***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: BACKGROUND Antidepressants are effective in adults with pain-related functional gastrointestinal disorders . We investigated the effectiveness of citalopram in the treatment of childhood functional abdominal pain ( FAP ) . METHODS Children with FAP , based on the Rome III criteria ( n = 115 , aged 6 - 18 years ) , were r and omized to receive either citalopram 20 mg/day or placebo for 4 weeks . Treatment response was defined as ≥ 2 point reduction in the 6-point Faces pain rating scale or ' no pain ' . Depression , anxiety , somatization , and physician-rated global severity and improvement were also evaluated . Patients were followed up for 8 weeks after medication period . KEY RESULTS Eighty-six patients completed the medication ( 43 in each group ) . Response rate in the citalopram and placebo groups based on per- protocol ( intention-to-treat ) analysis was 55.8 % ( 40.6 % ) and 39.5 % ( 30.3 % ) at week 4 ( p = 0.097 [ 0.169 ] ) and 72.0 % ( 52.5 % ) and 53.4 % ( 41.0 % ) at week 12 ( p = 0.059 [ 0.148 ] ) , respectively . In per- protocol analysis , more reduction was observed in pain ( F = 3.84 , p = 0.024 ) and global severity scores ( F = 4.12 , p = 0.021 ) in the citalopram group compared with the placebo group over the study period . Such differences were not present in the intention-to-treat analysis . No difference was found between the two groups regarding change in depression , anxiety , or somatization score over the study . CONCLUSIONS & INFERENCES Overall , we found a trend toward the effectiveness  of citalopram in the treatment of children with FAP . Trials with longer treatment duration in larger sample s of patients are required in this regard Background There are no approved medications for juvenile fibromyalgia ( JFM ) , a disorder that is often under-diagnosed . The effects of milnacipran , a drug approved for the management of fibromyalgia ( FM ) in adults , was assessed in a clinical trial program for JFM . Methods Patients , ages 13–17 years who met the Yunus and Masi criteria for JFM and /or 1990 American College of Rheumatology criteria for FM , were enrolled in a responder-enriched , r and omized withdrawal trial . After receiving open-label milnacipran ( 8 weeks ) , patients with ≥50 % improvement in pain underwent double-blind r and omization ( 1:2 ) to either placebo or continuing treatment with milnacipran ( 8 weeks ) . All patients , including those who did not meet the r and omization criteria for double-blind withdrawal , were allowed to enter an extension study with open-label milnacipran ( up to 52 weeks ) . The primary endpoint was loss of therapeutic response ( LTR ) during the double-blind period . Additional outcome measures included the Patient Global Impression of Severity ( PGIS ) , Pediatric Quality of Life Inventory ( PedsQL : Generic Core Scales , Multidimensional Fatigue Scale ) , and Multidimensional Anxiety Scale for Children ( MASC ) . Safety assessment s included adverse events ( AEs ) , vital signs , electrocardiograms , and laboratory tests . Results The milnacipran program was terminated early due to low enrollment . Because only 20 patients were r and omized into the double-blind withdrawal period , statistical analyses were not conducted for the LTR endpoint . However , 116 patients entered the open-label period of the initial study and 57 participated in the open-label extension study . Their experience provides preliminary information about the use of milnacipran in JFM patients . During both open-label periods , there were mean improvements in pain severity , PGIC , PedsQL , and MASC scores . No unexpected safety issues were detected . The most commonly reported treatment-emergent AEs were nausea , headache , vomiting , and dizziness . Mean increases in heart rate and blood pressure were observed , and were consistent with the AE profile in adults with FM . Conclusions The open-label findings provide preliminary evidence that milnacipran may improve symptoms of JFM , with a safety and tolerability profile that is consistent with the experience in adult FM patients . Future trial design s for JFM should consider the relatively low recognition of this condition compared to adult FM and the difficulties with enrollment . Trial registration NCT01328002 ; & NA ; The current analysis compares changes in pain with changes in function and health status in individuals with painful diabetic peripheral neuropathy ( DPN ) . The post hoc analysis is based on a 12 week , multinational , placebo‐controlled trial of pregabalin in which 401 patients were r and omized to treatment . Study measures included the Brief Pain Inventory short‐form ( BPI‐sf ) , EQ‐5D and other patient‐reported outcomes . Cutpoints were derived on the BPI‐sf 0–10 average pain numeric rating scale [ NRS ] to classify pain grade s of “ mild ” ( 1–3 ) , moderate ( 4–6 ) and severe ( 7–10 ) , adjusting for geographical regions where data were collected . Two different metrics were used to classify the importance of change in pain severity from baseline to 12 weeks : changes in pain severity grade s ( defined by cutpoint categories ) and percent reduction in the NRS ( categories ranging from 0–9 % to ≥50 % ) . An improvement in one pain grade or a ≥30 % reduction in the NRS served as determinants of a clinical ly important difference . Patients with a one‐ grade reduction in pain severity , either from “ severe‐to‐moderate ” or “ moderate‐to‐mild , ” had a 3‐point improvement the BPI‐sf Pain Interference Index ( PII ; a composite measure of function ) ; a reduction from “ severe‐to‐mild ” pain corresponded to a 6‐point improvement in the PII . Similarly , a reduction in the NRS of ≥30 % and ≥50 % corresponded to a 3‐point and a 5‐point improvement in the PII , respectively . Changes in pain were also associated with changes in health status . Results suggest that patients whose pain is not reduced to a mild level of severity can still experience clinical ly important changes in function and health status Objectives Evaluate the efficacy and safety of duloxetine at doses up to 120 mg once daily in patients with fibromyalgia . Methods This was a phase 3 , 60-week study , which included an 8-week open-label period followed by a 52-week , r and omized , double-blind period . Patients received duloxetine 30 mg daily for 1 week and duloxetine 60 mg daily for 7 weeks and were then r and omized to receive either 60 or 120 mg daily ( 1:2 ratio ) . Results Enrolled patients ( N=350 , 95.7 % female ) exhibited moderate disease symptoms at study entry ( Brief Pain Inventory average pain=6.7 , Clinical Global Impression of Severity=4.1 , and Patient 's Global Impression of Severity=4.1 ) . Significant pain reduction in patients was observed during the open-label study phase . This pain reduction continued during the 52-week double-blind study phase , as demonstrated by additional mean decreases in the Brief Pain Inventory average pain score within both duloxetine groups . The most common ( ≥15 % ) treatment-emergent adverse events ( overall phase ) were nausea , headache , insomnia , dizziness , constipation , and dry mouth . Seventy-four ( 21.1 % ) patients reported adverse events as a reason for discontinuation [ most common ( > 1 % ) were insomnia , vomiting , diarrhea , dizziness , and nausea ] . The mean change ( SD ) in sitting systolic blood pressure ( mm Hg ) was −0.1 ( 14.4 ) , in sitting diastolic blood pressure was −0.2 ( 9.6 ) , in sitting pulse rate was 1.9 ( 10.4 ) bpm , and in weight was 0.7 ( 4.3 ) kg . Discussion The profile of duloxetine for the long-term treatment of fibromyalgia was consistent with that seen in other indications for which the drug is currently marketed Abstract Background Treatment of neuropathic pain in children is challenging , and requires a multimodal approach of pharmacologic , physical , and psychological therapies ; however there is little evidence to guide practice . Amitriptyline and gabapentin are first-line drugs for treating neuropathic pain in adults , yet no studies have examined their efficacy , or compared them directly , to determine which might be better for pain relief and sleep disturbance in children . Methods After informed consent was obtained , 34 patients aged 7–18 years diagnosed with complex regional pain syndrome type I ( CRPS I ) or a neuropathic pain condition were r and omly allocated to receive either amitriptyline or gabapentin . Patients were followed for 6 weeks and assessed for pain intensity , sleep quality and adverse events . We blinded study personnel , including health-care providers , participants , parents , the research coordinator and the data analyst . Patients then completed quantitative sensory testing ( QST ) and a psychosocial pain assessment with the team psychologist , within 1–3 days of the start of the trial . Results At the end of the 6-week trial , patients on both drugs had important reductions in pain , having surpassed the minimally important difference ( MID ) of 1 . The difference between the groups however was not statistically significant . For the secondary outcomes , we found no statistically significant difference between the two drugs in sleep score or adverse events suggesting that both drugs improve sleep score to a similar degree and are equally safe . Conclusions Amitriptyline and gabapentin significantly decreased pain intensity scores and improved sleep . There were no significant differences between the two drugs in their effects on pain reduction or sleep disability . Implication s Although larger , multi-centred trials are needed to confirm our findings , including longterm follow-up , both drugs appear to be safe and effective in treating paediatric patients in the first-line treatment of CRPS I and neuropathic pain over 6-weeks AIMS To compare the effectiveness of adding cyclobenzaprine , tizanidine , or placebo to patient education and a self-care management program for patients with myofascial pain and specifically presenting with jaw pain upon awakening . METHODS Forty-five patients with a diagnosis of myofascial pain based on the guidelines of the American Academy of Orofacial Pain participated in this 3-week study . The subjects were r and omly assigned into one of three groups : placebo group , TZA group ( tizanidine 4 mg ) , or CYC group ( cyclobenzaprine 10 mg ) . Patients were evaluated for changes in pain intensity , frequency , and duration by using the modified Severity Symptoms Index and changes in sleep quality with the use of the Pittsburgh Sleep Quality Index . Data were analyzed by ANOVA and post-hoc or nonparametric statistical tests as appropriate . RESULTS All three groups had a reduction in pain symptoms and improvement of sleep quality based on a comparison of pretreatment and treatment scores . However , no significant differences among the groups were observed at the posttreatment evaluation . CONCLUSION The use of tizanidine or cyclobenzaprine in addition to self-care management and patient education was not more effective than placebo for the management of patients with myofascial jaw pain upon awakening & NA ; Chronic pain is associated with a range of other problems , including disturbed sleep , depression , anxiety , fatigue , reduced quality of life , and an inability to work or socialise . We investigated whether good symptom control of pain ( using definitions of moderate and substantial benefit ) is associated with improvement in other symptoms . Individual patient data from four r and omised trials in fibromyalgia ( 2575 patients ) lasting 8–14 weeks were used to calculate  percentage  pain reduction  for each completing patient ( 1858 ) , divided into one of five groups according to pain reduction , irrespective of treatment : substantial benefit – ≥50 % pain reduction ; moderate – 30 % to < 50 % ; minimal – 15 % to < 30 % ; marginal – 0 % to < 15 % ; worse – < 0 % ( increased pain intensity ) . We then calculated change from baseline to end of trial for measures of fatigue , function , sleep , depression , anxiety , ability to work , general health status , and quality ‐adjusted life year ( QALY ) gain over a 12‐month period . Substantial and moderate pain intensity reductions were associated with statistically significant reduction from baseline by end of trial in all measures , with values by trial end at or approaching normative values . Substantial pain intensity reduction result ed in 0.11 QALYs gained , and moderate pain intensity reduction in 0.07 QALYs gained over a 12‐month period . Substantial and moderate pain intensity reduction predicts broad beneficial outcomes and improved quality of life that do not occur without pain relief . Pain intensity reduction is a simple and effective predictor of which patients should continue treatment , and which should discontinue and try an alternative therapy Objective ( Background ): Amitriptyline ( AT ) is a st and ard therapy for postherpetic neuralgia ( PHN ) . Our hypothesis was that nortriptyline ( NT ) , a noradrenergic metabolite of AT , may be more effective . Methods : A r and omized , double-blind , crossover trial of AT versus NT was conducted in 33 patients . Results : Thirty-one patients completed the trial . Twenty-one of 31 ( 67.7 % ) had at least a good response to AT or NT , or both . We found no difference with regard to relief of steady , brief , or skin pain by visual analog scales for pain and pain relief ; mood ; disability ; satisfaction ; or 
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The clinical impression from extended use over many years is that antidepressants are useful for some neuropathic pain symptoms , and that effects on pain relief are divorced and different from effects on depression ; for example , the effects of tricyclic antidepressants on pain may occur at different , and often lower , doses than those on depression .
We identified only a small number of studies with small numbers of participants and insufficient data for analysis .As we could undertake no meta- analysis , we are unable to comment about efficacy or harm from the use of antidepressants to treat chronic non-cancer pain in children and adolescents .
There is evidence from adult r and omised controlled trials that some antidepressants , such as amitriptyline , can provide some pain relief in certain chronic non-cancer pain conditions .
There is no evidence from r and omised controlled trials to support or refute the use of antidepressants to treat chronic non-cancer pain in children or adolescents