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Monday, 21 March 2016
Taken alone, acetaminophen (also known as Paracetamol) is "not effective at any dose" for relieving pain or improving physical function for patients with osteoarthritis, concludes a large-scale meta-analysis recently published in The Lancet.
Dr. Sven Trelle, of the University of Bern in Switzerland, and colleagues found that acetaminophen - also known as paracetamol - was only marginally better than a placebo for treating symptoms of the degenerative joint disease.
Furthermore, the team found that the non-steroidal anti-inflammatory drug (NSAID) Diclofenac is most effective for short-term pain relief from osteoarthritis, though the authors recommend against taking the medication long term due to its side effects.
Osteoarthritis is the most common form of arthritis affecting more than 1% of all Irish people over the age of 25.
In osteoarthritis, the cartilage of the joints - the connective tissue that covers the end of the bones, acting as a cushion - breaks down, allowing the bones to rub together. This causes inflammation, stiffness and pain.
The hands, spine, knees and hips are the joints most commonly affected by osteoarthritis.
Acetaminophen and NSAIDs are considered a first-line treatment for relieving mild-to-moderate pain among patients with osteoarthritis, though Dr. Trelle and colleagues note that acetaminophen is more widely used in the long term because it poses fewer side effects than NSAIDs.
For their study, the researchers set out to determine which medications are most effective for treating osteoarthritis pain.
Paracetamol 'showed no clinically important difference'
The researchers analysed the data of 74 randomized trials conducted between 1980-2015 that included 58,556 patients with osteoarthritis.
Overall, the studies compared the effects of 22 different medications - including Paracetamol and seven different classes of NSAIDs - against a placebo, assessing how they affected patients' pain intensity and physical function at various doses.
All medications at all doses appeared to have beneficial effects in comparison with a placebo.
However, while some doses of paracetamol offered a slight improvement in pain intensity and physical function for patients, the effect did not reach the minimum standards of clinical effectiveness - defined as the smallest change in a treatment outcome that a patient would deem important.
In this study, the clinically important difference was -0.37, while treatment with acetaminophen only reached -0.17.
The NSAID diclofenac at a dose of 150 mg daily, however, was found to be most effective for reducing pain intensity and improving physical function, with a clinically important difference of -0.57. This effect was greater than that offered by maximum doses of other NSAIDs commonly used for the treatment of osteoarthritis, including ibuprofen, celecoxib and naproxen.