***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: BACKGROUND Combination therapy has been widely used for the clinical management of acute pain .  By combining 2 drugs with different mechanisms of action , such therapy provides additive analgesic effects while reducing the risk for adverse effects . OBJECTIVE This study compared the efficacy and tolerability of oxycodone 5 mg/ibuprofen 400 mg with those of oxycodone 5 mg/acetaminophen 325 mg , hydrocodone 7.5 mg/acetaminophen 500 mg , and placebo in a dental pain model . METHODS This was a multicenter , r and omized , double-blind , placebo- and active-controlled , parallel-group , single-dose study in patients experiencing moderate to severe pain after surgical removal of > or = 2 ipsilateral impacted third molars . Patients were r and omly assigned to receive oxycodone 5 mg/ibuprofen 400 mg , oxycodone 5 mg/acetaminophen 325 mg , hydrocodone 7.5 mg/acetaminophen 500 mg , or placebo . The primary outcome measures were total pain relief through 6 hours after dosing ( TOTPAR6 ) , sum of pain intensity differences through 6 hours ( SPID6 ) , and adverse events . Secondary efficacy measures included SPID3 and TOTPAR3 , peak pain relief , peak pain intensity difference , time to onset of pain relief , time to use of rescue medication , proportion of patients reporting pain half gone , and the patient 's global evaluation . RESULTS Two hundred forty-nine patients ( 43.5 % male ; 87.5 % white ; mean age , 19.1 years ; mean body weight , 153.6 pounds ) were r and omized to treatment as follows : 62 to oxycodone 5 mg/ibuprofen 400 mg , 61 to oxycodone 5 mg/acetaminophen 325 mg , 63 to hydrocodone 7.5 mg/acetaminophen 500 mg , and 63 to placebo . Oxycodone 5 mg/ibuprofen 400 mg provided significantly greater analgesia compared with oxycodone 5 mg/acetaminophen 325 mg , hydrocodone 7.5 mg/acetaminophen 500 mg , and placebo ( mean [ SD ] TOTPAR6 , 14.98 [ 5.37 ] , 9.53 [ 6.77 ] , 8.36 [ 6.68 ] , and 5.05 [ 6.49 ] , respectively ; P < 0.001 , oxycodone 5 mg/ibuprofen 400 mg vs all other treatments ) . SPID6 values also differed significantly for oxycodone 5 mg/ibuprofen 400 mg compared with all other treatments ( mean : 7.78 [ 4.11 ] , 3.58 [ 4.64 ] , 3.32 [ 4.73 ] , and 0.69 [ 4.85 ] ; P < 0.001 ) . Oxycodone 5 mg/ibuprofen 400 mg was significantly more effective compared with the other treatments on all secondary end points ( P < 0.001 , all variables except peak PID vs oxycodone 5 mg/acetaminophen 325 mg [ P = 0.006 ] ) , with the exception of the time to onset of analgesia . The lowest frequency of nausea and vomiting occurred in the groups that received oxycodone 5 mg/ibuprofen 400 mg ( 6.5 % and 3.2 % , respectively ) and placebo ( 3.2 % and 1.6 % ) . Rates of nausea and vomiting were significantly lower with oxycodone 5 mg/ibuprofen 400 mg compared with oxycodone 5 mg/acetaminophen 325 mg ( P = 0.011 and P = 0.009 , respectively ) but not with hydrocodone 7.5 mg/acetaminophen 500 mg . CONCLUSIONS In this study in patients with moderate to severe pain after surgery to remove impacted third molars , oxycodone 5 mg/ibuprofen 400 mg provided significantly better analgesia throughout the 6-hour study compared with the other opioid/nonopioid combinations tested , and was associated with fewer adverse events BACKGROUND The aim of this study was to evaluate the comparative efficacy of three commonly used analgesics ( Panadeine , Diflunisal and Etodolac ) in the control of pain after third molar surgery under local anaesthesia . METHODS A r and omized control study . Outcome of primary efficacy was judged by overall assessment of the area under the curve of graphs for pain intensity , measured from serial visual analogue scales over a 24-hour period . Other measures of efficacy included the number ( per cent ) of patients who took ' additional ' analgesics and the incidence of adverse effects occurring in each treatment group over the study period . RESULTS The three drugs were effective in the control of post-operative pain ( p<0.01 ) . Variations in pain intensity and the use of additional medication between the treatment groups were observed over the study period . The Diflunisal group experienced less pain than the Panadeine or Etodolac group ( p<0.01 ) . Furthermore , a lesser number of those in the Diflunisal group used additional medication compared to the other two groups ( p<0.01 ) . The incidence of side effects from all three drugs was low . CONCLUSION Diflunisal is superior in the control of  pain following third molar surgery under local anaesthesia than either Panadeine or Etodolac , and has few side effects BACKGROUND Butorphanol tartrate , a mixed synthetic agonistantagonist opioid analgesic has been used for management of postoperative pain in minor and major surgical procedures .(14,20 ) Tramadol hydrochloride is a central ly acting opioid which is effectively used in postoperative pain in various minor and major surgeries . MATERIAL S AND METHODS Twenty subjects selected r and omly received  butorphanol tartrate 1 mg intramuscular and 20 subjects received tramadol hydrochloride 50 mg intramuscular after the removal of m and ibular third molars .  Time of injection , amount of anesthetic injected , duration of surgery , adverse effects were recorded.(21 ) RESULTS The mean amount of LA administered in butorphanol group was 2.6450 ml and in tramadol group was 2.640 ml respectively , the mean duration for surgery was 56.75 and 53.5 minutes for butorphanol and tramadol groups respectively which was statistically not significant . Pain assessment was done with VAS which showed mean of 19.2 and 15.5 mm ( p = 0.001 ) which was significant for butorphanol and tramadol respectively after 12 hours . The mean time for rescue medication requirement was 5.9 hours ( for tramadol ) and 8.4 hours ( for butorphanol ) . Effective analgesic activity was seen by butorphanol 1 mg intramuscular then tramadol 50 mg . CONCLUSION Butorphanol 1 mg was more effective than tramadol 50 mg in respect to postoperative analgesia We conducted a r and omised double-blind placebo-controlled single-centre study to compare the effect of preoperative ibuprofen 600 mg , diclofenac 100 mg , paracetamol 1 g with codeine 60 mg or placebo ( Vitamin C 50 mg ) tablets for relief of postoperative pain in 119 patients who had day case operations under general anaesthesia for removal of impacted third molars . Patients were given the tablets 1 h before operation . Pain was assessed using visual analogue scales and verbal rating scales preoperatively at 15 and 30 min and 1 and 3 h postoperatively . After they had gone home , patients were contacted by telephone at 6 and 24 h postoperatively to find out whether they had any adverse effects from the analgesics . There was no significant difference in the extent of postoperative pain among the four groups , but the placebo group had significantly shorter times before their first request for postoperative analgesics ( median 17 min , range 14 - 90 ) than the diclofenac group ( median 32 , range 15 - 150 ) . Preoperative analgesics at the stated doses are effective in providing immediate postoperative pain control after operations on third molars . There were , however , some side-effects including nausea , vomiting , headaches , and gastrointestinal discomfort , but there were no significant differences among the active analgesic groups with respect to adverse events either shortly after operation or at 6 or 24 Tramadol hydrochloride is a novel , central ly acting analgesic with two complementary mechanisms of action : opioid and aminergic . Relative to codeine , tramadol has similar analgesic properties but may have fewer constipating , euphoric , and respiratory depressant effects . A two-center r and omized double-blind controlled clinical trial was performed to assess the analgesic efficacy and reported side effects of tramadol 100 mg , tramadol 50 mg , codeine 60 mg , aspirin ( ASA ) 650 mg with codeine 60 mg , and placebo .  Using a third molar extraction pain model , 200 healthy subjects were enrolled in a 6-hour evaluation after a single dose of drug . Of the 200 patients enrolled , seven provided incomplete efficacy data or discontinued prematurely and one was lost to follow-up . Using st and ard measures of analgesia , including total pain relief score ( TOTPAR ) , maximum pain relief score ( MaxPAR ) , sum of pain intensity difference scores ( SPID ) , peak pain intensity difference ( Peak PID ) , remedication , and global evaluations , all active treatments were found to be numerically superior to placebo . ASA/codeine was found to be statistically superior to placebo for all measures of efficacy .  Tramadol 100 mg was statistically superior to placebo for TOTPAR , SPID , and time of remedication , whereas tramadol 50 mg was statistically superior to placebo onlyfor remedication time .  Codeine was not found to be statistically superior to placebo for any efficacy measure . A greater TOTPAR response compared with all other active measures was seen for ASA/codeine during the first 3 hours of study . The 6-hour TOTPAR scores for the tramadol groups and ASA/ codeine group were not significantly different . Gastrointestinal side effects ( nausea , dysphagia , vomiting ) were reported more frequently with tramadol 100 mg , ASA/ codeine , and codeine 60 mg than with placebo BACKGROUND Aspirin is a widely used NSAID that has been extensively studied in numerous conditions . Nonprescription analgesics , such as aspirin , are frequently used for a wide variety of common ailments , including conditions such as dental pain and tension-type headache . OBJECTIVE We sought to compare the efficacy and safety profiles of aspirin , acetaminophen with codeine , and placebo in the treatment of post-operative dental pain and tension-type headache . METHODS These were 2 r and omized , double-blind , placebo-controlled , single-dose clinical trials that assigned participants ( 2:2:1 ) to receive either aspirin ( 1000 mg ) , acetaminophen ( 300 mg ) with codeine ( 30 mg ) , or placebo . The primary efficacy end point was the sum of pain intensity differences from baseline ( SPID ) over 6 hours for the dental pain study and over 4 hours for the tension-type headache study . Other common analgesic measures , in addition to safety , were also evaluated . RESULTS The results of the dental pain study for aspirin and acetaminophen with codeine suggest statistically significant efficacy for all measures compared with placebo at all time points . Aspirin provided statistically significant efficacy compared with acetaminophen with codeine for SPID(0 - 4 ) ( P = 0.028 ) . In the tension-type headache study , aspirin and acetaminophen with codeine provided statistically significant efficacy compared with placebo  for SPID(0 - 4 ) and SPID(0 - 6 ) ( P < 0.001 ) and for total pain relief ( P < 0.001 ) . There were no significant differences between aspirin and acetaminophen with codeine at any evaluation of SPID ( P ≥ 0.070 ) , complete relief ( P ≥ 0.179 ) , or time to meaningful relief ( P ≥ 0.245 ) . Regarding safety , there were no statistically significant differences between treatment groups in the incidence of adverse events in the dental pain and tension-type headache studies . CONCLUSIONS These 2 r and omized , double-blind , placebo-controlled studies demonstrate that treatment with aspirin ( 1000 mg ) provides statistically significant analgesic efficacy compared with placebo use and comparable efficacy with acetaminophen ( 300 mg ) with codeine ( 30 mg ) therapy after impacted third molar extraction and in tension- type headache Three hundred fifty out patients with postoperative pain after the surgical removal of impacted third molars were r and omly assigned , on a double-blind basis , to receive a single oral dose of aspirin 650 or 1000 mg , caffeine 65 mg , a combination of asp 
    Output:
    
Ibuprofen 200 mg with caffeine 100 mg or 200 mg had a reasonable analgesic effect with fewer side effects .
It was found in this systematic review Ibuprofen 400 mg combined with oxycodone HCL 5 mg has superior analgesic efficacy when compared to the other analgesic combinations included in this study