***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: & 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 ( 1 ) To assess the feasibility and tolerability of the therapeutic transdermal fentanyl system ( TTS-fentanyl ) by using a clinical protocol developed for children with cancer pain . ( 2 ) To estimate the pediatric pharmacokinetic parameters of TTS-fentanyl . METHODS The drug was administered in open-label fashion ; and measures of analgesia , side effects , and skin changes were obtained for a minimum of 2 doses ( 6 treatment days ) . Blood specimens were analyzed for plasma fentanyl concentrations . The pharmacokinetics of TTS-fentanyl were estimated by using a mixed effect modeling approach . RESULTS Treatment was well tolerated . Ten of the 11 patients who completed the 2 doses continued treatment with TTS-fentanyl . The duration of treatment ranged from 6 to 275 days . The time to reach peak plasma concentration ranged from 18 hours to > 66 hours in patients receiving the 25 microg/h patch . Compared with published pharmacokinetic data from adults , the mean clearance and volume of distribution of transdermal fentanyl were the same , but the variability was less . CONCLUSIONS Treatment of children with TTS-fentanyl is feasible and well tolerated and yields fentanyl pharmacokinetic parameter estimates similar to those for adults . A larger study is required to confirm these findings and further test the clinical protocol & 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 The World Health Organization ( WHO ) guidelines for the treatment of cancer pain recommend nonopioid analgesics as first-line therapy , so-called " weak " analgesics combined with nonopioid analgesics as second-line therapy , and so-called " strong " opioids ( with nonopioid analgesics ) only as third-line therapy . However , these guidelines can be question ed with regard to the extent of efficacy as well as the rationale for not using strong opioids as first-line treatment , especially in terminal cancer patients . The purpose of this r and omized study was to prospect ively compare the efficacy and tolerability of strong opioids as first-line agents with the recommendations of the WHO in terminal cancer patients . One hundred patients with mild-moderate pain were r and omized to treatment according to WHO guidelines or to treatment with strong opioids . Evaluated outcomes included pain intensity , need for change in therapy , quality of life , Karnofsky Performance Status , general condition of the patient , and adverse events . No between-treatment differences were observed for changes in quality of life or performance status , but patients started on strong opioids had significantly better pain relief than patients treated according to WHO guidelines ( P=0.041 ) . Additionally , patients started on strong opioids required significantly fewer changes in therapy , had greater reduction in pain when a change was initiated , and reported greater satisfaction with treatment than the comparator group ( P=0.041 ) . Strong opioids were safe and well-tolerated , with no development of tolerance or serious adverse events . These data suggest the utility of strong opioids for first-line treatment of pain in patients with terminal cancer 
    Output:
    
No conclusions can be drawn about efficacy or harm in the use of opioids to treat cancer-related pain in children and adolescents .
As a result , there is no RCT evidence to support or refute the use of opioids to treat cancer-related pain in children and adolescents