***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: DFP [ 3-(2-propyloxy)-(4-methyl-sulfonylphenyl)-(5,5-dimethyl)-fu ranone ] is a highly specific cyclooxygenase-2 inhibitor ( > 2500-fold selective in transfected Chinese hamster ovary cell assays ) that has demonstrated efficacy in pre clinical models of pain and inflammation . The present single-dose , r and omized , double-masked , double-dummy , placebo-controlled , parallel-group study was undertaken to compare DFP 5 , 25 , and 50 mg with naproxen sodium 550 mg and with placebo in 196 patients ( mean age , 25.8 years ; 187 [ 95.4 % ] males ) who experienced moderate-to-severe pain after surgical removal of > or = 2 third molars .  Overall analgesic effect , duration of effect , time to onset of analgesic effect , peak analgesic effect , and tolerability were assessed over a 24-hour postdose period . Both DFP 25 and 50 mg , as well as the active comparator , naproxen sodium 550 mg , were significantly more effective than placebo . The onset of analgesic effect in the DFP 25-mg , DFP 50-mg , and naproxen sodium 550-mg groups did not differ significantly . DFP was generally well tolerated in single doses up to 50 mg . DFP 50 mg was efficacious in the treatment of postoperative dental pain and was indistinguishable from the active comparator , naproxen sodium 550 mg In a double-blind , parallel , placebo-controlled study , 203 patients with post-operative dental pain following the extraction of one or two bony impacted third molars were r and omized to receive a single dose of naproxen sodium 220 mg , ibuprofen 200 mg or placebo .  Pain intensity and pain relief were assessed at intervals for 12 hours postdose . Both active drugs demonstrated superior analgesic efficacy over placebo . Naproxen sodium and ibuprofen were comparable both in onset of analgesic action and in pain relief . From 1 to 12 hours postdose , naproxen sodium showed a trend for superior analgesic efficacy compared with ibuprofen ; this trend reached statistical significance at the 12-hour time point . Both drugs were well-tolerated and effective analgesics for postoperative dental pain Abstract  Variability  in patients ' response to interventions in pain and other clinical setting s is large . Many explanations such as trial methods , environment or culture have been proposed , but this paper sets out to show that the main cause of the variability may be r and om chance , and that if trials are small their estimate of magnitude of effect may be incorrect , simply because of the r and om play of chance . This is highly relevant to the questions of ‘ How large do trials have to be for statistical accuracy ? ’ and ‘ How large do trials have to be for their results to be clinical ly valid ? ’ The true underlying control event rate ( CER ) and experimental event rate ( EER ) were determined from single‐dose acute pain analgesic trials in over 5000 patients . Trial group size required to obtain statistically significant and clinical ly relevant ( 0.95 probability of number‐needed‐to‐treat within ±0.5 of its true value ) results were computed using these values . Ten thous and trials using these CER and EER values were simulated using varying group sizes to investigate the variation due to r and om chance alone . Most common analgesics have EERs in the range 0.4–0.6 and CER of about 0.19 . With such efficacy , to have a 90 % chance of obtaining a statistically significant result in the correct direction requires group sizes in the range 30–60 . For clinical relevance nearly 500 patients are required in each group . Only with an extremely effective drug ( EER>0.8 ) will we be reasonably sure of obtaining a clinical ly relevant NNT with commonly used group sizes of around 40 patients per treatment arm . The simulated trials showed substantial variation in CER and EER , with the probability of obtaining the correct values improving as group size increased . We contend that much of the variability in control and experimental event rates is due to r and om chance alone . Single small trials are unlikely to be correct . If we want to be sure of getting correct ( clinical ly relevant ) results in clinical trials we must study more patients . Credible estimates of clinical efficacy are only likely to come from large trials or from pooling multiple trials of conventional ( small ) size Background Naproxen and naproxen sodium are non-steroidal anti-inflammatory drugs used in a variety of painful conditions , including the treatment of postoperative pain . This review aims to assess the efficacy , safety and duration of action of a single oral dose of naproxen/naproxen sodium for moderate to severe acute postoperative pain in adults , compared with placebo . Methods The Cochrane Library ( issue 4 2002 ) , EMBASE , PubMed , MEDLINE and an in-house data base were search ed for r and omised , double blind , placebo controlled trials of a single dose of orally administered naproxen or naproxen sodium in adults with acute postoperative pain .  Pain relief or pain intensity data were extracted and converted into dichotomous information to give the number of patients with at least 50 % pain relief over 4 to 6 hours . Relative benefit and number-needed-to-treat were then calculated . The percentage of patients with any adverse event , number-needed-to-harm , and time to remedication were also calculated . Results Ten trials with 996 patients in met the inclusion criteria . Six trials compared naproxen sodium 550 mg ( 252 patients ) with placebo ( 248 patients ) ; the NNT for at least 50 % pain relief over six hours was 2.6 ( 95 % confidence interval 2.2 to 3.2 ) . There was no significant difference between the number of patients experiencing any adverse event on treatment compared with placebo .  Weighted mean time to remedication was 7.6 hours for naproxen sodium 550 mg ( 206 patients ) and 2.6 hours for placebo ( 205 patients ) . Four other trials used lower doses . Conclusion A single oral dose of naproxen sodium 550 mg is an effective analgesic in the treatment of acute postoperative pain . A low incidence of adverse events was found , although these were not reported consistently Abstract A multidisciplinary , double blind , parallel placebo controlled investigation was made to find an effective anti-inflammatory drug which prevents  postoperative swelling , trismus and a general feeling of malaise . An additional aim was to evaluate objective ly the anti-inflammatory properties of anti-rheumatics . In 126 healthy patients , who were without complaints , the lower third molar was surgically removed . A drug had to be taken orally according to a fixed scheme for 4 days . Glafenine had to be taken in case of pain . The number of tablets taken was used to quantify pain . Swelling of the cheek was measured photographically and trismus was deducible from the maximal mouth-opening . The drugs investigated were betamethasone 14.5 mg decreasing over 4 days , ibuprofen 1200 mg/day , indomethacin 150 mg/day , naproxen 750 mg/day , niflumic acid 1000 mg/day , oxyphenylbutazone 600 mg/day and tranexamic acid 2000 mg/day . Oxyphenylbutazone and tranexamic acid were not significantly different from placebo in their pain-killing effects .  Betamethasone  prevents swelling and trismus significantly more than the placebo . Betamethasone is significantly better than the other drugs in the prevention of swelling . Reduction of the swelling by anti-rheumatics may be 10–15 % and a 20 % reduction of trismus is to be expected . The strongest analgesic is niflumic acid . Tranexamic acid may perhaps reduce the swelling by 28 % . The question naire and the blood- and urine-test showed that anti-rheumatics have to be considered to be acetylsalicylic acid-like drugs . Serious side effects have been reported previously for anti-rheumatics . When taken for a short time , corticosteroids are very safe drugs with a few mild side-effects . Many patients experience a slight euphoria .  Betamethasone , in a dosage of 14.5 mg decreasingly divided over 4 days prevents pain by 80 % , swelling by 65 % and trismus by 40 % compared with the placebo group . This safe drug is recommended in elective surgery Oral naproxen in doses of 100 , 200 and 400 mg was compared with oral meperidine in doses of 25 and 75 mg , in a double-blind , single-dose , completely-r and omized study of patients with postoperative pain . One hundred patients were studied , twenty for each of the five treatments . The patients 1 subjective pain scores were recorded by an observer for four hours after administration of the treatment . Dose-effect trends were present with both naproxen and meperidine . Naproxen 400 mg performed the best of all treatments in the study ; on pain-score measurements it was significantly superior to meperidine 25 mg ; and in terms of the number of patients requiring re-medication for pain during the four-hour observation period , significantly fewer patients failed on naproxen 400 than on naproxen 100 mg . No appreciable excess of side effects occurred with naproxen A double-blind parallel r and omized study comparing naproxen 600 mg , naproxen 400 mg , and propoxyphene 65 mg was performed in 105 patients suffering from pain after orthopedic surgery . A significant difference in analgesic effectiveness was shown between the three drugs with successful analgesia recorded in 66 % of patients who received naproxen 600 mg , 37 % of those who received naproxen 400 mg , and 20 % of those who received propoxyphene 65 mg ( X2 2dt= 15.34 , p<0.005 ) . Naproxen 600 mg provided successful analgesia more often than did naproxen 400 mg . Complaints were mild but frequent with ail drugs ( 36 % of patients ) . No serious side effects were & NA ; There is uncertainty over whether the patient group in which acute pain studies are conducted ( pain model ) has any influence on the estimate of analgesic efficacy . Data from four recently up date d systematic review s of aspirin 600/650 mg , paracetamol 600/650 mg , paracetamol 1000 mg and ibuprofen 400 mg were used to investigate the influence of pain model . Area under the pain relief versus time curve equivalent to at least 50 % maximum pain relief over 6 h was used as the outcome measure . Event rates with treatment and placebo , and relative benefit ( RB ) and number needed to treat ( NNT ) were used as outputs from the meta‐analyses . The event rate with  placebo was systematic ally statistically lower for dental than postsurgical pain for all four treatments . Event rates with analgesics , RB and NNT were infrequently different between the pain models . Systematic difference in the estimate of analgesic efficacy between dental and postsurgical pain models remains unproven , and , on balance , no major difference is likely One hundred and eighty patients scheduled for day-care surgery were allocated r and omly to one of three groups to receive naproxen sodium 1100 mg 1 h prior to surgery , naproxen sodium 1100 mg immediately after surgery , or placebo . The pre-surgery naproxen sodium group had significantly lower pain scores 1 h post-operatively and at discharge than the placebo group . At discharge both treatment groups were better than placebo . At 24 h post-operatively only the post-operative naproxen sodium group had lower pain scores . There was no difference in post-operative analgesic requirements until discharge between the groups , but at 24 h post-operatively the placebo group had required significantly more analgesics than the treatment groups . A question naire concerning general acceptability of anaesthesia/analgesia showed similar results . Our conclusion is that naproxen is better than placebo for treatment of post-operative pain . The time of administration pre- or post-operatively is important for the immediate post-operative pain , but we found no support for the existence of ' pre-emptive analgesia ' In a double-blind study , 198 out patients with pain after oral surgery were r and omly assigned to treatment with a single oral dose of naproxen sodium 550 mg , codeine sulfate 60 mg , a combination of naproxen sodium 550 mg with codeine sulfate 60 mg , aspirin 650 mg or placebo . Using a self-rating record , subjects rated their pain and its relief hourly for 12 hours after medication . Orthogonal contrasts for the four treatments making up the factorial component showed that the naproxen effect was significant for every measurement of total and peak analgesia ; the codeine effect was significant for total and peak pain relief and patients ' overall evaluation . The naproxen-codeine interaction was not statistically significant for any measure , which suggests that the analgesic effect of the combination represents the additive effect of its constituents . Based on pairwise comparisons , aspirin was significantly superior to placebo for most measures of effect , naproxen was significantly superior to both aspirin and codeine for all measures and the combination was significantly superior to naproxen for patients ' 
    Output:
    
Use of rescue medication was significantly less common with naproxen than placebo .
Associated adverse events were generally of mild to moderate severity and rarely led to withdrawal .
Doses equivalent to 500 mg and 400 mg naproxen administered orally provided effective analgesia to adults with moderate to severe acute postoperative pain .