Paracetamol 'ineffective' for treating osteoarthritis
Friday March 18th, 2016
Paracetamol does not alleviate osteoarthritis pain, according to a major analysis published today.
The
largest analysis of randomised trials of medical pain relief for osteoarthritis
found that although some doses of paracetamol - known as acetaminophen
in the USA - have a small effect on improving physical function and decreasing
pain, the effect was only slightly better than placebo.
Diclofenac, a non-steroidal anti-inflammatory drug (NSAID), was found to be the most effective short-term pain relief.
The results come from a study by Dr Sven Trelle from the University of Bern, Switzerland, and colleagues, who pooled data from 74 randomised trials published between 1980 and 2015 for their study, reported in The Lancet.
Using the data from 58,556 patients with osteoarthritis, they compared the effect of 22 different medical treatments, including various doses of paracetamol and seven different NSAIDs (rofecoxib, lumiracoxib, etoricoxib, diclofenac, celecoxib, naproxen, and ibuprofen), and placebo on pain intensity and physical activity.
All 22 medications, irrespective of dose, improved symptoms of pain compared with the placebo, however some doses of paracetamol did not reach the minimum clinically important difference, which is measured as effect size of –0.17 vs. clinically important difference of -0.37.
The maximum 150mg daily dose of diclofenac was the most effective for the treatment of pain and physical disability in osteoarthritis when compared with the maximum doses of frequently used NSAIDs.
Dr Trelle said: “NSAIDs are usually only used to treat short-term episodes of pain in osteoarthritis, because the side-effects are thought to outweigh the benefits when used longer term. Because of this, paracetamol is often prescribed to manage long-term pain instead of NSAIDs.
“However, our results suggest that paracetamol at any dose is not effective in managing pain in osteoarthritis, but that certain NSAIDs are effective and can be used intermittently without paracetamol.
“NSAIDs are some of the most widely used drugs for patients with osteoarthritis. There is a range of different drugs at different dosages that doctors can prescribe, but patients often switch between drugs, or stop taking them because the first one they use hasn’t sufficiently helped control the pain. We hope our study can help better inform doctors about how best to manage pain in this population.”
Dr Maureen Baker, chair of the UK Royal College of GPs, urged patients who take paracetamol not to panic as a result of the research.
“The majority of evidence still suggests that paracetamol is a safe drug for most patients, but a number of recent studies – today’s included - do cast doubt on its effectiveness at treating osteoarthritis,” she said.
“What the study doesn’t suggest is a suitable – and safe – alternative for pain management in patients with osteoarthritis. We would welcome more research into safe and effective alternatives to paracetamol, so that we can help our patients with osteoarthritis manage their condition and live as comfortable a life as possible.
“Patients who regularly take paracetamol – either as prescribed by their doctor or self-medicated – should not panic as a result of this research. But if they are concerned about taking the drug regularly, over a long period of time, they should make a non-urgent appointment with their GP, or discuss this with their local pharmacist.”
Da Costa BR, Reichenbach S, Keller N et al. Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis. The Lancet 17 March, 2016 [abstract]
Tags: Elderly Health | Europe | Pain Relief | Rheumatology | UK News
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