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Can We Use Paracetamol Without Worry?

Can We Use Paracetamol Without Worry?

“For most people, it’s a placebo,” Dixon said. “It’s kind of like they say, if you swear to your wife or husband, you’ll feel better. It’s the same concept.”

Another review of previous studies, published last year by Moore and colleagues, found that paracetamol relieved pain in some patients with migraines and tension headaches, but did little to help people with chronic back pain, cancer, postoperative, menstrual and pediatric pain, as well as rheumatoid and osteoarthritis. The study, published in BMJ in March, found that paracetamol was ineffective for acute low back pain and had only a “small, clinically irrelevant” effect on pain and disability in patients with osteoarthritis compared with placebo. It also highlights evidence that those who take it regularly are almost four times more likely to have abnormal liver function tests.

“Our findings therefore provide an argument for reconsidering the endorsement of paracetamol in clinical practice guidelines for low back pain and hip or knee osteoarthritis,” concluded lead author Gustavo Machado, from the George Institute for Global Health at the University of Sydney, and colleagues.

The real problem is that old models of judging drugs based on the average effect of studies make no sense when these drugs can vary greatly between individuals. “What we’re realizing now is that paracetamol, like all pain reliever, can provide great pain relief for some people and no relief at all for others,” Moore said. In this case, perhaps it makes sense to give patients a greater role in managing their own care, working with medical professionals to figure out what works for them.

Many GPS are starting to use paracetamol in this more nuanced way. Two years ago, the Royal College of general Practitioners was one of the loudest complaints when Nice considered withdrawing its support for the drug as the preferred treatment for chronic osteoarthritis pain. Now, however, Dr Martin Johnson, of the RCGP, says it no longer makes sense to drive GPS to give paracetamol to millions of these patients on a long-term basis.

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