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: Study design : Follow-up study of seven individuals with spinal cord injury ( SCI ) who completed a 9-month r and omized control trial ( RCT ) of exercise training .  Objective : In a 9-month RCT conducted in our lab , individuals with SCI who participated in a twice-weekly supervised exercise training reported greater perceived quality of life ( PQOL ) , and less stress and pain than a nonexercising control cohort . The present follow-up study examined the voluntary continuation of exercise training after the study ended and the persistence of the accrued psychosocial benefits . Setting : Centre for Health Promotion and Rehabilitation , McMaster University , Hamilton , Ontario , Canada . Methods : Five men and two women ( age 42.3±3.6 years ) with SCI ( C5–T12 ; ASIA A – D 12.7±8.2 years postinjury ) were invited to continue supervised exercise training twice weekly at the completion of the 9-month RCT . Exercise adherence , PQOL , stress and bodily pain were measured at a 3-month follow-up and were compared to values obtained at baseline , and at 3 , 6 and 9 months during the intervention . Results : There was a significant decrease in adherence at the 3-month follow-up compared to the overall 9-month adherence rate ( 42.7 versus 80.6 % , respectively ; P<0.01 ) . There was also a significant decrease in PQOL ( P<0.05 ) and a trend for increased pain ( P=0.07 ) and stress ( P=0.12 ) , at follow-up compared to the end of the 9-month trial . Finally , there was a significant negative correlation between pain at the conclusion of the RCT and exercise adherence over the 3-month follow-up period ( r=−0.91 ; P<0.01 ) . Conclusions : These findings emphasize the importance of continued exercise adherence to the maintenance of exercise-related increases in psychological well-being among individuals with SCI Background . It is suggested that transcranial direct current stimulation ( tDCS ) can produce lasting changes in corticospinal excitability and can potentially be used for the treatment of neuropathic pain . However , the detailed mechanisms underlying the effects of tDCS are unknown . Objective . We investigated the underlying neural mechanisms of tDCS for chronic pain relief using [18F]-fluorodeoxyglucose positron emission tomography ( [18F]FDG-PET ) . Methods . Sixteen patients with neuropathic pain ( mean age 44.1 ± 8.6 years , 4 females ) due to traumatic spinal cord injury received sham or active anodal stimulation of the motor cortex using tDCS for 10 days ( 20 minutes , 2 mA , twice a day ) . The effect of tDCS on regional cerebral glucose metabolism was evaluated by [18F]FDG-PET before and after tDCS sessions . Results . There was a significant decrease in the numeric rating scale scores for pain , from 7.6 ± 0.5 at baseline to 5.9 ± 1.8 after active tDCS ( P = .016 ) . We found increased metabolism in the medulla and decreased metabolism in the left dorsolateral prefrontal cortex after active tDCS treatment compared with the changes induced by sham tDCS . Additionally , an increase in metabolism after active tDCS was observed in the subgenual anterior cingulate cortex and insula . Conclusion . The results of this study suggest that anodal stimulation of the motor cortex using tDCS can modulate emotional and cognitive components of pain and normalize excessive attention to pain and pain-related information Abstract Objective To investigate the analgesic effect of repetitive transcranial magnetic stimulation ( rTMS ) on intractable neuropathic pain in patients with spinal cord injury ( SCI ) . Design A single center , prospect i ve , r and omized , double-blinded , controlled study . Setting SCI rehabilitation unit of university rehabilitation center . Participants Seventeen patients with SCI and chronic neuropathic pain who met the inclusion criteria recruited between April 2010 and January 2012 . Interventions Ten daily treatment sessions of real or sham rTMS ( 30 trains of 10-Hz stimuli for a duration of 5 seconds ; a total of 1500 pulses at intensity equal to 110 % of the resting motor threshold ) was applied over vertex using a ﬁgure-of-8-shaped coil . Outcome measures Pain was assessed with visual analog scale ( VAS ) at baseline and 10 days , 6 weeks and 6 months after the treatment . Patients ’ satisfactions obtained using a 5-point Likert scale at 6 months . Results Both real and sham rTMS provided a significant reduction in the VAS scores  ( real rTMS group , P = 0.004 ; sham rTMS group , P = 0.020 ) . Post hoc analysis revealed the significant difference was at 10 days and 6 weeks compared to baseline in the real rTMS group and only at 10 days compared to baseline in the sham rTMS  group . Comparison of VAS scores and patient satisfaction did not show any significant difference at each assessment point ( P > 0.05 ) . Conclusion Our results demonstrated analgesic effect of rTMS on intractable neuropathic pain in SCI was not superior to placebo . However , middle-term ( over 6 weeks ) pain relief by rTMS is encouraging and suggests the need for future studies with a larger sample size PURPOSE To compare the effects of 9 weeks of training with a concurrent flow resistance ( CFR ) device versus a concurrent pressure threshold resistance ( CPTR ) device on health-related quality of life ( HRQoL ) in wheelchair rugby ( WR ) athletes . METHOD Twenty-four male WR athletes ( 22 with tetraplegia , 1 with a spastic cerebral palsy , and 1 with congenital upper and lower limb deformities ) were matched by lesion level , completeness of injury , and rugby classification prior to being r and omly assigned to 1 of 3 groups : ( 1 ) CPTR ( n=8 ) , ( 2 ) CFR ( n=8 ) , or ( 3 ) controls ( CON , n=8 ) . Pre/post testing included assessment of HRQoL as measured by the Short-Form Health Survey Version 2.0 ( SF-36v2 ) . Manufacturer protocol guidelines for the CFR and CPTR groups were followed for breathing exercises . RESULTS Sixteen participants completed the study ( CPTR=4 , CFR=5 , CON=7 ) . The Mann-Whitney U rank order revealed significantly greater reductions in bodily pain ( P = .038 ) and improvements in vitality ( P = .028 ) for CFR versus CON . CONCLUSION Results from this study suggest that training with a CFR device improves some aspects of HRQoL ( eg , vitality and bodily pain ) in WR athletes . Further research with a larger sample size is needed to examine the impact of these devices on improving HRQoL for wheelchair athletes Summary A multidisciplinary cognitive behavioral program might have beneficial effects on people with chronic neuropathic spinal cord injury pain . ABSTRACT Many people with spinal cord injury ( SCI ) rate chronic neuropathic pain as one of the most difficult problems to manage . The aim of the CONECSI ( COping with NEuropathiC Spinal cord Injury pain ) trial was to evaluate a multidisciplinary cognitive behavioral treatment program for persons with chronic neuropathic pain after SCI . The intervention consisted of educational , cognitive , and behavioral elements .  A total of 61 people were r and omized to either the intervention group or the waiting list control group in 4 Dutch rehabilitation centers . Primary outcomes were pain intensity and pain‐related disability ( Chronic Pain Grade question naire ) , and secondary outcomes were mood ( Hospital Anxiety and Depression Scale ) , participation in activities ( Utrecht Activities List ) , and life satisfaction ( Life Satisfaction Question naire ) . Measurements were performed at baseline , and at 3 , and 6 months follow‐up . The primary statistical technique was r and om coefficient analysis . The analyses showed significant changes over time on both primary ( t1–t2 ) , and 2 out of 4 secondary outcomes ( both t1–t2 and t1–t3 ) . Significant intervention effects ( Time * Group interactions ) were found for anxiety and participation in activities , but not for the primary outcomes . Subsequent paired t tests showed significant changes in the intervention group that were not seen in the control group : decrease of pain intensity , pain‐related disability , anxiety , and increase of participation in activities . This study implies that a multidisciplinary cognitive behavioral program might have beneficial effects on people with chronic neuropathic SCI pain Summary In a r and omized sham‐controlled crossover study , transcranial direct current stimulation over the primary motor cortex did not provide relief for long‐st and ing neuropathic spinal cord injury pain . Abstract Neuropathic pain remains one of the most difficult consequences of spinal cord injury ( SCI ) to manage . It is a major cause of suffering and adds to the physical , emotional , and societal impact of the injury . Despite the use of the best available treatments , two thirds of people experiencing neuropathic pain after SCI do not achieve satisfactory pain relief . This study was undertaken in response to a recent clinical trial reporting short‐term , clinical ly significant reductions in neuropathic SCI pain with primary motor cortex transcranial direct current stimulation ( tDCS ) . In this investigation , we aim ed to build on this previous clinical trial by extending the assessment period to determine the short‐ , medium‐ , and long‐term efficacy of tDCS for the treatment of neuropathic pain after SCI . We found that , contrary to previous reports , after 5 tDCS treatment periods , mean pain intensity and unpleasantness rating were not significantly different from initial assessment . That is , in this trial tDCS did not provide any pain relief in subjects with neuropathic SCI pain ( n = 10 ) . A similar lack of effect was also seen after sham treatment . Because the injury duration in this study was significantly greater than that of previous investigations , it is possible that tDCS is an effective analgesic only in individuals with relatively recent injuries and pain . Future investigations comparing a range of injury duration s are required if we are to determine whether this is indeed the case Abstract Background Chronic pain is a significant problem for many individuals following spinal cord injury ( SCI ) . Unfortunately , SCI-related neuropathic pain has proven to be largely refractory to analgesic medications and other available treatments . Cranial electrotherapy stimulation ( CES ) has been effective in managing some types of pain . It involves the application of a small amount of current through the head via ear clip electrodes . Objective Explore the effectiveness of CES for neuropathic pain in persons with SCI and chronic pain . Study design Multi-site , double-blind , sham-controlled study . Participants Adults with SCI and chronic neuropathic pain at or below the level of injury were r and omized to receive active or sham CES . Intervention Application of active CES or sham CES 1 hour daily for 21 days . Six-month open-label phase to assess ‘ as-needed ’ CES use . Outcome measures Change in pre- to post-session pain ratings as well as change in pain intensity , pain interference , pain quality , pain beliefs and coping strategies , general physical and mental health status , depressive symptomatology , perceived stress , and anxiety pre- to post-treatment . Results The active group reported a significantly greater average decrease in pain during daily treatments than the sham group ( Kruskal – Wallis chi-square = 4.70 , P < 0.05 ) . During the 21-day trial , there was a significant group × time interaction for only one outcome variable ; the active group showed larger pre- to post-treatment decreases in pain interference than the sham group did ( F = 8.50 , P < 0.01 , d = 0.59 ) . Conclusions On average , CES appears to have provided a small but statistically significant improvement in pain intensity and pain interference with few troublesome side effects . Individual results varied from no pain relief to a great deal of relief OBJECTIVE To assess whether a comprehensive multidisciplinary pain management programme could contribute to improvement regarding sleep quality , mood , life satisfaction , health-related quality of life , sense of coherence and pain for patients with a spinal cord injury and neuropathic pain . DESIGN A prospect i ve intervention study . PATIENTS Twenty-seven patients with spinal cord injury and neuropathic pain participated in a pain management programme  in parallel with 11 patients in a control group . METHODS A comprehensive pain management programme comprising educational , cognitive , and behavioural interventions was created for patients with spinal cord injury and neuropathic pain . The pain management programme consisted of 20 sessions over a 10-week period and included educational sessions , behavioural therapy , relaxation , stretching , light exercise and body awareness training . All patients were followed-up 3 , 6 and 12 months after completion of the programme . RESULTS At the 12-month follow-up , levels of anxiety and depression in the treatment group decreased compared with baseline values , and a tendency towards better quality of sleep was seen . In comparison with the control group , patients in the treatment group improved regarding sense of coherence and depression . CONCLUSION This study implies that a multidimensional pain management programme can be a valuable complement in the treatment of spinal cord injured patients with neuropathic pain Objective : To assess cortical excitability changes in patients with chronic neuropathic pain at baseline and after repetitive transcranial magnetic stimulation ( rTMS ) of the motor cortex . Methods : In 22 patients with unilateral h and pain of various neurologic origins and 22 age-matched healthy controls , we studied the following parameters of cortical excitability : motor threshold at rest , motor evoked potential amplitude ratio at two intensities , cortical silent period ( CSP ) , and intracortical inhibition ( ICI ) and intracortical facilitation . We compared these parameters between healthy subjects and patients at baseline . We also studied excitability changes in 
    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: Study design : Follow-up study of seven individuals with spinal cord injury ( SCI ) who completed a 9-month r and omized control trial ( RCT ) of exercise training .  Objective : In a 9-month RCT conducted in our lab , individuals with SCI who participated in a twice-weekly supervised exercise training reported greater perceived quality of life ( PQOL ) , and less stress and pain than a nonexercising control cohort . The present follow-up study examined the voluntary continuation of exercise training after the study ended and the persistence of the accrued psychosocial benefits . Setting : Centre for Health Promotion and Rehabilitation , McMaster University , Hamilton , Ontario , Canada . Methods : Five men and two women ( age 42.3±3.6 years ) with SCI ( C5–T12 ; ASIA A – D 12.7±8.2 years postinjury ) were invited to continue supervised exercise training twice weekly at the completion of the 9-month RCT . Exercise adherence , PQOL , stress and bodily pain were measured at a 3-month follow-up and were compared to values obtained at baseline , and at 3 , 6 and 9 months during the intervention . Results : There was a significant decrease in adherence at the 3-month follow-up compared to the overall 9-month adherence rate ( 42.7 versus 80.6 % , respectively ; P<0.01 ) . There was also a significant decrease in PQOL ( P<0.05 ) and a trend for increased pain ( P=0.07 ) and stress ( P=0.12 ) , at follow-up compared to the end of the 9-month trial . Finally , there was a significant negative correlation between pain at the conclusion of the RCT and exercise adherence over the 3-month follow-up period ( r=−0.91 ; P<0.01 ) . Conclusions : These findings emphasize the importance of continued exercise adherence to the maintenance of exercise-related increases in psychological well-being among individuals with SCI Background . It is suggested that transcranial direct current stimulation ( tDCS ) can produce lasting changes in corticospinal excitability and can potentially be used for the treatment of neuropathic pain . However , the detailed mechanisms underlying the effects of tDCS are unknown . Objective . We investigated the underlying neural mechanisms of tDCS for chronic pain relief using [18F]-fluorodeoxyglucose positron emission tomography ( [18F]FDG-PET ) . Methods . Sixteen patients with neuropathic pain ( mean age 44.1 ± 8.6 years , 4 females ) due to traumatic spinal cord injury received sham or active anodal stimulation of the motor cortex using tDCS for 10 days ( 20 minutes , 2 mA , twice a day ) . The effect of tDCS on regional cerebral glucose metabolism was evaluated by [18F]FDG-PET before and after tDCS sessions . Results . There was a significant decrease in the numeric rating scale scores for pain , from 7.6 ± 0.5 at baseline to 5.9 ± 1.8 after active tDCS ( P = .016 ) . We found increased metabolism in the medulla and decreased metabolism in the left dorsolateral prefrontal cortex after active tDCS treatment compared with the changes induced by sham tDCS . Additionally , an increase in metabolism after active tDCS was observed in the subgenual anterior cingulate cortex and insula . Conclusion . The results of this study suggest that anodal stimulation of the motor cortex using tDCS can modulate emotional and cognitive components of pain and normalize excessive attention to pain and pain-related information Abstract Objective To investigate the analgesic effect of repetitive transcranial magnetic stimulation ( rTMS ) on intractable neuropathic pain in patients with spinal cord injury ( SCI ) . Design A single center , prospect i ve , r and omized , double-blinded , controlled study . Setting SCI rehabilitation unit of university rehabilitation center . Participants Seventeen patients with SCI and chronic neuropathic pain who met the inclusion criteria recruited between April 2010 and January 2012 . Interventions Ten daily treatment sessions of real or sham rTMS ( 30 trains of 10-Hz stimuli for a duration of 5 seconds ; a total of 1500 pulses at intensity equal to 110 % of the resting motor threshold ) was applied over vertex using a ﬁgure-of-8-shaped coil . Outcome measures Pain was assessed with visual analog scale ( VAS ) at baseline and 10 days , 6 weeks and 6 months after the treatment . Patients ’ satisfactions obtained using a 5-point Likert scale at 6 months . Results Both real and sham rTMS provided a significant reduction in the VAS scores  ( real rTMS group , P = 0.004 ; sham rTMS group , P = 0.020 ) . Post hoc analysis revealed the significant difference was at 10 days and 6 weeks compared to baseline in the real rTMS group and only at 10 days compared to baseline in the sham rTMS  group . Comparison of VAS scores and patient satisfaction did not show any significant difference at each assessment point ( P > 0.05 ) . Conclusion Our results demonstrated analgesic effect of rTMS on intractable neuropathic pain in SCI was not superior to placebo . However , middle-term ( over 6 weeks ) pain relief by rTMS is encouraging and suggests the need for future studies with a larger sample size PURPOSE To compare the effects of 9 weeks of training with a concurrent flow resistance ( CFR ) device versus a concurrent pressure threshold resistance ( CPTR ) device on health-related quality of life ( HRQoL ) in wheelchair rugby ( WR ) athletes . METHOD Twenty-four male WR athletes ( 22 with tetraplegia , 1 with a spastic cerebral palsy , and 1 with congenital upper and lower limb deformities ) were matched by lesion level , completeness of injury , and rugby classification prior to being r and omly assigned to 1 of 3 groups : ( 1 ) CPTR ( n=8 ) , ( 2 ) CFR ( n=8 ) , or ( 3 ) controls ( CON , n=8 ) . Pre/post testing included assessment of HRQoL as measured by the Short-Form Health Survey Version 2.0 ( SF-36v2 ) . Manufacturer protocol guidelines for the CFR and CPTR groups were followed for breathing exercises . RESULTS Sixteen participants completed the study ( CPTR=4 , CFR=5 , CON=7 ) . The Mann-Whitney U rank order revealed significantly greater reductions in bodily pain ( P = .038 ) and improvements in vitality ( P = .028 ) for CFR versus CON . CONCLUSION Results from this study suggest that training with a CFR device improves some aspects of HRQoL ( eg , vitality and bodily pain ) in WR athletes . Further research with a larger sample size is needed to examine the impact of these devices on improving HRQoL for wheelchair athletes Summary A multidisciplinary cognitive behavioral program might have beneficial effects on people with chronic neuropathic spinal cord injury pain . ABSTRACT Many people with spinal cord injury ( SCI ) rate chronic neuropathic pain as one of the most difficult problems to manage . The aim of the CONECSI ( COping with NEuropathiC Spinal cord Injury pain ) trial was to evaluate a multidisciplinary cognitive behavioral treatment program for persons with chronic neuropathic pain after SCI . The intervention consisted of educational , cognitive , and behavioral elements .  A total of 61 people were r and omized to either the intervention group or the waiting list control group in 4 Dutch rehabilitation centers . Primary outcomes were pain intensity and pain‐related disability ( Chronic Pain Grade question naire ) , and secondary outcomes were mood ( Hospital Anxiety and Depression Scale ) , participation in activities ( Utrecht Activities List ) , and life satisfaction ( Life Satisfaction Question naire ) . Measurements were performed at baseline , and at 3 , and 6 months follow‐up . The primary statistical technique was r and om coefficient analysis . The analyses showed significant changes over time on both primary ( t1–t2 ) , and 2 out of 4 secondary outcomes ( both t1–t2 and t1–t3 ) . Significant intervention effects ( Time * Group interactions ) were found for anxiety and participation in activities , but not for the primary outcomes . Subsequent paired t tests showed significant changes in the intervention group that were not seen in the control group : decrease of pain intensity , pain‐related disability , anxiety , and increase of participation in activities . This study implies that a multidisciplinary cognitive behavioral program might have beneficial effects on people with chronic neuropathic SCI pain Summary In a r and omized sham‐controlled crossover study , transcranial direct current stimulation over the primary motor cortex did not provide relief for long‐st and ing neuropathic spinal cord injury pain . Abstract Neuropathic pain remains one of the most difficult consequences of spinal cord injury ( SCI ) to manage . It is a major cause of suffering and adds to the physical , emotional , and societal impact of the injury . Despite the use of the best available treatments , two thirds of people experiencing neuropathic pain after SCI do not achieve satisfactory pain relief . This study was undertaken in response to a recent clinical trial reporting short‐term , clinical ly significant reductions in neuropathic SCI pain with primary motor cortex transcranial direct current stimulation ( tDCS ) . In this investigation , we aim ed to build on this previous clinical trial by extending the assessment period to determine the short‐ , medium‐ , and long‐term efficacy of tDCS for the treatment of neuropathic pain after SCI . We found that , contrary to previous reports , after 5 tDCS treatment periods , mean pain intensity and unpleasantness rating were not significantly different from initial assessment . That is , in this trial tDCS did not provide any pain relief in subjects with neuropathic SCI pain ( n = 10 ) . A similar lack of effect was also seen after sham treatment . Because the injury duration in this study was significantly greater than that of previous investigations , it is possible that tDCS is an effective analgesic only in individuals with relatively recent injuries and pain . Future investigations comparing a range of injury duration s are required if we are to determine whether this is indeed the case Abstract Background Chronic pain is a significant problem for many individuals following spinal cord injury ( SCI ) . Unfortunately , SCI-related neuropathic pain has proven to be largely refractory to analgesic medications and other available treatments . Cranial electrotherapy stimulation ( CES ) has been effective in managing some types of pain . It involves the application of a small amount of current through the head via ear clip electrodes . Objective Explore the effectiveness of CES for neuropathic pain in persons with SCI and chronic pain . Study design Multi-site , double-blind , sham-controlled study . Participants Adults with SCI and chronic neuropathic pain at or below the level of injury were r and omized to receive active or sham CES . Intervention Application of active CES or sham CES 1 hour daily for 21 days . Six-month open-label phase to assess ‘ as-needed ’ CES use . Outcome measures Change in pre- to post-session pain ratings as well as change in pain intensity , pain interference , pain quality , pain beliefs and coping strategies , general physical and mental health status , depressive symptomatology , perceived stress , and anxiety pre- to post-treatment . Results The active group reported a significantly greater average decrease in pain during daily treatments than the sham group ( Kruskal – Wallis chi-square = 4.70 , P < 0.05 ) . During the 21-day trial , there was a significant group × time interaction for only one outcome variable ; the active group showed larger pre- to post-treatment decreases in pain interference than the sham group did ( F = 8.50 , P < 0.01 , d = 0.59 ) . Conclusions On average , CES appears to have provided a small but statistically significant improvement in pain intensity and pain interference with few troublesome side effects . Individual results varied from no pain relief to a great deal of relief OBJECTIVE To assess whether a comprehensive multidisciplinary pain management programme could contribute to improvement regarding sleep quality , mood , life satisfaction , health-related quality of life , sense of coherence and pain for patients with a spinal cord injury and neuropathic pain . DESIGN A prospect i ve intervention study . PATIENTS Twenty-seven patients with spinal cord injury and neuropathic pain participated in a pain management programme  in parallel with 11 patients in a control group . METHODS A comprehensive pain management programme comprising educational , cognitive , and behavioural interventions was created for patients with spinal cord injury and neuropathic pain . The pain management programme consisted of 20 sessions over a 10-week period and included educational sessions , behavioural therapy , relaxation , stretching , light exercise and body awareness training . All patients were followed-up 3 , 6 and 12 months after completion of the programme . RESULTS At the 12-month follow-up , levels of anxiety and depression in the treatment group decreased compared with baseline values , and a tendency towards better quality of sleep was seen . In comparison with the control group , patients in the treatment group improved regarding sense of coherence and depression . CONCLUSION This study implies that a multidimensional pain management programme can be a valuable complement in the treatment of spinal cord injured patients with neuropathic pain Objective : To assess cortical excitability changes in patients with chronic neuropathic pain at baseline and after repetitive transcranial magnetic stimulation ( rTMS ) of the motor cortex . Methods : In 22 patients with unilateral h and pain of various neurologic origins and 22 age-matched healthy controls , we studied the following parameters of cortical excitability : motor threshold at rest , motor evoked potential amplitude ratio at two intensities , cortical silent period ( CSP ) , and intracortical inhibition ( ICI ) and intracortical facilitation . We compared these parameters between healthy subjects and patients at baseline . We also studied excitability changes in 
    Output:
    