Tylenol 500 mg capsules. Credit: Wikipedia
Paracetamol is not effective in the treatment of spinal pain and provides negligible benefits for osteoarthritis, according to a study published in The BMJ today.
Spinal pain, which includes neck and lower back pain, and osteoarthritis, the most common form of arthritis, are leading causes of disability worldwide.
Clinical guidelines recommend paracetamol as the first line drug treatment for both conditions, but the evidence to support this recommendation is weak and inconsistent and there are safety concerns with the recommended full dosage (up to 4000 mg/day).
For these reasons, the recent move by the National Institute for Health and Care Excellence (NICE) to continue to recommend paracetamol for osteoarthritis has been considered controversial.
Lead author Gustavo Machado from The George Institute for Global Health at the University of Sydney carried out a systematic review and meta-analysis to examine the efficacy and safety of paracetamol for lower back pain and osteoarthritis of the hip or knee.
The study included 13 randomised controlled studies that looked at the effects of paracetamol use compared with a placebo: 10 trials included 3,541 patients and evaluated the use of paracetamol for osteoarthritis of the hip or knee, and 3 trials included 1,825 patients on the use of paracetamol for lower back pain.
The following outcomes were analysed: reduction of pain intensity and improvement of disability and quality of life as well as safety and patient adherence.
The study showed that for lower back pain, paracetamol had no effect and did not reduce disability or improve quality of life compared with the use of a placebo. For osteoarthritis, they found small, but not clinically important benefits in the reduction of pain and disability compared with the use of a placebo.
Paracetamol use for osteoarthritis was also shown to increase the likelihood of having abnormal results on liver function tests by almost four times compared with a placebo, but the clinical relevance of this is still not certain, explain the authors.
Adverse side effects varied across all of the trials, but no differences were found in terms of the number of patients using paracetamol reporting these or being withdrawn from studies due to adverse events compared to those using a placebo.
Similarly, adherence to treatment schedule rates were similar between those taking paracetamol compared with those using a placebo.
The trials evaluated paracetamol and placebo usage in the short term, with the longest follow-up being 6 months so more research is needed to determine effects over a longer period of time.
Nevertheless, the authors conclude that "these results support the reconsideration of recommendations to use paracetamol for patients with low back pain and osteoarthritis of the hip or knee in clinical practice guidelines."
In a linked editorial, Christian Mallen and Elaine Hay from Keele University write that this latest study "re-opens the debate" on the effectiveness and safety of paracetamol.
They explain that if paracetamol is taken off existing guidelines this will lead to an increase in the use other prescribed drugs, such as, opioids, and this will present new associated health problems.
Instead, they call for the use of safe and effective alternative treatments, especially non-drug options, such as exercise, which has clear benefits in the management of spinal pain and osteoarthritis.
Explore further: Paracetamol no better than placebo for lower back pain
More information: Research article: Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta analysis of randomised placebo controlled trials, http://ift.tt/1NG0gMA
Editorial: Managing back pain and osteoarthritis without paracetamol, http://ift.tt/1NG0eEr
Medical Xpress on facebook
Related Stories
Paracetamol no better than placebo for lower back pain
Paracetamol is no better than placebo at speeding recovery from acute episodes of lower back pain or improving pain levels, function, sleep, or quality of life, according to the first large randomised trial to compare the ...
Risks of taking paracetamol long-term may have been underestimated by clinicians
Doctors may have underestimated the risks for patients who take paracetamol long-term, suggests research published online in the Annals of the Rheumatic Diseases.
Is painful knee and hand osteoarthritis in women associated with excess mortality?
Research looking at risk of early mortality of British middle-aged women and osteoarthritis was presented today at the World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases. It shows that any painful ...
NSAIDs may be more effective than paracetamol for period pain
Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may be more effective for relieving period pain than paracetamol, according to the update of a Cochrane Review. However, it remains unclear whether any one NSAID ...
Reported link between early life exposure to paracetamol and asthma 'overstated'
Respiratory infections are likely to have an influential role, the findings suggest. And the evidence is simply not strong enough to warrant changes to current guidance on the use of this medicine, say the researchers.
Recommended for you
Why drug names are so increasingly weird
Naming a brand drug is a lot harder than it used to be.
How newest class of drugs could save billions of dollars
Clad in white lab coats, blue gloves and safety goggles, scientists are buzzing around a lab at Hospira in this suburb north of Chicago.
Pharmacists' group discourages providing execution drugs (Update)
A leading association for U.S. pharmacists adopted a policy Monday that discourages its members from providing drugs for use in lethal injections—a move that could make carrying out such executions even harder for states ...
Rate of opioid misuse is around 25 percent, addiction rate 10 percent
New estimates suggest that 20 to 30 percent of opioid analgesic drugs prescribed for chronic pain are misused, while the rate of opioid addiction is approximately 10 percent, reports a study in the April issue of Pain, the of ...
UnitedHealth bulks up for prescription drug cost battle
The nation's largest health insurer, UnitedHealth, will muscle up for its fight against rising prescription drug costs by spending more than $12 billion to buy pharmacy benefits manager Catamaran Corp.
Teva buying Auspex for $3.2 billion
Teva Pharmaceutical Industries Ltd. is buying Auspex Pharmaceuticals Inc. for about $3.2 billion in a move to strengthen its position on central nervous system condition treatments.
User comments
Please sign in to add a comment. Registration is free, and takes less than a minute. Read more
Click here to reset your password.
Sign in to get notified via email when new comments are made.
Tylenol 500 mg capsules. Credit: Wikipedia
Paracetamol is not effective in the treatment of spinal pain and provides negligible benefits for osteoarthritis, according to a study published in The BMJ today.
Spinal pain, which includes neck and lower back pain, and osteoarthritis, the most common form of arthritis, are leading causes of disability worldwide.
Clinical guidelines recommend paracetamol as the first line drug treatment for both conditions, but the evidence to support this recommendation is weak and inconsistent and there are safety concerns with the recommended full dosage (up to 4000 mg/day).
For these reasons, the recent move by the National Institute for Health and Care Excellence (NICE) to continue to recommend paracetamol for osteoarthritis has been considered controversial.
Lead author Gustavo Machado from The George Institute for Global Health at the University of Sydney carried out a systematic review and meta-analysis to examine the efficacy and safety of paracetamol for lower back pain and osteoarthritis of the hip or knee.
The study included 13 randomised controlled studies that looked at the effects of paracetamol use compared with a placebo: 10 trials included 3,541 patients and evaluated the use of paracetamol for osteoarthritis of the hip or knee, and 3 trials included 1,825 patients on the use of paracetamol for lower back pain.
The following outcomes were analysed: reduction of pain intensity and improvement of disability and quality of life as well as safety and patient adherence.
The study showed that for lower back pain, paracetamol had no effect and did not reduce disability or improve quality of life compared with the use of a placebo. For osteoarthritis, they found small, but not clinically important benefits in the reduction of pain and disability compared with the use of a placebo.
Paracetamol use for osteoarthritis was also shown to increase the likelihood of having abnormal results on liver function tests by almost four times compared with a placebo, but the clinical relevance of this is still not certain, explain the authors.
Adverse side effects varied across all of the trials, but no differences were found in terms of the number of patients using paracetamol reporting these or being withdrawn from studies due to adverse events compared to those using a placebo.
Similarly, adherence to treatment schedule rates were similar between those taking paracetamol compared with those using a placebo.
The trials evaluated paracetamol and placebo usage in the short term, with the longest follow-up being 6 months so more research is needed to determine effects over a longer period of time.
Nevertheless, the authors conclude that "these results support the reconsideration of recommendations to use paracetamol for patients with low back pain and osteoarthritis of the hip or knee in clinical practice guidelines."
In a linked editorial, Christian Mallen and Elaine Hay from Keele University write that this latest study "re-opens the debate" on the effectiveness and safety of paracetamol.
They explain that if paracetamol is taken off existing guidelines this will lead to an increase in the use other prescribed drugs, such as, opioids, and this will present new associated health problems.
Instead, they call for the use of safe and effective alternative treatments, especially non-drug options, such as exercise, which has clear benefits in the management of spinal pain and osteoarthritis.
Explore further: Paracetamol no better than placebo for lower back pain
More information: Research article: Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta analysis of randomised placebo controlled trials, http://ift.tt/1NG0gMA
Editorial: Managing back pain and osteoarthritis without paracetamol, http://ift.tt/1NG0eEr
Medical Xpress on facebook
Related Stories
Paracetamol no better than placebo for lower back pain
Paracetamol is no better than placebo at speeding recovery from acute episodes of lower back pain or improving pain levels, function, sleep, or quality of life, according to the first large randomised trial to compare the ...
Risks of taking paracetamol long-term may have been underestimated by clinicians
Doctors may have underestimated the risks for patients who take paracetamol long-term, suggests research published online in the Annals of the Rheumatic Diseases.
Is painful knee and hand osteoarthritis in women associated with excess mortality?
Research looking at risk of early mortality of British middle-aged women and osteoarthritis was presented today at the World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases. It shows that any painful ...
NSAIDs may be more effective than paracetamol for period pain
Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may be more effective for relieving period pain than paracetamol, according to the update of a Cochrane Review. However, it remains unclear whether any one NSAID ...
Reported link between early life exposure to paracetamol and asthma 'overstated'
Respiratory infections are likely to have an influential role, the findings suggest. And the evidence is simply not strong enough to warrant changes to current guidance on the use of this medicine, say the researchers.
Recommended for you
Why drug names are so increasingly weird
Naming a brand drug is a lot harder than it used to be.
How newest class of drugs could save billions of dollars
Clad in white lab coats, blue gloves and safety goggles, scientists are buzzing around a lab at Hospira in this suburb north of Chicago.
Pharmacists' group discourages providing execution drugs (Update)
A leading association for U.S. pharmacists adopted a policy Monday that discourages its members from providing drugs for use in lethal injections—a move that could make carrying out such executions even harder for states ...
Rate of opioid misuse is around 25 percent, addiction rate 10 percent
New estimates suggest that 20 to 30 percent of opioid analgesic drugs prescribed for chronic pain are misused, while the rate of opioid addiction is approximately 10 percent, reports a study in the April issue of Pain, the of ...
UnitedHealth bulks up for prescription drug cost battle
The nation's largest health insurer, UnitedHealth, will muscle up for its fight against rising prescription drug costs by spending more than $12 billion to buy pharmacy benefits manager Catamaran Corp.
Teva buying Auspex for $3.2 billion
Teva Pharmaceutical Industries Ltd. is buying Auspex Pharmaceuticals Inc. for about $3.2 billion in a move to strengthen its position on central nervous system condition treatments.
User comments
Please sign in to add a comment. Registration is free, and takes less than a minute. Read more
Click here
to reset your password.
Sign in to get notified via email when new comments are made.
0 comments:
Post a Comment