Paracetamol won’t ease the pain of arthritis

Paracetamol is ineffective at treating hip and knee pain caused by osteoarthritis, new research has shown.

Osteoarthritis is the most common form of arthritis, affecting one in 10 men and nearly one in five women over the age of 60.

The study, published in The Lancet, suggests that the drug is ineffective regardless of dosage. The researchers found that diclofenac — a strong anti-inflammatory — was the most effective osteoarthritis treatment, but warned against long-term use of the drug, saying it was only appropriate for intermittent pain relief.

Paracetamol is popular with arthritis patients because it has fewer side effects than other painkillers, but in 2013 NICE advised GPs to stop prescribing the drug for osteoarthritis treatment because of the side effects associated with long-term use. These can include kidney, heart and intestinal problems.

The researchers, from the University of Bern in Switzerland, say that paracetamol does not meet the minimum clinically important effect for pain reduction in osteoarthritis patients, and that they ‘see no role for single-agent paracetamol for the treatment of patients with osteoarthritis irrespective of dose’. They also found that paracetamol was just five per cent more effective than a placebo.

The study’s lead author, Dr Sven 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.’

Instant analysis
A meta-analysis of randomised controlled trials is the gold standard when assessing an intervention. We know that paracetamol has a vastly weaker anti-inflammatory effect compared to NSAIDs (non-steroidal anti-inflammatory drugs, eg diclofenac) and clinical experience does inform the premise of the article — that single-agent paracetamol does little when it comes to arthritic pain. The study is thus consistent at multiple levels and does not downplay the side effects of the most effective therapy, diclofenac.
Research score: 4/5


  • Zarniwoop

    Before I even read this piece I thought to myself Big Pharma must be pushing Diclofenac.

    And lo! I was right! My mother suffers arthritis and was prescribed diclofenac which led to all sorts of unwanted side effects. She reverted to plain paracetomol and the pain subsides within half an hour and usually carries her through most of the day.

    It’s funny that paracetomol is now not rated for long term use. Some one should advise her GP who has prescribed paracetomol for the last 7 years.

    A simple check on Diclofenac (WIkipedia) confirms the side effects some of which she suffered while taking this quack remedy

    https://en.wikipedia.org/wiki/Diclofenac#Side_effects

    • Tarek

      NSAID’s like diclofenac are excellent for inflammatory pain. As you rightly point out, there are side effects that can occur with long-term use that are far from benign. I can assure you Big Pharma of whom I am no fan are not pushing diclofenac, simply because it is a drug whose patent has expired and which costs peanuts.

  • Machiavelli

    I’m sceptical of this ‘research’. Most people with this condition are well aware that a anti-inflammatory painkiller, aspirin, ibuprofen etc (NSAIDS) are more effective, and wouldn’t take paracetamol for pain relief form it.