***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: Objective To compare the efficacy and safety of celecoxib and naproxen in children with juvenile rheumatoid arthritis ( JRA ) . Methods In this multicenter , r and omized , double-blind , noninferiority study , subjects with JRA were r and omized to receive a target dose of celecoxib 3 mg/kg bid or 6 mg/kg bid , or a target dose of naproxen 7.5 mg/kg bid for 12 weeks ( maximum allowed dose = 600 mg total daily dose ) . The primary efficacy measure was the percentage of responders at Week 12 attaining the American College of Rheumatology pediatric 30 % improvement criterion ( ACR Pediatric-30 ) . Results Both celecoxib doses were at least as effective as naproxen at Week 12 [ ACR Pediatric-30 treatment differences : celecoxib 3 mg/kg bid – naproxen = 1.36 % ( 95 % CI –13.08 to 15.80 ) ; celecoxib 6 mg/kg bid – naproxen = 13.02 % ( 95 % CI –0.22 to 26.25 ) ] . Celecoxib 6 mg/kg bid had a numerically higher response rate than celecoxib 3 mg/kg bid at all postr and omization visits and a numerically higher response rate than naproxen 7.5 mg/kg bid at Weeks 4 , 8 , and 12 . Improvement in each ACR Pediatric-30 core set measure was comparable to or numerically higher for celecoxib 6 mg/kg bid than naproxen or celecoxib 3 mg/kg bid . Adverse event rates were similar for all treatment groups , except that gastrointestinal adverse events were more common in the naproxen group , although the difference was not statistically significant . Conclusion Celecoxib 3 mg/kg bid and 6 mg/kg bid were at least as effective as naproxen 7.5 mg/kg bid in treating the signs and symptoms of JRA over 12 weeks . All treatments were generally well tolerated Background . Recently ibuprofen has been introduced as a nonprescription analgesic/antipyretic for use in children . Objective . To compare the incidence of serious adverse clinical events among children < 2 years old given ibuprofen and acetaminophen to control fever . Study Design . A practitioner-based , r and omized clinical trial . A total of 27 065 febrile children were r and omized to receive acetaminophen ( 12 mg/kg ) , ibuprofen ( 5 mg/kg ) , or ibuprofen ( 10 mg/kg ) . Rates of hospitalization for acute gastrointestinal bleeding , acute renal failure , anaphylaxis , Reye 's syndrome , asthma , bronchiolitis , and vomiting/gastritis were compared by r and omization group . Results . The risk of hospitalization with any diagnosis in the 4 weeks after enrollment was 1.4 % ( 95 % confidence interval , 1.3%–1.6 % ) and did not vary by antipyretic assignment . No children were hospitalized for acute renal failure , anaphylaxis , or Reye 's syndrome . Three children were hospitalized with gastrointestinal bleeding ; all 3 had been assigned to treatment with ibuprofen . The risk of hospitalization with gastrointestinal bleeding among children r and omized to ibuprofen was 17 per 100 000 ( 95 % confidence interval , 3.5–49 per 100 000 ) but was not significantly greater than the risk among children given acetaminophen . The risk of hospitalization with asthma , bronchiolitis , or vomiting/gastritis did not differ by antipyretic assignment . Conclusions . The risk of serious adverse clinical events among children < 2 years old receiving short-term treatment with either acetaminophen or ibuprofen suspension was small and did not vary by choice of medication . These data do not provide any information on the safety of these medications when used for prolonged periods or when used together , regardless of duration Naproxen at 10 mg per kg body weight was compared with aspirin at 80 mg per kg body weight in children suffering from juvenile chronic polyarthritis . It was found to be as effective as aspirin , with certainly no more and possibly fewer gastrointestinal side effects . A long-term tolerance study up to 12 months confirmed that naproxed was a satisfactory nonsteroidal anti-inflammatory drug in the management of various types of juvenile chronic arthritis & 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 Ninety-two children with juvenile rheumatoid arthritis were r and omly assigned to treatment in a multicenter , double-blind , 12-week trial design ed to compare the efficacy and safety of a liquid formulation of ibuprofen at a dosage of 30 to 40 mg/kg/day versus those of aspirin at a dosage of 60 to 80 mg/kg/day . No significant intergroup differences in response rates or in the amount of improvement in articular indexes of disease activity were observed . More children treated with aspirin  discontinued treatment early because of adverse reactions . After this trial , 84 additional patients with juvenile rheumatoid arthritis entered a 24-week , multidose ( 30 , 40 , and 50 mg/kg/day ) , open trial of ibuprofen suspension .  Favorable response rates for the three groups were similar , and continued improvement was observed throughout the 24-week period . A dose-response relationship was observed with respect to adverse reactions of the upper gastrointestinal tract . We conclude that ibuprofen suspension is an effective nonsteroidal antiinflammatory drug and that its tolerability in children is acceptable We compared efficacy and safety of aspirin ( ASA ) and fenoprofen in the treatment of JRA . Ninety-nine children with JRA were given ASA or fenoprofen in a 12-wk , multicentered , double-blind , parallel study . Initial fenoprofen dosage was 900 mg/m2/d increased to 1800 mg/m2/d ( 3200 mg/d-max ) . Initial ASA dosage was 1500 mg/m2/d increased to 3000 mg/m2/d ( 5450 mg/d-max ) . Adverse reactions forced removal of 14 % of ASA treated patients from the trial , whereas no fenoprofen patient was removed for this reason . Forty of 50 ASA patients , and 47 of 49 fenoprofen patients completed at least 10 wk of therapy and analysis showed that the 2 drugs were nearly identical in efficacy , but toxicity was considerably less among fenoprofen treated patients OBJECTIVE To test the hypothesis that ibuprofen increases the risk of hospitalization for gastrointestinal bleeding , renal failure , or anaphylaxis  among febrile children . DESIGN R and omized double-blind acetaminophen-controlled trial . SETTING Outpatient pediatric and family medicine practice s. PATIENTS A total of 84,192 children . INTERVENTION Patients were r and omly assigned to receive 12 mg/kg of acetaminophen , 5 mg/kg of ibuprofen , or 10 mg/kg of ibuprofen . MAIN OUTCOME MEASURES Hospitalizations for acute gastrointestinal bleeding , acute renal failure , and anaphylaxis . RESULTS A total of 277 patients ( 0.3 % ) were unavailable for follow-up . Overall , 795 participants ( 1 % ) were hospitalized , primarily for infectious diseases ; hospitalization rates did not differ according to treatment group . Four children had diagnoses of acute , nonmajor gastrointestinal bleeding ( two in each ibuprofen dosage group ) ; among ibuprofen-treated children , the observed risk of gastrointestinal bleeding , 7.2 per 100,000 ( 95 % confidence interval , 2 to 18 per 100,000 ) , was not significantly different from the risk among acetaminophen-treated children ( P = .31 ) . There were no hospitalizations for acute renal failure or anaphylaxis ; the upper 95 % confidence bound for the risk of either of these outcomes was 5.4 per 100,000 ibuprofen-treated children . Among a number of other possibly serious adverse drug events , low white blood cell count was marginally associated with ibuprofen treatment . Because this association was observed in the setting of multiple comparisons and white blood cell counts may have been low before treatment , causation is unclear . CONCLUSIONS The risk of hospitalization for gastrointestinal bleeding , renal failure , or anaphylaxis was not increased following short-term use of ibuprofen in children . These data , however , provide no information on the risks of less severe outcomes or the risks of prolonged ibuprofen use Ketoprofen ( Orudis ; Maybaker ) , whose use has not previously been reported in choldren , was compared with indomethacin in a double-blind crossover trial in 30 children with juvenile chronic arthritis . Both drugs proved to be safe and effective analgesics and anti-inflammatory agents although  indomethacin  emerged as the preferred drug . Perhaps higher doses of ketoprofen would be safe and more effective . Side-effects were few and mild . The problems of patient compliance and the assessment of pain in children are discussed & 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 In a double lind test 60 patients with ankylosing spondylitis received either Azapropazone ( 30 patients ) or Indomethacin ( 30 patients ) during a period of three weeks . In the two well comparable groups the therapeutic effect was equally good . As the results show the Azapropazone group came out a little better concerning the finger-ground distance and the difference in circumference of thorax , and the Azapropazone group was favoured slightly by the general judgement of the patients . However , these differences are not relevant . The influence on the spontaneous pain in the daytime and during the night and the shifting of dorsal and lumbar vertebral column was equally good in both groups . The compatibility was good in 59 out of 60 patients . One patient had to stop the Azapropazone medication because of gastric trouble in the second week 
    Output:
    
We identified only a small number of studies , with insufficient data for analysis .As we could undertake no meta- analysis , we are unable to comment about efficacy or harm from the use of NSAIDs to treat chronic non-cancer pain in children and adolescents .
Similarly , we can not comment on our remaining secondary outcomes : Carer Global Impression of Change ; requirement for rescue analgesia ; sleep duration and quality ; acceptability of treatment ; physical functioning ; and quality of life .
We know from adult r and omised controlled trials that some NSAIDs , such as ibuprofen , naproxen , and aspirin , can be effective in certain chronic pain conditions