***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The clinical efficacy of tolfenamic acid and mefenamic acid in the treatment of primary dysmenorrhoea was studied in a prospect i ve , controlled , double-blind , cross-over study comprising 73 patients aged 13 - 39 with an average body weight of 56 kilos . The patients were r and omized to receive either tolfenamic acid ( 200 mg t.i.d . ) or mefenamic acid ( 500 mg t.i.d . ) for 3 days , during 3 consecutive menstrual cycles each , in a sequential design A-B or B-A. At the beginning and at the end of each treatment period , 13 dysmenorrhoeic symptoms were evaluated on a visual analogue scale ( lower back pain , interference with daily activities , nausea , vomiting , diarrhoea , headache , dizziness , fatigue , sweating , chills , hot flashes , depressant states , and mood swings ) . The data were analyzed by using two statistical models . The first one , for the 73 patients , by making paired comparisons regardless of treatment sequence . With respect to the initial values , the results showed that both drugs were statistically significant ( P < 0.05 ) in reducing the intensity of the evaluated symptoms . When comparing both treatments , tolfenamic acid showed a significant difference as to interference with daily activities ( P < 0.025 ) and hot flashes ( P < 0.005 ) . In the result analysis with the second model , the groups were divided according to the first assigned treatment and paired comparisons were made . It was observed that the group receiving tolfenamic acid in the last sequence reached a higher level of response and statistical significance was demonstrated in 8 of 13 evaluated symptoms . ( ABSTRACT TRUNCATED AT 250 WORDS In 12 dysmenorrheic patients we examined the therapeutic action of the Prostagl and in- synthesis inhibitor : Ibuprofen , a non-steroidal analgesic agent . Ibuprofen highly significantly reduced the resting pressure ( P less than 0.001 ) , active pressure ( P less than 0.001 ) and frequency ( P less than 0.05 ) of cyclic activity of the uterus , as well as menstrual pain ( P less than 0.001 ) . Since these effects occurred after a single oral dose of 800 mg Ibuprofen , without side effects or complications , extensive field trials are recommended with this and other PG- synthesis inhibitors , to assess their therapeutic benefits Following the demonstration that increased prostagl and in F2 alpha production causes pain similar to dysmenorrhea , and the finding that prostagl and in synthetase inhibitors are capable of relieving menstrual pain , the early theory of uterine ischemia has once again gained support as the most likely explanation for this condition . In a double-blind , placebo-controlled , crossover study , 30 of 43 women with moderate to severe dysmenorrhea who completed the trial preferred flurbiprofen ( Ansaid , Upjohn ) , a potent new analgesic/anti-inflammatory agent ( 50 mg four times daily ) , to aspirin ( 650 mg four times daily ) and placebo . Flurbiprofen was also rated superior to aspirin and placebo in the degree of pain relief . An algorithm for the diagnosis and treatment of 90 percent of women with primary dysmenorrhea is presented A multicenter open crossover study compared piroxicam and mefenamic acid and piroxicam and diclofenac in the treatment of primary dysmenorrhea in 91 patients .  Piroxicam 40 mg/day for two days followed by 20 mg/day was compared with mefenamic acid 500 mg t.i.d . and diclofenac 50 mg b.i.d . for two menstrual cycles on each drug . Assessment of efficacy found that piroxicam was more effective than either comparative drug . All three agents were well tolerated . It is concluded that piroxicam is a safe and effective drug for the treatment of primary dysmenorrhea Prostagl and ins E2 and F2a in the menstrual fluid from 12 patients with primary dysmenorrhea were measured by radioimmunoassay ( RIA ) . Each patient was studied for 3 cycles , using vaginal tampons issued for this study . All tampons were collected individually for prostagl and in extraction and RIA . Severity of dysmenorrhea and clinical response to treatment were evaluated by a scoring method and by the patients ' self- assessment . Each patient in this double-blind cross-over study had a control cycle and 2 treatment cycles with naproxen sodium tablets ( 275 mg ) or placebo in r and om order . The treatment regimen was 2 tablets at the first sign of menses followed by one tablet 4 times daily for 3 days . Nine patients obtained good to excellent relief from  naproxen sodium  , but no relief from the placebo . Two patients had moderate to good response to both naproxen and placebo , and one patient showed no response . Naproxen therapy but not placebo therapy sharply reduced menstrual prostagl and in F2a and prostagl and in E2 release . There was a positive correlation between menstrual prostagl and in levels and the severity of dysmenorrhea . Symptomatically , naproxen sodium was most effective in alleviating severe menstrual cramps but had little effect on mild cramps . It was also effective in ameliorating many but not all of the subjective symptoms such as dizziness , nausea , and vomiting . Relief of dysmenorrhea was apparent within one hour after the initial dose , attained maximum level in 2 hours , and was maintained throughout therapy Background : Dysmenorrhea has negative effects on women 's life . Due to side-effects of chemical drugs , there is growing trend toward herbal medicine . The aim of this study was to assess the effect of Dill compared to mefenamic acid on primary dysmenorrhea . Material s and Methods : This double-blind , r and omized , clinical trial study was conducted on 75 single female students between 18 and 28 years old educating in Nursing and Midwifery School and Paramedical Faculty of Qom University of Medical Sciences of Iran in 2011 . They were allocated r and omly into one of the three groups : In Dill group , they took 1000 mg of Dill powder q12h for 5 days from 2 days before the beginning of menstruation for two cycles . Other groups received 250 mg mefenamic acid or 500 mg starch capsule as placebo , respectively . Dysmenorrhea severity was determined by a verbal multidimensional scoring system and a visual analog scale ( VAS ) . Students with mild dysmenorrhea were excluded . Data were analyzed by SPSS using the descriptive statistic , paired- sample s t-test , Wilcoxon signed-rank test , Mann-Whitney test , and Kruskal-Wallis test . Results : There were no significant differences between three groups for demographic or descriptive variables . Comprising the VAS showed that the participants of Dill and mefenamic acid groups had lower significant pain in the 1st and the 2nd months after treatment , whereas in the placebo group this was only significant in the 2nd month ( P < 0.05 ) . Conclusion : Dill was as effective as mefenamic acid in reducing the pain severity in primary dysmenorrhea . Further studies regarding side-effects of Dill and its interactivity are recommended & NA ; The paradoxical improvement of many subjective phenomena during placebo therapy is both well established and notorious for confounding many well design ed studies . Consistently high placebo response rates of as much as 44 % have been reported in subjective studies of dysmenorrhea . In an effort to evaluate the discordant role of objective uterine activity known to be associated with primary dysmenorrhea and the subjective sensation of discomfort , data from 18 patients undergoing meclofenamate therapy for primary dysmenorrhea were evaluated . In this study both the sum of pain intensity differences ( SPID ) and the total pain relief scores at each study time ( TOTPAR ) showed increases during both drug and placebo therapy with statistically significant differences favoring drug therapy . Ten percent of patients eventually reported ‘ complete relief ’ during placebo therapy . In contrast to this subjective placebo response , objective measures of intrauterine pressure showed consistent worsening in 13 out of 14 pressure parameters with 25 % of patients experiencing a 2‐fold or greater increase in the number of contractions while on placebo therapy . The ability to document unchanged or worsening objective parameters associated with the development of ‘ pain ’ in the face of reported subjective improvements may provide new insight into the mechanisms by which the ‘ placebo effect ’ occurs Forty-two women with primary dysmenorrhea were successfully enrolled in a double-blind , three-way crossover study in which each patient received either ibuprofen ( Motrin ) , indomethacin ( Indocin ) , or a placebo during each of three successive painful menstrual cycles . Thirty-one patients successfully completed the study . The results showed that ibuprofen and indomethacin were superior to the placebo in their ability to relieve pain and that patients preferred ibuprofen to indomethacin . Ibuprofen was significantly superior to the placebo regarding the number of patients who could pursue normal daily function , whereas indomethacin was not . Four patients reported side effects , all during the indomethacin cycle 90 women participated in a 4-month study . During the first 2 periods , they took no pain relievers whatsoever ; during their last 2 periods they took 2 X 325 mg aspirin , acetaminophen or an identically packaged placebo every 4 h to total 8 tablets during the first 24 h of their periods beginning with spotting . For statistical analysis , periods 1 and 2 were combined and averaged , then compared with periods 3 and 4 combined and averaged . Total menstrual loss in grams , number of days of flow , and pain of cramps and headaches were analyzed by MANOVA for each of the three treatment groups . An ANOVA for each of these variables as well as for daily menstrual loss for the first 3 menstrual days was also performed . The MANOVA for all variables by the three treatment groups failed to show any significant differences . Similarly , ANOVAs for the individual variables failed to indicate significant differences except for the variable pain of cramps ( p = 0.0072 ) . The Duncan 's Multiple Range Test for pain of cramps showed that the average pain for the placebo group was higher than for either the aspirin or the acetaminophen group , although the means for these two groups were not significantly different . These results indicate that neither aspirin nor acetaminophen in the doses given alter either total menstrual loss or the pattern of loss during the first 3 menstrual days . However , both preparations were found to be more effective than placebo in reducing pain of cramps BACKGROUND Dysmenorrhea is the most common menstrual complaint in young women , with a prevalence as high as 90 % . It is responsible for substantial repeated short-term absenteeism from school and work in young women . Effective treatments are available , including nonsteroidal anti-inflammatory drugs ( NSAIDs ) . In many countries , a variety of NSAIDs have become available as over-the-counter ( OTC ) drugs . OBJECTIVE The goal of this study was to compare the efficacy and safety of OTC doses of naproxen ( 400 mg ) and naproxen/naproxen sodium ( 200/220 mg ) with acetaminophen ( 1000 mg ) , ibuprofen ( 200 mg ) , and placebo in the treatment of primary dysmenorrhea . METHODS A pooled analysis of 5 trials was performed . Efficacy was assessed by pain relief , relief of other dysmenorrheic symptoms , time to backup medication or remedication , and treatment preference . Tolerability was assessed by recording adverse events ( AEs ) . RESULTS A total of 443 women were enrolled in the combined studies .  Naproxen 400 mg provided greater pain relief than acetaminophen and placebo within 30 minutes of administration ( P < 0.01 and P < 0.05 , respectively ) . Furthermore , naproxen 400 mg and 200 mg provided greater pain relief than both acetaminophen ( P < 0.01 and P < 0.05 , respectively ) and ibuprofen ( P < 0.001 and P < 0.01 , respectively ) at 6 hours after administration . Both doses of naproxen had higher scores than placebo for symptom relief and drug preference ( all P < 0.001 ) . The AEs and their frequency were similar among the treatment groups . No serious AEs were reported . CONCLUSION When administered at OTC doses , naproxen was effective in the relief of pain and other symptoms of primary dysmenorrhea and had a good safety profile in the population studied Our objective was to examine the effect of an Iranian herbal drug in the treatment of primary dysmenorrhea . A r and omized , double-blind , placebo-controlled pilot trial among 180 female students at Isfahan University dormitory aged 18 to 27 who suffered from primary dysmenorrhea was undertaken . The participants were r and omly divided into three groups : herbal drug , mefenamic acid , and placebo . The herbal drug group was given 500 mg of highly purified saffron , celery seed , and anise ( SCA ) extracts three times a day for three days , starting from the onset of bleeding or pain . Participants were followed for two to three cycles from the beginning of menstruation through the three days of bleeding . Main outcome measures were the severity and duration of pain at 2 and 3 months . A visual analogue scale was used to record pain . There were statistically significant reductions in pain scores and pain duration scores in the groups that took SCA ( P < . 
    Output:
    
NSAIDs versus other NSAIDsWhen NSAIDs were compared with each other there was little evidence of the superiority of any individual NSAID for either pain relief or safety .
There was no evidence that COX-2-specific inhibitors were more effective or tolerable for the treatment of dysmenorrhoea than traditional NSAIDs ; however data were very scanty .
There was no evidence of a difference with regard to adverse effects , though data were very scanty .
NSAIDs appear to be a very effective treatment for dysmenorrhoea , though women using them need to be aware of the substantial risk of adverse effects .
There is insufficient evidence to determine which ( if any ) individual NSAID is the safest and most effective for the treatment of dysmenorrhoea .