries from 4 weeks before to 12 weeks after r and omization and from week 21 to 24 after r and omization . MAIN OUTCOME MEASURES Difference in headache days of moderate or severe intensity between the 4 weeks before and weeks 9 to 12 after r and omization . RESULTS Between baseline and weeks 9 to 12 , the mean ( SD ) number of days with headache of moderate or severe intensity decreased by 2.2 ( 2.7 ) days from a baseline of 5.2 ( 2.5 ) days in the acupuncture group compared with a decrease to 2.2 ( 2.7 ) days from a baseline of 5.0 ( 2.4 ) days in the sham acupuncture group , and by 0.8 ( 2.0 ) days from a baseline if 5.4 ( 3.0 ) days in the waiting list group . No difference was detected between the acupuncture and the sham acupuncture groups ( 0.0 days , 95 % confidence interval , -0.7 to 0.7 days ; P = .96 ) while there was a difference between the acupuncture group compared with the waiting list group ( 1.4 days ; 95 % confidence interval ; 0.8 - 2.1 days ; P<.001 ) . The proportion of responders ( reduction in headache days by at least 50 % ) was 51 % in the acupuncture group , 53 % in the sham acupuncture group , and 15 % in the waiting list group . CONCLUSION Acupuncture was no more effective than sham acupuncture in reducing migraine headaches although both interventions were more effective than a waiting list control OBJECTIVE To search for a better therapy for temporom and ibular joint dysfunction syndrome . METHODS Two hundred and ten cases of temporom and ibular joint dysfunction syndrome were r and omly divided into a treatment group , a control group I and a control group II , 70 cases in each group . The treatment group were treated with warming needle moxibustion plus exercise , with Hegu ( LI 4 ) , Xiaguan ( ST 7 ) , Yifeng ( TE 17 ) and so on selected , in combination with opening and closing the mouth ; the control group I were treated with simple filiform needle needling , and the control group II with local blocking therapy . The therapeutic effects of the 3 groups were compared . RESULTS The total effective rate was 94.3 % in the treatment group , 87.1 % in the control group I and 85.7 % in the control group II with a significant difference among the 3 groups , the treatment group being better than the two control groups ( P < 0.05 ) . CONCLUSION Warming needle moxibustion plus exercise has a good therapeutic effect on temporom and ibular joint dysfunction syndrome A modified double-blind evaluation of naloxone reversibility of dental analgesia produced by auricular electrical stimulation ( AES ) was examined in 40 subjects assigned r and omly to one of four groups :  AES followed by saline ( AS ) , AES followed by naloxone ( AN ) , placebo AES followed by saline ( PS ) , and placebo AES followed by naloxone ( PN ) . Dental pain threshold was tested using a h and -held dental pulp tester . A second investigator administered the true or placebo AES using an electrical stimulator . A third investigator injected intravenously saline or naloxone . The subjects and investigators 1 and 3 were blind to all treatment conditions . A repeated measures analysis of variance revealed a significant difference among the four groups . The AES groups exhibited a statistically significant 18 % elevation of pain threshold , whereas the two placebo stimulation groups ( PS and PN ) remained essentially unchanged . The mean pain threshold increased to more than 23 % for group AS , but fell to less than 12 % for the subjects in group AN , who were given naloxone . These findings indicate a small but significant elevation of pain threshold by AES , an effect partially blocked by naloxone , suggesting an endogenous opioid system as one mechanism for AES analgesia Summary CONTEXT : Patients with disorders of the stomatognathic system describe pain and clicking phenomena as primary symptoms . Rapid improvement of the pain is required to ensure and maintain adequate patient compliance . OBJECTIVE : The study was intended to assess the effects of acupuncture in patients with temporom and ibular disorders as compared to placebo therapy ( sham laser ) ; the primary target parameter was the subjective pain sensation . DESIGN : R and omized , placebo-controlled trial . PATIENTS AND METHODS : 23 patients were enrolled and r and omly assigned to one of the two groups . One group received acupuncture treatment according to the very-point technique , the other group received sham laser treatment . The following observer-blinded findings were evaluated before and after treatment : subjective pain , mouth opening , and muscular tenderness and pain on pressure . In addition , m and ibular joint movement pathways were recorded using electronic axiography . OUTCOMES : Improvements in pain scores ( scale , 0–100 ) in the acupuncture group ( 19.1 ± 11.9 ) were significant ( p = 0.03 ) versus those in the placebo group ( 6.2 ± 14.8 ) . Mouth opening showed an insignificant trend towards improvement ( p > 0.1 ) in the acupuncture ( 5.0 ± 6.2 mm ) versus the placebo group ( 1.0 ± 4.7 mm ) , differences in tenderness and pain on pressure in neck and masticatory muscles were significant ( p < 0,05 ) for most of the muscles having shown pretreatment tenderness or pain . The axiographic tracings were assessed for quality , symmetry and curve characteristics . Recordings of the opening and closing movement in the acupuncture group showed an increased frequency of improvements of curve characteristics as compared to the placebo group . The acupuncture group also showed an increased frequency of improvement in protrusion and retrusion movements , though no statistical significance could be obtained . CONCLUSION : On the basis of the results of the present study , acupuncture may be recommended as acute treatment of craniom and ibular disorders , but studies with larger numbers of patients as well as about long-term treatment outcomes should be conducted . ZusammenfassungEINFÜHRUNG : Patienten mit Störungen des stomatognathen Systems beschreiben als Hauptsymptome Schmerzen und Knackphänomene . Eine rasche Besserung des Schmerzes soll eine gute Patientencompliance sicherstellen . 
    Output:
    