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Paracetamol ‘not effective’ in treating osteoarthritis

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Paracetamol is not clinical effective in reducing pain or improving physical function in patients with knee and hip osteoarthritis, according to Swiss researchers.

Although paracetamol was slightly better than placebo, they concluded that on its own paracetamol had no role in the treatment of patients with osteoarthritis, irrespective of dose.

“Our results suggest that paracetamol at any dose is not effective in managing pain in osteoarthritis”

Sven Trelle

Paracetamol and NSAIDs are usually the first line treatment for mild to moderate pain management in osteoarthritis, but paracetamol is used more frequently in the long-term because of the cardiovascular and gastrointestinal side effects of long-term NSAID use.

The study, published in The Lancet, is the largest analysis of randomised trials of medical pain relief for osteoarthritis to date. It found the non-steroidal anti-inflammatory drug diclofenac 150mg/day was the most effective short-term pain relief.

The University of Bern researchers pooled data from 74 trials published between 1980 and 2015, with data from a total of 58,556 patients with osteoarthritis.

Although some doses of paracetamol had a small effect on improving physical function and decreasing pain, the effect was only slightly better than placebo.

In comparison, diclofenac at the maximum daily dose of 150mg/day was most effective for the treatment of pain and physical disability in osteoarthritis, and superior to the maximum doses of frequently used NSAIDs – including ibuprofen, naproxen, and celecoxib.

Study author Dr Sven Trelle said: “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.”

He added that he hoped study could help “better inform” clinicians about how best to manage pain among arthritis patients.

“Our results suggest that paracetamol at any dose is not effective in managing pain in osteoarthritis”

Maureen Baker

Writing in an accompanying editorial, Professor Nicholas Moore, a pharmacology expert at the University of Bordeaux in France, said: “Paracetamol has been on the market for as long as most of us remember. Its efficacy has never been properly established or quantified in chronic diseases.”

He added: “Many patients could be suffering needlessly because of perceived NSAIDs risks and paracetamol benefits.”

Dr Maureen Baker, chair of the Royal College of GPs, said: “Paracetamol is a very effective drug at easing pain and controlling fevers in our patients – but like with everything else, it is best to err on the side of caution when taking the drug over a long period of time.

“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 know that alternatives, such as NSAIDs, can be effective but they can have nasty side-effect if taken over a long period of time,” said Dr Baker.

“As new research is published, it is important that we take this on board as guidelines for healthcare professionals are updated in the best interests of our patients,” she added.

 

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Readers' comments (2)

  • michael stone

    Something of an aside, but I have always found paracetamol 'pretty-much useless'. On the rare occasions when I used to suffer from a headache, aspirin seemed to be much more effective than paracetamol - however there was a long spell when clinicians seemed to be promoting paracetamol and trying to reduce aspirin use.

    My dad, used to 'like' paracetamol.

    I'm not sure if this type of thing is because of different medical conditions, or whether there really are significant differences (presumably in personal metabolic pathways) which influence aspirin/paracetamol effectiveness.

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  • Laha78

    Paracetomol is actually a very good base painkiller when used in conjunction such as NSAIDs for certain conditions.

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