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Paracetamol is not effective for osteoarthritis pain, study finds

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Paracetamol is no more effective than placebo for knee and hip osteoarthritis pain, according to a Swiss study published in The Lancet.

A large-scale analysis of pain-relief medication showed that paracetamol did not show any clinically relevant efficacy, while diclofenac, a non-steroidal anti-inflammatory drug (NSAID), was more effective than many newer pain relievers on the market.

Researchers from the University of Bern noted that recommendations and guidelines tend not to differentiate between NSAIDs and paracetamol or between the various NSAIDs available. In fact, it was not known whether the various preparations differ in terms of their pain-relieving efficacy, the university said.

For the new study, the Swiss researchers analysed 74 randomised trials with a total of 58,556 patients and examined the effect of 22 medical treatments and placebo in terms of pain reduction and improvement of function. These 22 therapies included different doses of paracetamol and of seven different NSAIDs.

Results showed that all 22 treatments improved symptoms of osteoarthritis pain when compared with placebo, irrespective of the dose given.

However, the difference between paracetamol and placebo was small and the researchers concluded that paracetamol does not meet the minimum standard of clinical effectiveness in reducing pain or improving physical function in patients with knee and hip osteoarthritis. Taken on its own, paracetamol has no role in the treatment of patients with osteoarthritis, they said.

Diclofenac — and, with a few concessions, etoricoxib — were found to be most effective with regard to pain and function.

Commenting on the findings, Dr. Sven Trelle from the University of Bern 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.”

Dr. Trelle added: “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.”

The seven NSAIDs included in the study were rofecoxib, lumiracoxib, etoricoxib, diclofenac, celecoxib, naproxen and ibuprofen.



http://www.thelancet.com/journals/lancet/article/PIIS0140-6736 %2816%2930002-2/abstract