***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: Following the demonstration that increased prostagl and in F2 alpha production causes pain similar to dysmenorrhea , and the finding that prostagl and in synthetase inhibitors are capable of relieving menstrual pain , the early theory of uterine ischemia has once again gained support as the most likely explanation for this condition . In a double-blind , placebo-controlled , crossover study , 30 of 43 women with moderate to severe dysmenorrhea who completed the trial preferred flurbiprofen ( Ansaid , Upjohn ) , a potent new analgesic/anti-inflammatory agent ( 50 mg four times daily ) , to aspirin ( 650 mg four times daily ) and placebo . Flurbiprofen was also rated superior to aspirin and placebo in the degree of pain relief . An algorithm for the diagnosis and treatment of 90 percent of women with primary dysmenorrhea is presented The purpose of the present investigation was to compare the analgesic efficacy of flurbiprofen , a nonsteroidal anti-inflammatory drug , which is a phenyl propionic acid derivative , with acetaminophen and placebo in 63 adult out patients with moderate to severe dental pain following periodontal surgery . After surgery was completed under local anesthesia , the patients received under double-blind conditions an envelope containing four tablets of either flurbiprofen 100 mg , acetaminophen 500 mg , or placebo and they were instructed to take one tablet every 6 hours when postoperative pain reached moderate to severe intensity . To determine analgesic efficacy and patients recorded pain intensity on a scale of 0 to 3 . Patients were allowed to remedicate after 1 hour if pain was not reduced . Flurbiprofen was shown to possess an adequate analgesic effect superior to either placebo ( P less than 0.005 ) or acetaminophen ( P less than 0.01 ) in the parameters studied . Our results seem to further support earlier data obtained with the drug in dental patients with postoperative pain after the surgical removal of impacted third molars ; therefore , it is concluded that flurbiprofen used as directed is a new alternative for the proper treatment of pain following periodontal surgery 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 & 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 Flurbiprofen ( Ansaid , Upjohn ) , a potent new analgesic and anti-inflammatory agent , was compared with phenylbutazone in 90 patients with ankylosing spondylitis . In this double-blind , r and omized , 26-week study , a total daily dose of 200 mg of flurbiprofen , administered three times daily , was as effective as 300 mg of phenylbutazone in controlling the pain and other symptoms of ankylosing spondylitis . In some patients , symptoms were adequately controlled by 150 mg of flurbiprofen per day , administered twice daily . There were no statistically significant differences between flurbiprofen and phenylbutazone in the investigators ' and patients ' assessment s of improvement at all key follow-up periods . In addition , there were no consistently significant differences between drugs in the efficacy pain scales and quantitative measurements studied . Flurbiprofen was well tolerated in doses of up to 300 mg per day , and no clinical ly significant laboratory abnormalities were detected . Flurbiprofen appears to be an excellent alternative to phenylbutazone in the management of patients with ankylosing spondylitis Abstract A previously established relationship for deriving dichotomous from continuous information in r and omised controlled trials ( RCTs ) of analgesics has been tested using an independent data set . Individual patient information from 18 RCTs of parallel‐group design in acute postoperative pain ( after abdominal , gynaecological and oral surgery ) was used to calculate the percentage of the maximum possible pain relief score  ( % maxTOTPAR ) and the proportion of patients with > 50%maxTOTPAR for the different treatments . The relationship between the measures was investigated in 85 treatments with over 3400 patients . In 80 of 85 treatments ( 94 % ) agreement between calculated and actual number of patients with > 50%maxTOTPAR was within four patients per treatment and in 72 ( 85 % ) was within three ( average of 40 patients per treatment , range 21–58 patients ) . Summing the positive and negative differences between actual and calculated numbers of patients with > 50%maxTOTPAR gave an average difference of 0.30 patients per treatment arm . Reports of RCTs of analgesics frequently describe results of studies in the form of mean derived indices , rather than using discontinuous events , such as number or proportion of patients with 50 % pain relief . Because mean data inadequately describe information with a non‐normal distribution , combining mean data in systematic review s may compromise the results . Showing that dichotomous data can reliably be derived from mean data in acute pain studies enables data published as means to be used for quantitative systematic review s which require data in dichotomous form This single-dose , double-blind , r and omized , placebo-controlled study compared the efficacy of 50 mg of oral flurbiprofen ( Ansaid , Upjohn ) , 10 mg of intramuscular morphine sulfate , and placebo in 92 patients with moderate to severe postoperative gynecologic pain . According to pain intensity , pain relief , and pain intensity difference scores , the morphine-treated patients experienced significantly more pain reduction than the other patients by the first hour after treatment . The flurbiprofen group obtained the same level of significant pain relief as the morphine group by two hours after dosing , but relief persisted longer than in the morphine-treated patients . Evaluation of other efficacy variables revealed similar levels of significant pain reduction in both the flurbiprofen and morphine groups compared with the placebo group . Flurbiprofen was well tolerated and led to fewer side effects than either morphine or placebo & NA ; Reports of RCTs of analgesics frequently describe results of studies in the form of mean derived indices , rather than using discontinuous events — such as number or proportion of patients with 50 % pain relief . Because mean data inadequately describe information with a non‐normal distribution , combining mean data in systematic review s may compromise the results . Showing that dichotomous data can reliably be derived from mean data , at least in acute pain models , indicates that more meaningful overviews or meta‐ analysis may be possible . This study investigated the relationship between continuous and dichotomous analgesic measures in a set of individual patient data , and then used that relationship to derive dichotomous from continuous information in r and omised controlled trials ( RCTs ) of analgesics .  Individual patient information from 13 RCTs of parallel‐group and crossover design in acute postoperative pain was used to calculate the percentage of the maximum possible pain relief score ( % maxTOTPAR ) and the proportion of patients with greater than 50 % pain relief ( > 50%maxTOTPAR ) for the different treatments . The relationship between the measures was investigated in 45 actual treatments and 10 000 treatments simulated using the underlying actual distribution ; 1283 patients had 45 separate treatments . Mean % maxTOTPAR correlated with the proportion of patients with > 50%maxTOTPAR ( r2 = 0.90 ) . The relationship calculated from all the 45 treatments predicted to within three patients the number of patients with more than 50 % pain relief in 42 of 45 treatments , and 98.8 % of 10 000 simulated treatments . For seven effective treatments , actual numbers‐needed‐to‐treat ( NNT ) to achieve > 50%maxTOTPAR compared with placebo were very similar to those derived from calculated data The analgesic efficacy of flurbiprofen 25 mg and 50 mg compared with aspirin 650 mg and placebo ( lactose ) was evaluated . Subjects were 164 dental out patients undergoing the surgical removal of impacted teeth . Each subject received a single dose of study medication and was evaluated hourly for six hours . Aspirin was superior to placebo in all measures of analgesic efficacy , and both dosages of flurbiprofen were superior to aspirin In a series of three studies involving dental out patients undergoing removal of impacted third molars , preoperative and postoperative administration of flurbiprofen ( Ansaid , Upjohn ) led to superior pain relief when compared with acetaminophen alone or in combination with oxycodone .  Patient preference and global evaluations clearly favored flurbiprofen .  Side effects were mild and generally more common in patients receiving the opiate/mild analgesic combination . In two additional studies , flurbiprofen and etidocaine , a long-acting local anesthetic , also result ed in significantly less postoperative pain than a combination of acetaminophen/oxycodone and lidocaine ; 67 percent of patients in the flurbiprofen plus etidocaine group reported no or only slight pain during the entire observation period . The greater analgesic efficacy of flurbiprofen appears to represent a genuine therapeutic advantage , since it is not achieved at the expense of greater side effects Pain , swelling , loss of function , and hyperthermia are acute postoperative sequelae of inflammation due to tissue injury during surgical procedures . Pharmacologic strategies for minimizing the clinical manifestations of surgical trauma are often directed toward blocking the formation or inhibiting the effects of the biochemical mediators of acute inflammation . This study compared two nonsteroidal anti-inflammatory drugs ( NSAIDs ) , flurbiprofen and ibuprofen , with a prototype glucocorticoid , methylprednisolone , in two replicate placebo-controlled studies for suppression of inflammation due to the surgical removal of impacted third molars . The results indicate that NSAIDs produce greater initial analgesia than do steroids , whereas steroids result in greater suppression of swelling and less loss of function . Examination of the pooled data from the two studies indicates that NSAID pretreatment results in a modest suppression of swelling in comparison with placebo . These data suggest that the acute analgesic effects of NSAIDs in the oral surgery model are due to suppression of a nociceptive process , presumably prostagl and in formation , rather than a generalized anti-inflammatory effect The purpose of this double-blind , r and omized , parallel , multiple-dose study was to compare the efficacy and safety of flurbiprofen with acetaminophen with codeine phosphate in the 96-hr postoperative period following foot surgery . Analysis of mean pain intensity and mean pain relief for the patients not requiring rescue medication did not reveal any significant differences between treatment groups . There were also no significant differences between treatment groups with respect to patient and investigator global evaluations of therapy . The incidence of termination of the study because of side effects was higher for the acetaminophen with codeine group This single-dose , double-blind , r and omized , placebo-controlled study assessed the efficacy and safety of 50 mg of flurbiprofen ( 
    Output:
    
Adverse events were uncommon , and not significantly different from placebo .
AUTHORS ' CONCLUSIONS Flurbiprofen at doses of 50 mg and 100 mg is an effective analgesic in moderate to severe acute postoperative pain .
The NNT for at least 50 % pain relief is similar to that of commonly used NSAIDs such as ibuprofen and naproxen at usual doses .
Use of rescue medication indicates a duration of action exceeding 6 hours