***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: Butorphanol tartrate ( 4 mg and 8 mg ) was compared to codeine phosphate ( 60 mg ) and placebo for oral analgesic activity and side-effects employing a double-blind design in ninety-three out- patients suffering from moderate to very severe musculoskeletal pain . The study duration was 72 hours with medication administered every 4 to 6 hours ( four times daily ) for a total of twelve doses per patient . The results demonstrate that both the 4 mg and 8 mg doses of butorphanol were significantly better ( p<0.05 ) than placebo . While codeine 60 mg also proved active , it appears to be less efficacious than the high dose of butorphanol . The peak effect appeared to be evident in 1 to 2 hours . Butorphanol may be at least seven times more potent than codeine on a milligram basis . Although no serious side-effects were observed , butorphanol appeared to present a greater incidence of side-effects than codeine and placebo in this study Short-term and long-term effects of neonatal pain and its analgesic treatment have been topics of translational research over the years . This study aim ed to identify the long-term effects of continuous morphine infusion in the neonatal period on thermal pain sensitivity , the incidence of chronic pain , and neurological functioning .  Eighty-nine of the 150 participants of a neonatal r and omized controlled trial on continuous morphine infusion versus placebo during mechanical ventilation underwent quantitative sensory testing and neurological examination at the age of 8 or 9 years . Forty-three children from the morphine group and 46 children from the placebo group participated in this follow-up study . Thermal detection and pain thresholds were compared with data from 28 healthy controls . Multivariate analyses revealed no statistically significant differences in thermal detection thresholds and pain thresholds between the morphine and placebo groups . The incidence of chronic pain was comparable between both groups . The neurological examination was normal in 29 ( 76 % ) of the children in the morphine group and 25 ( 61 % ) of the children in the control group ( P = .14 ) . We found that neonatal continuous morphine infusion ( 10 μg/kg/h ) has no adverse effects on thermal detection and pain thresholds , the incidence of chronic pain , or overall neurological functioning 8 to 9 years later . Perspective : This unique long-term follow-up study shows that neonatal continuous morphine infusion ( 10 μg/kg/h ) has no long-term adverse effects on thermal detection and pain thresholds or overall neurological functioning . These findings will help clinicians to find the most adequate and safe analgesic dosing regimens for neonates and infants & 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 & 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 Background : Recent warnings from Health Canada regarding codeine for children have led to increased use of nonsteroidal anti-inflammatory drugs and morphine for common injuries such as fractures . Our objective was to determine whether morphine administered orally has superior efficacy to ibuprofen in fracture-related pain . Methods : We used a parallel group , r and omized , blinded superiority design . Children who presented to the emergency department with an uncomplicated extremity fracture were r and omly assigned to receive either morphine ( 0.5 mg/kg orally ) or ibuprofen ( 10 mg/kg ) for 24 hours after discharge . Our primary outcome was the change in pain score using the Faces Pain Scale — Revised ( FPS-R ) . Participants were asked to record pain scores immediately before and 30 minutes after receiving each dose . Results : We analyzed data from 66 participants in the morphine group and 68 participants in the ibuprofen group . For both morphine and ibuprofen , we found a reduction in pain scores ( mean pre – post difference ± st and ard deviation for dose 1 : morphine 1.5 ± 1.2 , ibuprofen 1.3 ± 1.0 , between-group difference [ δ ] 0.2 [ 95 % confidence interval ( CI ) −0.2 to 0.6 ] ; dose 2 : morphine 1.3 ± 1.3 , ibuprofen 1.3 ± 0.9 , δ 0 [ 95 % CI −0.4 to 0.4 ] ; dose 3 : morphine 1.3 ± 1.4 , ibuprofen 1.4 ± 1.1 , δ −0.1 [ 95 % CI −0.7 to 0.4 ] ; and dose 4 : morphine 1.5 ± 1.4 , ibuprofen 1.1 ± 1.2 , δ 0.4 [ 95 % CI −0.2 to 1.1 ] ) . We found no significant differences in the change in pain scores  between morphine and ibuprofen between groups at any of the 4 time points ( p = 0.6 ) . Participants in the morphine group had significantly more adverse effects than those in the ibuprofen group ( 56.1 % v. 30.9 % , p < 0.01 ) . Interpretation : We found no significant difference in analgesic efficacy between orally administered morphine and ibuprofen . However , morphine was associated with a significantly greater number of adverse effects . Our results suggest that ibuprofen remains safe and effective for outpatient pain management in children with uncomplicated fractures . Trial registration : Clinical Trials.gov , no. NCT01690780 SUMMARY Two double-blind between-patient comparisons of the analgesic activity of orally administered pentazocine 50 mg , dihydrocodeine 60 mg and placebo are described , which involved 99 patients in " severe " or " moderate " pain , mainly of skeletal origin , and 103 patients in " severe " or " moderate " pain predominatly of postoperative origin . In both studies pain was assessed by a single observer prior to and 1 hour after the administration of a single dose of one of the test preparations . Both active drugs were significantly superior to placebo , and in both studies a firm trend showed pentazocine to be more effective than dihydrocodeine which was in turn more effective than placebo .  Drowsiness more commonly followed pentazocine administration , but nausea and vomiting more commonly followed dihydrocodeine Background : The aim was to compare the efficacy and safety of a combination of intramuscular ketorolac and chlorpromazine for the treatment of acute exacerbations of chronic pain with the more commonly used regimen of intramuscular meperidine and promethazine . Methods : Use-effective case series were drawn from a real-life , rural emergency department practice , in which 200 consecutive patients coming to a rural emergency department with acute exacerbations of chronic pain syndromes were assigned on an every-other basis in a single-blind fashion to one of the two treatment conditions . Patients were given intramuscular doses of either 60 mg of ketorolac plus 50 mg of chlorpromazine ( 75 mg of chlorpromazine for patients weighing more than 100 kg ) , or 50 mg of meperidine plus 25 mg of promethazine ( 50 mg of promethazine for patients weighing more than 75 kg ) ; patients weighing more than 100 kg were given 1.5 doses . Patients older than 65 years or whose blood pressure at the time of injection was less than 110/70 mmHg were given half-doses . Patients could receive one additional half-dose injection if they had no results within 30 to 60 minutes after the first injection . Patients were assessed on self-report and on a verbal and visual analog scale of pain rating . Temperature , blood pressure , heart rate , and respirations were monitored every 15 minutes . Results : Both regimens performed well , with more than 90 percent of patients reporting good or excellent improvement on acute exacerbations of chronic pain .  Ketorolac-chlorpromazine offered significant advantages compared with meperidine-promethazine when patients rated their pain on a visual analog pain scale ( P < 0.05 ) but not on a verbal scale . Adverse reactions were minimal and consisted of more respiratory tract depression with meperidine and more vertigo or dizziness with chlorpromazine . There was no difference in incidence of hypotension between the two groups . Conclusions : The combination of ketorolac and chlorpromazine is a safe and efficacious alternative to meperidine plus promethazine for the treatment of exacerbations of chronic pain in the rural emergency department setting BACKGROUND Gastrointestinal ( GI ) adverse effects are common with oral opioid treatments ; their impact on health-related quality of life ( HRQoL ) is poorly understood . OBJECTIVES To estimate the extent to which GI adverse effects impact HRQoL. DESIGN 28-day prospect i ve , multicenter , observational registry . SETTING Outpatient setting s. PARTICIPANTS Six hundred thirty-nine patients with acute pain ( AP ; n = 243 ) and acute episodes of chronic pain ( CP ; pain ≥3 months ; n = 396 ) requiring treatment with a prescription medication containing oxycodone immediate-release on an as-needed basis for ≥5 days . MEASUREMENTS Modified Memorial Symptom Assessment Scale ; 12-item Short Form Health Survey ( SF-12 ) Physical ( PCS ) ; and Mental Component Scales ( MCS ) on days 3 , 7 , 14 , 21 , and 28 . Repeated measures mixed models provided estimates of impact of GI events on HRQoL. RESULTS Forty-seven percent of AP patients and 24 percent of CP patients developed constipation . More AP patients than CP developed nausea ( 31 percent vs 19 percent ) . After adjustment for confounders , constipation was associated with a 3.9-point reduction in PCS and a 2.3-point reduction in MCS among AP patients ( p < 0.0001 ) . Among AP patients , nausea/vomiting was associated with a reduction in PCS ( PCS = 3.2 ; p < 0.0001 ) and MCS ( MCS = 2.2 ; p = 0.0042 ) . Among CP patients , constipation was not associated with reductions in HRQoL , and nausea/vomiting was associated with a reduction in MCS but not PCS ( MCS = 2 
    Output:
    
There was no evidence from r and omised controlled trials to support or refute the use of opioids to treat chronic non-cancer pain in children and adolescents .
We are unable to comment about efficacy or harm from the use of opioids to treat chronic non-cancer pain in children and adolescents .
We know from adult r and omised controlled trials that some opioids , such as morphine and codeine , can be effective in certain chronic pain conditions .
This means that no conclusions could be made about efficacy or harm in the use of opioids to treat chronic non-cancer pain in children and adolescents