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: Evidence that placebo acupuncture is an effective treatment for  chronic pain  presents a puzzle : how do placebo needles appearing to patients to penetrate the body , but instead sitting on the skin 's surface in the manner of a tactile stimulus , evoke a healing response ? Previous accounts of ritual touch healing in which patients often described enhanced touch sensations ( including warmth , tingling or flowing sensations ) suggest an embodied healing mechanism . In this qualitative study , we asked a subset of patients in a singleblind r and omized trial in irritable bowel syndrome to describe their treatment experiences while undergoing placebo treament . Analysis focused on patients ' unprompted descriptions of any enhanced touch sensations ( e.g. , warmth , tingling ) and any significance patients assigned to the sensations . We found in 5/6 cases , patients associated sensations including " warmth " and " tingling " with treatment efficacy . The conclusion offers a " neurophenomenological " account of the placebo effect by considering dynamic effects of attentional filtering on early sensory cortices , possibly underlying the phenomenology of placebo acupuncture Objective . To investigate the relationship between changes in clinical rating scale items and endpoint Patient Global Impression of Improvement ( PGI-I ) . Methods . Data were pooled from 4 r and omized , double-blind , placebo-controlled studies of duloxetine in patients with fibromyalgia ( FM ) . Variables included in the analyses were those that assessed symptoms in FM domains of pain , fatigue , sleep , cognitive difficulties , emotional well-being , physical function , and impact on daily living . The association of endpoint PGI-I with changes from baseline in individual variables was assessed using Pearson product-moment correlations ( r ) . Stepwise linear regression was used to identify those variables for which changes from baseline were statistically significant independent predictors of the endpoint PGI-I ratings . Results . Changes in pain variables and interference of symptoms with the ability to work were highly correlated ( r ≥ 0.5 or r ≤ −0.5 ) with endpoint PGI-I. Moderate correlation with endpoint PGI-I ( 0.30 ≤ r < 0.5 or −0.5 < r ≤ −0.30 ) included changes in variables that assessed physical functioning , depression , anxiety , fatigue , and several variables related to impact on daily living . Independent predictor variables of endpoint PGI-I identified by stepwise linear regression included assessment s for pain , physical function , vitality , anxiety , social function , and tender point thresholds . Conclusion . In addition to pain reduction , what makes patients with FM feel better may include improvement in fatigue , physical functioning , mood , and impact on daily living . An assessment of these domains may be important in clinical trials of FM and in the management of patients with FM OBJECTIVE Fibromyalgia syndrome ( FMS ) is characterized by widespread musculoskeletal pain and lowered pain threshold . Other prominent symptoms include disordered sleep and fatigue . FMS affects an estimated 2 % of the population , predominantly women . This trial was design ed to evaluate the efficacy and safety of pregabalin , a novel alpha(2)-delta lig and , for treatment of symptoms associated with FMS . METHODS This multicenter , double-blind , 8-week , r and omized clinical trial compared the effects of placebo with those of 150 , 300 , and 450 mg/day pregabalin on pain , sleep , fatigue , and health-related quality of life in 529 patients with FMS . The primary outcome variable was the comparison of end point mean pain scores , derived from daily diary ratings of pain intensity , between each of the pregabalin treatment groups and the placebo group . RESULTS Pregabalin at 450 mg/day significantly reduced the average severity of pain in the primary analysis compared with placebo ( -0.93 on a 0 - 10 scale ) ( P < /= 0.001 ) , and significantly more patients in this group had > /=50 % improvement in pain at the end point ( 29 % , versus 13 % in the placebo group ; P = 0.003 ) . Pregabalin at 300 and 450 mg/day was associated with significant improvements in sleep quality , fatigue , and global measures of change .  Pregabalin at 450 mg/day improved several domains of health-related quality of life . Dizziness and somnolence were the most frequent adverse events . Rates of discontinuation due to adverse events were similar across all 4 treatment groups . CONCLUSION Pregabalin at 450 mg/day was efficacious for the treatment of FMS , reducing symptoms of pain , disturbed sleep , and fatigue compared with placebo . Pregabalin was well tolerated and improved global measures and health-related quality of life The paper describes the type and frequency of adverse events and transient reactions following consultations with  professional acupuncturists .  In a postal survey , involving 1848 professional acupuncturists , all of whom were members of the British Acupuncture Council and practising in the UK , details of adverse events and transient reactions following treatment were recorded on st and ardised self-report forms . A sample size of 30,000 treatments was sought , and piloting indicated that a four-week period was required . Practitioners also provided information on themselves , including age , sex , length of training and years of practice . A total of 574 practitioners responded , 31 % of the total population . These practitioners reported on  adverse events and transient reactions associated with 34,407 treatments . No serious adverse events were reported , where these were defined as requiring hospital admission , prolonging hospital stays , permanently disabling , or result ing in death ( 95 % CI : 0 to 1.1 per 10,000 treatments ) . A total of 43 significant minor adverse events were reported , a rate of 1.3 per 1,000 treatments ( 95 % CI : 0.9 to 1.7 ) . These included severe nausea and actual fainting ( 12 ) , unexpected , severe and prolonged aggravation of symptoms ( 7 ) , prolonged and unacceptable pain and bruising ( 5 ) and psychological and emotional reactions ( 4 ) . There were three avoidable events : two patients had needles left in by mistake , and one patient had moxa burns to the skin , also caused by practitioner error . The acupuncturists also recorded 10,920 mild transient reactions occurring in 5136 treatments , 15 % ( 95 % CI : 14.6 to 15.3 ) of the 34,407 total . In terms of local reactions , there were reports of mild bruising ( 1.7 % ) , pain ( 1.2 % ) and bleeding ( 0.4 % ) . Practitioners reported that patients experienced an aggravation of existing symptoms after 2.8 % of treatments . The most common mild transient reactions to treatment were feeling relaxed ( 11.9 % ) and feeling energised ( 6.6 % ) . In this prospect i ve survey of 34,407 treatments , practitioners reported no serious adverse events . This conclusion was based on data collected from one in three members of the British Acupuncture Council . Given that the whole membership delivers between one and a half and two million treatments a year , this is important evidence on public health and safety . When compared with medication routinely prescribed in primary care , the results suggest that acupuncture is a relatively safe treatment modality OBJECTIVE To test the hypothesis that acupuncture improves symptoms of fibromyalgia .  PATIENTS AND METHODS We conducted a prospect i ve , partially blinded , controlled , r and omized clinical trial of patients receiving true acupuncture  compared with a control group of patients who received simulated acupuncture . All patients met American College of Rheumatology criteria for fibromyalgia and had tried conservative symptomatic treatments other than acupuncture .  We measured symptoms with the Fibromyalgia Impact Question naire ( FIQ ) and the Multidimensional Pain Inventory at baseline , immediately after treatment , and at 1 month and 7 months after treatment . The trial was conducted from May 28 , 2002 , to August 18 , 2003 . RESULTS Fifty patients participated in the study : 25 in the acupuncture group and 25 in the control group .  Total fibromyalgia symptoms , as measured by the FIQ , were significantly improved in the acupuncture group compared with the control group during the study period ( P = .01 ) . The largest difference in mean FIQ total scores was observed at 1 month ( 42.2 vs 34.8 in the control and acupuncture groups , respectively ; P = .007 ) . Fatigue and anxiety were the most significantly improved symptoms during the follow-up period . However , activity and physical function levels did not change . Acupuncture was well tolerated , with minimal adverse effects . CONCLUSION This study paradigm allows for controlled and blinded clinical trials of acupuncture . We found that acupuncture significantly improved symptoms of fibromyalgia . Symptomatic improvement was not restricted to pain relief and was most significant for fatigue and anxiety UNLABELLED Evoked pain measures such as tender point count and dolorimetry are often used to determine tenderness in studies of fibromyalgia ( FM ) . However , these measures frequently do not improve in clinical trials and are known to be influenced by factors other than pain such as distress and expectancy . The purpose of this investigation was to determine whether evoked pain paradigms that present pressure stimuli in a r and om fashion ( eg , Multiple R and om Staircase [ MRS ] ) would track with clinical pain improvement in patients with FM better than traditional measures . Sixty-five subjects enrolled in a r and omized clinical trial of acupuncture were observed longitudinally .  Clinical pain was measured on a 101-point numerical rating scale ( NRS ) and the Short Form McGill Pain Question naire ( SF-MPQ ) , whereas evoked pressure sensitivity was assessed via manual tender point count , dolorimetry , and MRS methods . Improvements in clinical pain and evoked pain were assessed irrespective of group assignment . Improvement was seen in clinical pain during the course of the trial as measured by both NRS ( P = .032 ) and SF-MPQ ( P = .001 ) . The MRS was the only evoked pain measure to improve correspondingly with treatment ( MRS , P = .001 ; tender point count and dolorimeter , P > .05 ) . MRS change scores were correlated with changes in NRS pain ratings ( P = .003 ) ; however , this association was not stronger than tender point or dolorimetry correlations with clinical pain improvement ( P > .05 ) . Pain sensitivity as assessed by r and om paradigms was associated with improvements in clinical FM pain . Sophisticated pain testing paradigms might be responsive to change in clinical trials . PERSPECTIVE Trials in fibromyalgia often use both clinical and experimental methods of pain assessment ; however , these two outcomes are often poorly correlated . We explore the relationship between changes in clinical and experimental pain within FM patients .  Pressure pain testing that applies stimuli in a r and om order is associated with improvements in clinical pain , but this association was not stronger than other experimental techniques OBJECTIVE --To determine the efficacy of electroacupuncture in patients with fibromyalgia , a syndrome of unknown origin causing diffuse musculoskeletal pain . DESIGN --Three weeks ' r and omised study with blinded patients and evaluating physician . SETTING --University divisions of physical medicine and rehabilitation and rheumatology , Geneva . PATIENTS --70 patients ( 54 women ) referred to the division for fibromyalgia as defined by the American College of Rheumatology . INTERVENTIONS -- Patients were r and omised to electroacupuncture ( n = 36 ) or a sham procedure ( n = 34 ) by means of an electronic numbers generator . MAIN OUTCOME MEASURES --Pain threshold , number of analgesic tablets used , regional pain score , pain recorded on visual analogue scale , sleep quality , morning stiffness , and patient 's and evaluating physician 's appreciation . RESULTS --Seven of the eight outcome parameters showed a significant improvement in the active treatment group whereas none were improved in the sham treatment group . Differences between the groups were significant for five of the eight outcome measures after treatment . CONCLUSIONS --Electroacupuncture is effective in relieving symptoms of fibromyalgia . Its potential in long term management should now be studied Background The results of many clinical trials and experimental studies regarding acupoint specificity are contradictory . This review aims to investigate whether a difference in efficacy exists between ordinary acupuncture  on specific acupoints and sham acupuncture controls on non-acupoints or on irrelevant acupoints . Methods Data bases including Medline , Embase , AMED and Chinese Biomedical Data base were search ed to identify r and omized controlled trials published between 1998 and 2009 that compared  traditional body acupuncture  on acupoints  with sham acupuncture controls  on irrelevant acupoints or non-acupoints with the same needling depth . The Cochrane Collaboration 's tool for assessing risk of bias was employed to address the quality of the included trials . Results Twelve acupuncture clinical trials with sham acupuncture controls were identified and included in the review . The conditions treated varied . Half of the included trials had positive results on the primary outcomes and demonstrated acupoint specificity . However , among those six trials ( total sample size : 985 ) with low risk of bias , five trials ( sample size : 940 ) showed no statistically significant difference between proper and sham acupuncture treatments . Conclusion This review did not demonstrate the existence of acupoint specificity . Further clinical trials with larger sample sizes , optimal acupuncture treatment protocol s and appropriate sham acupuncture controls are required to resolve this important issue BACKGROUND Temporal summation of pain , a phenomenon of the central nervous system ( CNS ) , represents enhanced painful sensation or reduced pain threshold upon repeated stimulation . This pain model has been used to evaluate the analgesic effect of various medications on the CNS . A 
    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: Evidence that placebo acupuncture is an effective treatment for  chronic pain  presents a puzzle : how do placebo needles appearing to patients to penetrate the body , but instead sitting on the skin 's surface in the manner of a tactile stimulus , evoke a healing response ? Previous accounts of ritual touch healing in which patients often described enhanced touch sensations ( including warmth , tingling or flowing sensations ) suggest an embodied healing mechanism . In this qualitative study , we asked a subset of patients in a singleblind r and omized trial in irritable bowel syndrome to describe their treatment experiences while undergoing placebo treament . Analysis focused on patients ' unprompted descriptions of any enhanced touch sensations ( e.g. , warmth , tingling ) and any significance patients assigned to the sensations . We found in 5/6 cases , patients associated sensations including " warmth " and " tingling " with treatment efficacy . The conclusion offers a " neurophenomenological " account of the placebo effect by considering dynamic effects of attentional filtering on early sensory cortices , possibly underlying the phenomenology of placebo acupuncture Objective . To investigate the relationship between changes in clinical rating scale items and endpoint Patient Global Impression of Improvement ( PGI-I ) . Methods . Data were pooled from 4 r and omized , double-blind , placebo-controlled studies of duloxetine in patients with fibromyalgia ( FM ) . Variables included in the analyses were those that assessed symptoms in FM domains of pain , fatigue , sleep , cognitive difficulties , emotional well-being , physical function , and impact on daily living . The association of endpoint PGI-I with changes from baseline in individual variables was assessed using Pearson product-moment correlations ( r ) . Stepwise linear regression was used to identify those variables for which changes from baseline were statistically significant independent predictors of the endpoint PGI-I ratings . Results . Changes in pain variables and interference of symptoms with the ability to work were highly correlated ( r ≥ 0.5 or r ≤ −0.5 ) with endpoint PGI-I. Moderate correlation with endpoint PGI-I ( 0.30 ≤ r < 0.5 or −0.5 < r ≤ −0.30 ) included changes in variables that assessed physical functioning , depression , anxiety , fatigue , and several variables related to impact on daily living . Independent predictor variables of endpoint PGI-I identified by stepwise linear regression included assessment s for pain , physical function , vitality , anxiety , social function , and tender point thresholds . Conclusion . In addition to pain reduction , what makes patients with FM feel better may include improvement in fatigue , physical functioning , mood , and impact on daily living . An assessment of these domains may be important in clinical trials of FM and in the management of patients with FM OBJECTIVE Fibromyalgia syndrome ( FMS ) is characterized by widespread musculoskeletal pain and lowered pain threshold . Other prominent symptoms include disordered sleep and fatigue . FMS affects an estimated 2 % of the population , predominantly women . This trial was design ed to evaluate the efficacy and safety of pregabalin , a novel alpha(2)-delta lig and , for treatment of symptoms associated with FMS . METHODS This multicenter , double-blind , 8-week , r and omized clinical trial compared the effects of placebo with those of 150 , 300 , and 450 mg/day pregabalin on pain , sleep , fatigue , and health-related quality of life in 529 patients with FMS . The primary outcome variable was the comparison of end point mean pain scores , derived from daily diary ratings of pain intensity , between each of the pregabalin treatment groups and the placebo group . RESULTS Pregabalin at 450 mg/day significantly reduced the average severity of pain in the primary analysis compared with placebo ( -0.93 on a 0 - 10 scale ) ( P < /= 0.001 ) , and significantly more patients in this group had > /=50 % improvement in pain at the end point ( 29 % , versus 13 % in the placebo group ; P = 0.003 ) . Pregabalin at 300 and 450 mg/day was associated with significant improvements in sleep quality , fatigue , and global measures of change .  Pregabalin at 450 mg/day improved several domains of health-related quality of life . Dizziness and somnolence were the most frequent adverse events . Rates of discontinuation due to adverse events were similar across all 4 treatment groups . CONCLUSION Pregabalin at 450 mg/day was efficacious for the treatment of FMS , reducing symptoms of pain , disturbed sleep , and fatigue compared with placebo . Pregabalin was well tolerated and improved global measures and health-related quality of life The paper describes the type and frequency of adverse events and transient reactions following consultations with  professional acupuncturists .  In a postal survey , involving 1848 professional acupuncturists , all of whom were members of the British Acupuncture Council and practising in the UK , details of adverse events and transient reactions following treatment were recorded on st and ardised self-report forms . A sample size of 30,000 treatments was sought , and piloting indicated that a four-week period was required . Practitioners also provided information on themselves , including age , sex , length of training and years of practice . A total of 574 practitioners responded , 31 % of the total population . These practitioners reported on  adverse events and transient reactions associated with 34,407 treatments . No serious adverse events were reported , where these were defined as requiring hospital admission , prolonging hospital stays , permanently disabling , or result ing in death ( 95 % CI : 0 to 1.1 per 10,000 treatments ) . A total of 43 significant minor adverse events were reported , a rate of 1.3 per 1,000 treatments ( 95 % CI : 0.9 to 1.7 ) . These included severe nausea and actual fainting ( 12 ) , unexpected , severe and prolonged aggravation of symptoms ( 7 ) , prolonged and unacceptable pain and bruising ( 5 ) and psychological and emotional reactions ( 4 ) . There were three avoidable events : two patients had needles left in by mistake , and one patient had moxa burns to the skin , also caused by practitioner error . The acupuncturists also recorded 10,920 mild transient reactions occurring in 5136 treatments , 15 % ( 95 % CI : 14.6 to 15.3 ) of the 34,407 total . In terms of local reactions , there were reports of mild bruising ( 1.7 % ) , pain ( 1.2 % ) and bleeding ( 0.4 % ) . Practitioners reported that patients experienced an aggravation of existing symptoms after 2.8 % of treatments . The most common mild transient reactions to treatment were feeling relaxed ( 11.9 % ) and feeling energised ( 6.6 % ) . In this prospect i ve survey of 34,407 treatments , practitioners reported no serious adverse events . This conclusion was based on data collected from one in three members of the British Acupuncture Council . Given that the whole membership delivers between one and a half and two million treatments a year , this is important evidence on public health and safety . When compared with medication routinely prescribed in primary care , the results suggest that acupuncture is a relatively safe treatment modality OBJECTIVE To test the hypothesis that acupuncture improves symptoms of fibromyalgia .  PATIENTS AND METHODS We conducted a prospect i ve , partially blinded , controlled , r and omized clinical trial of patients receiving true acupuncture  compared with a control group of patients who received simulated acupuncture . All patients met American College of Rheumatology criteria for fibromyalgia and had tried conservative symptomatic treatments other than acupuncture .  We measured symptoms with the Fibromyalgia Impact Question naire ( FIQ ) and the Multidimensional Pain Inventory at baseline , immediately after treatment , and at 1 month and 7 months after treatment . The trial was conducted from May 28 , 2002 , to August 18 , 2003 . RESULTS Fifty patients participated in the study : 25 in the acupuncture group and 25 in the control group .  Total fibromyalgia symptoms , as measured by the FIQ , were significantly improved in the acupuncture group compared with the control group during the study period ( P = .01 ) . The largest difference in mean FIQ total scores was observed at 1 month ( 42.2 vs 34.8 in the control and acupuncture groups , respectively ; P = .007 ) . Fatigue and anxiety were the most significantly improved symptoms during the follow-up period . However , activity and physical function levels did not change . Acupuncture was well tolerated , with minimal adverse effects . CONCLUSION This study paradigm allows for controlled and blinded clinical trials of acupuncture . We found that acupuncture significantly improved symptoms of fibromyalgia . Symptomatic improvement was not restricted to pain relief and was most significant for fatigue and anxiety UNLABELLED Evoked pain measures such as tender point count and dolorimetry are often used to determine tenderness in studies of fibromyalgia ( FM ) . However , these measures frequently do not improve in clinical trials and are known to be influenced by factors other than pain such as distress and expectancy . The purpose of this investigation was to determine whether evoked pain paradigms that present pressure stimuli in a r and om fashion ( eg , Multiple R and om Staircase [ MRS ] ) would track with clinical pain improvement in patients with FM better than traditional measures . Sixty-five subjects enrolled in a r and omized clinical trial of acupuncture were observed longitudinally .  Clinical pain was measured on a 101-point numerical rating scale ( NRS ) and the Short Form McGill Pain Question naire ( SF-MPQ ) , whereas evoked pressure sensitivity was assessed via manual tender point count , dolorimetry , and MRS methods . Improvements in clinical pain and evoked pain were assessed irrespective of group assignment . Improvement was seen in clinical pain during the course of the trial as measured by both NRS ( P = .032 ) and SF-MPQ ( P = .001 ) . The MRS was the only evoked pain measure to improve correspondingly with treatment ( MRS , P = .001 ; tender point count and dolorimeter , P > .05 ) . MRS change scores were correlated with changes in NRS pain ratings ( P = .003 ) ; however , this association was not stronger than tender point or dolorimetry correlations with clinical pain improvement ( P > .05 ) . Pain sensitivity as assessed by r and om paradigms was associated with improvements in clinical FM pain . Sophisticated pain testing paradigms might be responsive to change in clinical trials . PERSPECTIVE Trials in fibromyalgia often use both clinical and experimental methods of pain assessment ; however , these two outcomes are often poorly correlated . We explore the relationship between changes in clinical and experimental pain within FM patients .  Pressure pain testing that applies stimuli in a r and om order is associated with improvements in clinical pain , but this association was not stronger than other experimental techniques OBJECTIVE --To determine the efficacy of electroacupuncture in patients with fibromyalgia , a syndrome of unknown origin causing diffuse musculoskeletal pain . DESIGN --Three weeks ' r and omised study with blinded patients and evaluating physician . SETTING --University divisions of physical medicine and rehabilitation and rheumatology , Geneva . PATIENTS --70 patients ( 54 women ) referred to the division for fibromyalgia as defined by the American College of Rheumatology . INTERVENTIONS -- Patients were r and omised to electroacupuncture ( n = 36 ) or a sham procedure ( n = 34 ) by means of an electronic numbers generator . MAIN OUTCOME MEASURES --Pain threshold , number of analgesic tablets used , regional pain score , pain recorded on visual analogue scale , sleep quality , morning stiffness , and patient 's and evaluating physician 's appreciation . RESULTS --Seven of the eight outcome parameters showed a significant improvement in the active treatment group whereas none were improved in the sham treatment group . Differences between the groups were significant for five of the eight outcome measures after treatment . CONCLUSIONS --Electroacupuncture is effective in relieving symptoms of fibromyalgia . Its potential in long term management should now be studied Background The results of many clinical trials and experimental studies regarding acupoint specificity are contradictory . This review aims to investigate whether a difference in efficacy exists between ordinary acupuncture  on specific acupoints and sham acupuncture controls on non-acupoints or on irrelevant acupoints . Methods Data bases including Medline , Embase , AMED and Chinese Biomedical Data base were search ed to identify r and omized controlled trials published between 1998 and 2009 that compared  traditional body acupuncture  on acupoints  with sham acupuncture controls  on irrelevant acupoints or non-acupoints with the same needling depth . The Cochrane Collaboration 's tool for assessing risk of bias was employed to address the quality of the included trials . Results Twelve acupuncture clinical trials with sham acupuncture controls were identified and included in the review . The conditions treated varied . Half of the included trials had positive results on the primary outcomes and demonstrated acupoint specificity . However , among those six trials ( total sample size : 985 ) with low risk of bias , five trials ( sample size : 940 ) showed no statistically significant difference between proper and sham acupuncture treatments . Conclusion This review did not demonstrate the existence of acupoint specificity . Further clinical trials with larger sample sizes , optimal acupuncture treatment protocol s and appropriate sham acupuncture controls are required to resolve this important issue BACKGROUND Temporal summation of pain , a phenomenon of the central nervous system ( CNS ) , represents enhanced painful sensation or reduced pain threshold upon repeated stimulation . This pain model has been used to evaluate the analgesic effect of various medications on the CNS . A 
    Output:
    