***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 
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    ***EXAMPLES*** 
    Input: STUDY OBJECTIVE This r and omized , placebo-controlled trial evaluates the analgesic efficacy and safety of intravenous single-dose paracetamol and morphine for the treatment of renal colic . METHODS We conducted a r and omized , double-blind , placebo-controlled clinical trial comparing single intravenous doses of paracetamol ( 1 g ) , morphine ( 0.1 mg/kg ) , and placebo ( normal saline solution ) for patients presenting to the emergency department ( ED ) with suspected renal colic . Subjects with inadequate pain relief at 30 minutes received rescue fentanyl ( 0.75 microg/kg ) . We compared changes in pain intensity 30 minutes after treatment among the 3 arms , as well as the need for rescue medication and the presence of adverse effects . RESULTS Six hundred forty-five consecutive patients were screened for study and 165 were entered . Eight subjects were subsequently excluded from analysis because of protocol violations and 11 were excluded because of uncertain diagnoses , leaving 146 subjects available for analysis . The mean reduction in visual analogue scale pain intensity scores at 30 minutes was 43 mm for paracetamol ( 95 % confidence interval [ CI ] 35 to 51 mm ) , 40 mm for morphine ( 95 % CI 29 to 52 mm ) , and 27 mm for placebo ( 95 % CI 19 to 34 mm ) . Statistically significant mean differences in pain intensity reductions compared with those for placebo were observed for paracetamol ( 16 ; 95 % CI 5 to 27 ; P=.005 ) and morphine ( 14 ; 95 % CI 0.4 to 27 ; P=.05 ) ; however , no difference was found between paracetamol and morphine ( 2 ; 95 % CI -13 to 16 ; P=.74 ) . Rescue analgesics at 30 minutes were required by 21 subjects ( 45 % ) receiving paracetamol , 24 subjects ( 49 % ) receiving morphine , and 34 subjects ( 67 % ) receiving placebo ( P=.08 ) . At least 1 adverse effect was experienced by 11 ( 24 % ) receiving paracetamol , 16 ( 33 % ) receiving morphine , and 8 ( 16 % ) in the placebo group ( P=.14 ) . There were no serious adverse events . CONCLUSION Intravenous paracetamol is an efficacious and safe treatment for ED patients with renal colic Intravenous indoprofen ( 400 mg ) , a cyclooxygenase inhibitor , was compared with intramuscular oxicodone hydrochloride (= oxicone 10 mg ) , a narcotic analgesic agent , in regard to efficacy and side effects in the treatment of renal colic .  Oxicone was combined with papaverine ( 20 mg ) . Patients were r and omized to either treatment , and the drugs were given in double-dummy fashion , i.e. one injection of active drug plus one placebo injection . Pain intensity before and after treatment was registered by the patient ( visual analog scale ) and by a nurse , who also registered side effects . Oxicone was given to 46 patients and indoprofen to 48 . The groups did not differ in body weight , age , sex distribution , or pretreatment intensity of pain .  More patients required additional treatment in the oxicone than in the indoprofen group ( 19 v. 10 ) . At 2 - 5 min after injection , pain reduction was greater with indoprofen , and more patients in this group had pain relief after 3 - 5 hours . Side effects were less frequent with indoprofen than with oxicone ( 1 v. 20 patients ) , in particular from the central nervous system . This difference probably was related to indoprofen 's slow and poor penetration of the blood-brain barrier . The study affirmed that non-narcotic cyclooxygenase inhibitors can replace narcotic analgesics for acute pain alleviation in renal colic . Indoprofen seems to be a useful alternative , with low risk of central nervous side effects OBJECTIVES Intravenous ( IV ) opioid titration is an accepted method of relieving acute renal colic . Studies have shown that nonsteroidal anti-inflammatory drugs ( NSAIDs ) are also effective in this setting . Our objective was to compare single-dose ketorolac and titrated meperidine , both administered intravenously , with respect to speed and degree of analgesia , adverse effects and functional status . Our primary hypothesis was that these agents provide equivalent analgesia within 60 minutes . Our secondary hypotheses were that ketorolac-treated patients would experience fewer adverse effects and would be better able to resume usual activity . METHODS This was a multicentre , double-blind r and omized equivalence trial in a convenience sample of patients age 18 - 65 with moderate or severe renal colic , documented by intravenous pyelogram , ultrasound or stone passage .  Meperidine-treated patients received 50 mg IV meperidine at 0 minutes , then 25 - 50 mg every 15 minutes as needed for ongoing pain . Ketorolac-treated patients received 30 mg IV ketorolac at 0 minutes and placebo injections every 15 minutes as needed . Pain levels and adverse effects were assessed every 15 minutes , and functional status was evaluated at 60 minutes . Our primary outcome was the proportion of patients with mild or no pain at 60 minutes . RESULTS Overall , 49 of 77 meperidine-treated patients ( 64 % ; 95 % confidence interval [ CI ] , 53%-75 % ) and 47 of 65 ketorolac-treated patients ( 72 % ; 95 % CI , 61%-83 % ) achieved successful pain relief at 60 minutes ( p value for equivalence = 0.002 ) . Ten percent of meperidine-treated patients and 44 % of ketorolac-treated patients were able to resume usual activity at 60 minutes ( p = 0.001 ) . CONCLUSIONS In the doses studied , single-dose IV ketorolac is as effective as titrated IV meperidine for the relief of acute renal colic and causes less functional impairment OBJECTIVE To compare the analgesic efficacy of a single 30 mg intramuscular dose of ketorolac with that of intramuscular pethidine 100 mg , in a double-blind , parallel-group investigation of patients presenting with pain suggestive of renal colic . PATIENTS AND METHODS Seventy-six patients ( 17 women , 15 men ; mean age 45.2 years , range 20 - 80 ) were allocated by means of a pre-determined r and omization schedule to receive ketorolac and 78 patients ( 20 women , 58 men ; mean age 42.1 , years range 18 - 70 ) to receive pethidine .  Data from eight patients in the ketorolac group and six in the pethidine group were excluded from the efficacy analyses because of protocol violations . The severity of each patient 's pain was assessed on a four-point verbal rating scale ( VRS ) and a 10 cm visual analogue scale at pre-dose and at 15 min intervals for the first hour post dosing . The time to first administration of rescue analgesic , up to 24 h following dosing with the study medication , was recorded . Adverse events were elicited by general question ing . RESULTS Eighty-eight per cent of patients in each treatment group had improved according to the VRS of pain severity 1 h after dosing ; the summed pain intensity differences up to 1 h were statistically significantly different in favour of ketorolac ( P < 0.05 ) . Fifty-six per cent of patients who were receiving ketorolac required rescue analgesia during the study period compared with 74 % receiving pethidine . The incidences of adverse events were lower in the ketorolac group ( 28 % ) than the pethidine group ( 51 % ) . CONCLUSION Ketorolac can be considered a viable alternative to pethidine for the treatment of renal colic OBJECTIVE To compare the efficacy of desmopressin ( DDAVP ) , tramadol and indomethacin on pain intensity of patients with acute renal colic caused by urolithiasis . METHODS This prospect i ve , r and omized clinical trial was conducted between July 2005 and July 2006 including 120 patients ( 70 men and 50 women , mean age 38.2±5.8 years ) referring to emergency room of Shahid Faghihi hospital with renal colic caused by urolithiasis without any previous treatment . The patients were r and omly assigned to three groups : group A received tramadol 50 mg intramuscularly ( n=40 ) , group B received desmopressin 40 µg intranasally ( n=40 ) and group C received indomethacin 100 mg rectally ( n=40 ) . The pain was assessed both on admission and 30 minutes after the intervention . The pain intensity and the side effects were compared between two study groups . RESULTS There was no significant difference between two study groups regarding the baseline characteristics . The intensity of pain of presentation was almost similar in all groups . In group A , 30 patients ( 75 % ) , in group B , 15 patients ( 37.5 % ) and in group C , 19 patients ( 47.5 % ) had complete pain relief . The pain intensity decreased significantly after the intervention within all three groups ( p<0.001 ) . CONCLUSION According to the results of the current study , rectal indomethacin , intramuscular tramadol and intranasal desmopressin are effective and safe routs of controlling pain in acute renal colic secondary to urolithiasis . Tramadol was the most effective agent in controlling the pain Objective To determine the analgesic efficacy and safety of intravenous single-dose paracetamol versus morphine in patients presenting to the emergency department with renal colic . Methods A r and omised double-blind study was performed to compare the efficacy of intravenous paracetamol ( 1 g ) and 0.1 mg/kg morphine in patients with renal colic . The efficacy of the study drugs was measured by a visual analogue scale and a verbal rating scale at baseline and after 15 and 30 min . The adverse effects and need for rescue medication ( 1 μg/kg intravenous fentanyl ) were also recorded at the end of the study . Results 133 patients were eligible for enrolment in the study , with 73 patients included in the final analysis ( 38 in the paracetamol group and 35 in the morphine group ) . The mean±SD age of the subjects was 30.2±8.6 years and 51 ( 70 % ) were men .  The mean reduction in scores at 30 min after study drug administration was 63.7 mm ( 95 % CI 57 to 71 ) for paracetamol and 56.6 mm ( 95 % CI 48 to 65 ) for morphine . The difference between pain reduction scores for the two groups at 30 min was 7.1 mm ( 95 % CI −18 to 4 ) , demonstrating no statistical or clinical significance . Two adverse events ( 5.3 % ) were recorded in the paracetamol group and five ( 14.3 % ) in the morphine group ( difference 9 % , 95 % CI −7 % to 26 % ) . Conclusion Intravenous paracetamol is effective in treating patients presenting with renal colic to the emergency department . Clinical trials registration no Clinical Trials.gov ID number NCT01318187 BACKGROUND The excruciating pain of patients with renal colic on presentation to the emergency department requires effective analgesia to be administered in the shortest possible time . Trials comparing intramuscular non-steroidal anti-inflammatory drugs with intravenous opioids or paracetamol have been inconclusive because of the challenges associated with concealment of r and omisation , small sample size , differences in outcome measures , and inadequate masking of participants and assessors . We did this trial to develop definitive evidence regarding the choice of initial analgesia and route of administration in participants presenting with renal colic to the emergency department . METHODS In this three-treatment group , double-blind , r and omised controlled trial , adult participants ( aged 18 - 65 years ) presenting to the emergency department of an academic , tertiary care hospital in Qatar , with moderate to severe renal colic ( Numerical pain Rating Scale ≥ 4 ) were recruited . With the use of computer-generated block r and omisation ( block sizes of six and nine ) , participants were assigned ( 1:1:1 ) to receive diclofenac ( 75 mg/3 mL intramuscular ) , morphine ( 0.1 mg/kg intravenous ) , or paracetamol ( 1 g/100 mL intravenous ) . Participants , clinicians , and trial personnel were masked to treatment assignment . The primary outcome was the proportion of participants achieving at least a 50 % reduction in initial pain score at 30 min after analgesia , assessed by intention-to-treat analysis and per- protocol analysis , which included patients where a calculus in the urinary tract was detected with imaging . This trial is registered with Clinical Trials.gov , number NCT02187614 . FINDINGS Between Aug 5 , 2014 , and March 15 , 2015 , we r and omly assigned 1645 participants , of whom 1644 were included in the intention- 
    Output:
    
There was less vomiting and fewer requirements for rescue analgesia with NSAIDs compared with opioids .
Despite observed heterogeneity among the included studies and the overall quality of evidence , the findings of a lower need for rescue analgesia and fewer adverse events , in conjunction with the practical advantages of ease of delivery , suggest that NSAIDs should be the preferred analgesic option for patients presenting to the emergency department with renal colic .
PATIENT SUMMARY In kidney stone-related acute pain episodes in patients with adequate renal function , treatment with nonsteroidal anti-inflammatory drugs offers effective and most sustained pain relief , with fewer side effects , when compared with opioids or paracetamol