***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: An observer-blind comparative clinical study was carried out in 108 patients presenting with ankle sprains at an Accident and Emergency department . The efficacy and tolerability of diclofenac potassium ( 50 mg 3-times daily ) was compared with that of piroxicam ( 20 mg once daily ) , and placebo . Patients were allocated at r and om to receive one or other of the three treatments for 7 days . There were 36 patients in each group . The analgesic and anti-inflammatory effects of treatment were assessed from volumetric measurements of inflammation at the injured ankle , tenderness , pain on passive movement , severity of the joint lesion , severity of pain at rest and on movement . The overall reductions in pain and inflammation were assessed at the end of the study . The results in patients treated with diclofenac potassium were significantly better than those in patients treated with piroxicam with respect to the improvement in pain on walking and the overall reduction in pain and inflammation , and both active treatments were superior to placebo . There was no significant difference between diclofenac potassium and piroxicam with respect to inflammation measured by volumetry , tenderness , and severity of pain at rest , but both active treatments were consistently superior to placebo . No serious adverse effects were reported . All the patients treated with diclofenac potassium and all those treated with piroxicam said that they would be willing to take the drug again ; this was the case with only 27.8 % of the placebo group . Diclofenac potassium can be considered an effective treatment for acute ankle sprains with a rapid onset of analgesic and anti-inflammatory action and good tolerability Objective : This study aim ed to determine which of two paramedic administered nalbuphine dosing regimens combined the greater analgesic effect with the minimum of adverse events . Methods : Patients suffering from chest pain or trauma were r and omised to receive either a rapid dosing regimen ( 10 mg over 30 seconds , repeated once after three minutes if pain score remained above three ) or a cautious regimen ( 5 mg over two minutes , repeated at three minute intervals if pain score remained above three to a maximum dose of 20 mg ) . Data were collected on analgesic effectiveness , changes in vital signs , and patient reported side effects . Results : The pain score fell by a mean of 4.29 and 3.49 in the rapid and cautious regimen groups respectively ( difference = 0.79 , 95 % CI 0.09 to 1.5 , p = 0.028 ) . However , over half the patients in both groups continued to suffer significant pain on arrival at hospital . There were no significant changes in vital signs after nalbuphine , but there was a greater incidence of patient reported drowsiness in rapid regimen patients ( 42 % compared with 21 % , 95 % CI = 6.96 to 34.12 % , p = 0.003 ) . Conclusion : A rapid dosing regimen of nalbuphine using 10 mg increments is more effective than and equally as safe as a cautious regimen using 5 mg increments . Further research is required to determine if a maximum dose exceeding 20 mg would result in fewer patients continuing to suffer significant pain before arrival at hospital STUDY OBJECTIVE We investigate the efficacy and safety of oral paracetamol compared with oral nonsteroidal antiinflammatory drugs or combination therapy in relieving  pain after blunt limb injury in an emergency department ( ED ) . METHODS This was a double-blind , r and omized , controlled study in an ED of a university hospital in the New Territories of Hong Kong . Three hundred adult patients with painful isolated limb injuries were enrolled . Primary outcome measures were pain relief at rest and with limb movement , adverse events , and patient satisfaction . RESULTS There was no statistical difference in the mean reduction in pain score between any of the combinations at any point , although combination therapy was the first to reach a clinical ly significant reduction in pain score ( < 13 mm ) , and diclofenac-paracetamol combinations consistently produced a greater reduction in mean pain score than either nonsteroidal antiinflammatory drugs or paracetamol alone . All combinations appeared to be safe , although more patients receiving diclofenac-paracetamol combination complained of abdominal pain . The median patient satisfaction scores were poor . CONCLUSION In the doses , frequencies , and routes of administration used for this study , any analgesic benefit of oral paracetamol-nonsteroidal antiinflammatory drug combinations over single nonsteroidal antiinflammatory drugs or paracetamol treatment is small and of doubtful clinical significance . Nonsteroidal antiinflammatory drugs , paracetamol , and diclofenac-paracetamol combinations appeared equally safe in the management of musculoskeletal pain OBJECTIVE The purpose s of this study were to determine the most effective nursing intervention to decrease pain for patients with minor musculoskeletal trauma and moderate pain at triage and to examine patient satisfaction . METHODS Patients were assigned to 1 of 3 intervention groups : ( 1 ) st and ard care ( ice , elevation , and immobilization ) ; ( 2 ) st and ard care and ibuprofen ; or ( 3 ) st and ard care and music distraction . Patients were monitored for pain ratings for 60 minutes . Patients who sustained minor musculoskeletal trauma within the past 24 hours and presented with pain ratings of 4 or greater were included . Two patient satisfaction questions were asked upon discharge from the emergency department . RESULTS Seventy-seven patients met the inclusion criteria . No differences in pain ratings between groups were demonstrated . A statistically significant reduction in pain for all patients occurred at 30 minutes ( F = 16.18 , P < .01 ) and was maintained at 60 minutes . However , 70 % of patients continued to report pain ratings of 4 or greater ( on a scale of 1 to 10 ) at 60 minutes . The reduction in pain was not found to be clinical ly significant . Eighty-four percent of patients stated that they were more satisfied with their overall care in the emergency department because of the immediate attention to pain relief they received at triage . No differences in satisfaction existed between treatment groups , although patients who reported higher pain ratings expressed statistically significant lower satisfaction with pain management scores ( F = 9.375 , P = .003 ) . CONCLUSION None of the therapies-st and ard care ( ice , elevation , immobilization ) , st and ard care with ibuprofen , or st and ard care with music distraction-provided clinical ly significant pain relief to patients who had minor musculoskeletal trauma ( ie , sprains and fractures ) and moderate pain at triage . Interestingly , satisfaction scores were sometimes positive , even when pain was not relieved BACKGROUND Previous studies have demonstrated the efficacy of oxycodone and hydrocodone for the treatment of  acute pain .  However , to the best of the authors ' knowledge , no previous reports have compared the efficacies of these commonly prescribed agents . OBJECTIVES To compare the efficacies of oxycodone and hydrocodone for the treatment of  acute pain associated with fractures in emergency department ( ED ) patients . METHODS This prospect i ve , double-blind , r and omized , controlled trial was conducted at an urban trauma center with an annual census of 65,000 . Eligible participants included ED patients over the age of 12 years with fractures who consented to participate . Subjects were r and omized to receive either oxycodone ( 5 mg orally [ po ] ) with acetaminophen , or hydrocodone ( 5 mg po ) with acetaminophen . Measurements included demographic information ; pain scores on a verbal numeric rating scale at baseline and at 30 and 60 minutes ; vital signs at baseline and at 30 and 60 minutes ; and adverse effects . Ninety-five-percent confidence intervals ( 95 % CIs ) constructed about means and proportions were used to assess differences between the oxycodone and hydrocodone groups in analgesic efficacy and side effects . RESULTS Seventy-three subjects were r and omized to receive oxycodone or hydrocodone .  Sixty-seven subjects completed the ED study period ( n = 35 , oxycodone ; n = 32 , hydrocodone ) . There was no difference between the two groups in age , weight , gender , ethnicity , diagnoses , baseline pain scores , or vital signs . Patients in both groups had pain relief from baseline to 30 minutes ( oxycodone mean change 3.7 , 95 % CI = 2.9 to 4.6 ; hydrocodone mean change 2.5 , 95 % CI = 1.7 to 3.3 ) , and from baseline to 60 minutes ( oxycodone mean change 4.4 , 95 % CI = 3.2 to 5.6 ; hydrocodone mean change 3.0 , 95 % CI = 2.1 to 3.9 ) . There was no difference in pain between the patients treated with oxycodone and hydrocodone at 30 minutes ( mean difference between groups -0.6 , 95 % CI = -1.8 to 0.5 ) or at 60 minutes ( mean difference -0.5 , 95 % CI = -2.0 to 1.0 ) . There was no difference between the groups in nausea , vomiting , itching , or drowsiness ; however , the hydrocodone patients had a higher incidence of constipation ( oxycodone 0 % , hydrocodone 21 % , difference in proportions 21 % , 95 % CI = 3 % to 39 % more with hydrocodone ) . CONCLUSIONS Treatment with acetaminophen and either oxycodone , 5 mg po , or hydrocodone , 5 mg po , result ed in pain relief among ED patients with acute fractures , and there was no difference between the two agents at 30 and 60 minutes . Adverse effect profiles were similar , with the exception of a higher incidence of subsequent constipation with the use of hydrocodone . These results suggest that oxycodone and hydrocodone have similarly potent analgesic effects in the first hour of treatment for ED patients with acute fractures STUDY OBJECTIVE We compare the efficacy of intranasal fentanyl versus intravenous morphine in a pediatric population presenting to an emergency department ( ED ) with acute long-bone fractures . METHODS We conducted a prospect i ve , r and omized , double-blind , placebo-controlled , clinical trial in a tertiary pediatric ED between September 2001 and January 2005 . A convenience sample of children aged 7 to 15 years with clinical ly deformed closed long-bone fractures was included to receive either active intravenous morphine ( 10 mg/mL ) and intranasal placebo or active intranasal concentrated fentanyl ( 150 microg/mL ) and intravenous placebo . Exclusion criteria were narcotic analgesia within 4 hours of arrival , significant head injury , allergy to opiates , nasal blockage , or inability to perform pain scoring .  Pain scores were rated by using a 100-mm visual analog scale at 0 , 5 , 10 , 20 , and 30 minutes . Routine clinical observations and adverse events were recorded . RESULTS Sixty-seven children were enrolled ( mean age 10.9 years [ SD 2.4 ] ) . Fractures were radius or ulna 53 ( 79.1 % ) , humerus 9 ( 13.4 % ) , tibia or fibula 4 ( 6.0 % ) , and femur 1 ( 1.5 % ) . Thirty-four children received intravenous ( i.v . ) morphine and 33 received intranasal fentanyl . Statistically significant differences in visual analog scale scores were not observed between the 2 treatment arms either preanalgesia or at 5 , 10 , 20 , or 30 minutes postanalgesia ( P=.333 ) . At 10 minutes , the difference in mean visual analog scale between the morphine and fentanyl groups was -5 mm ( 95 % confidence interval -16 to 7 mm ) . Reductions in combined pain scores occurred at 5 minutes ( 20 mm ; P=.000 ) , 10 minutes ( 4 mm ; P=.012 ) , and 20 minutes ( 8 mm ; P=.000 ) postanalgesia . The mean total INF dose was 1.7 microg/kg , and the mean total i.v . morphine dose was 0.11 mg/kg . There were no serious adverse events . CONCLUSION Intranasal fentanyl delivered as 150 microg/mL at a dose of 1.7 microg/kg was shown to be an effective analgesic in children aged 7 to 15 years presenting to an ED with an acute fracture when compared to intravenous morphine at 0.1 mg/kg STUDY OBJECTIVE We aim ed to determine the best intravenous morphine titration protocol by comparing 2 protocol s for prehospital treatment of patients with severe acute pain . METHODS Eligible patients with a numerical rating scale ( NRS ) score of 60/100 or higher were r and omly allocated to receive either 0.05 mg/kg morphine then 0.025 mg/kg every 5 minutes ( group A ) or 0.1 mg/kg morphine then 0.05 mg/kg every 5 minutes ( group B ) intravenously . The protocol -defined primary outcome measure was the percentage of patients with pain relief ( with a NRS score of 30/100 or lower ) 30 minutes after the first injection . RESULTS A total of 106 consecutive patients were r and omized . Thirty minutes after the injection , 66 % of the patients in group A had an NRS of 30 or lower vs 76 % of those in group B ( P = .25 ) . Ten minutes after the injection , 1 
    Output:
    
Paracetamol ( both orally and intravenously ) and intravenous opioids ( morphine and fentanyl ) proved to be effective .
Non-steroidal anti-inflammatory drugs ( NSAIDs ) showed mixed results and are not recommended for use in pre-hospital ambulance or ( helicopter ) emergency medical services [ (H)EMS ] .