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No role for paracetamol in treating pain in osteoarthritis

Large meta-analysis finds that no dose of paracetamol is effective for managing osteoarthritic pain

Ingrid Torjesen

Friday, 18 March 2016

Paracetamol is not clinically effective in alleviating pain and improving physical function in patients with osteoarthritis, a study* published in The Lancet has found.

Researchers pooled data from 74 randomised trials, published between 1980 and 2015, which compared the effects of 22 treatments and placebo on pain intensity and physical activity.

While all 22 medicines improved symptoms of pain compared with placebo to some extent, the improvement with paracetamol was not sufficient to be deemed clinically important. The effect size was –0·17, and a difference of -0.37 is required for the effect to be clinically important.                 

The greatest improvement in pain alleviation was seen with the maximum daily dose of diclofenac (150 mg/day), which had an effect size –0.57. This was greater than the improvement seen with the maximum doses of frequently used NSAIDs, including ibuprofen, naproxen, and celecoxib.

Researcher Dr Sven Trelle from the University of Bern, Bern, Switzerland, 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.”

* da Costa BR, 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, published online: 17 March 2016. DOI: 10.1016/S0140-6736(16)30002-2

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