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Acetaminophen about as effective as placebo for pain management
New York Times Blog:
Acetaminophen (Tylenol) is widely recommended for the relief of back pain and the pain of knee and hip arthritis. But a systematic review of randomized trials has found that it works no better than a placebo.
Australian researchers reviewed three randomized trials that compared acetaminophen with a placebo for the relief of spinal pain, and 10 trials that compared their use for easing the pain of osteoarthritis. All together, the analysis included 5,366 patients. Acetaminophen was given orally in doses between 3,000 and 4,000 milligrams a day, except for one study in which a dose of 1,000 milligrams was administered intravenously.
The review, published online in BMJ, found high quality evidence that Tylenol is ineffective in treating low back pain or disability. It also found evidence that the drug quadruples the risk of an abnormal liver function test, but the clinical significance of that finding is unclear.
The studies of pain from knee and hip arthritis found a small but clinically insignificant short-term pain-relief effect for acetaminophen compared with a placebo.
Clinical guidelines from medical groups typically recommend acetaminophen for pain relief, but “the American guidelines were published in 2007, when the evidence was weaker,” said the senior author, Manuela L. Ferreira, an associate professor at the George Institute for Global Health in Sydney. “This new evidence — the highest quality evidence from papers all over the world — shows that it is time to review the recommendations on acetaminophen.”
The lead author, Gustavo C. Machado, a Ph.D. candidate at the George Institute, added that patients should talk to their doctors and “discuss what are the best treatment options, and what are the harms and benefits. And they should be aware that this review shows that acetaminophen should not be recommended as a first line analgesic for these conditions.”
Acetaminophen (Tylenol) is widely recommended for the relief of back pain and the pain of knee and hip arthritis. But a systematic review of randomized trials has found that it works no better than a placebo.
Australian researchers reviewed three randomized trials that compared acetaminophen with a placebo for the relief of spinal pain, and 10 trials that compared their use for easing the pain of osteoarthritis. All together, the analysis included 5,366 patients. Acetaminophen was given orally in doses between 3,000 and 4,000 milligrams a day, except for one study in which a dose of 1,000 milligrams was administered intravenously.
The review, published online in BMJ, found high quality evidence that Tylenol is ineffective in treating low back pain or disability. It also found evidence that the drug quadruples the risk of an abnormal liver function test, but the clinical significance of that finding is unclear.
The studies of pain from knee and hip arthritis found a small but clinically insignificant short-term pain-relief effect for acetaminophen compared with a placebo.
Clinical guidelines from medical groups typically recommend acetaminophen for pain relief, but “the American guidelines were published in 2007, when the evidence was weaker,” said the senior author, Manuela L. Ferreira, an associate professor at the George Institute for Global Health in Sydney. “This new evidence — the highest quality evidence from papers all over the world — shows that it is time to review the recommendations on acetaminophen.”
The lead author, Gustavo C. Machado, a Ph.D. candidate at the George Institute, added that patients should talk to their doctors and “discuss what are the best treatment options, and what are the harms and benefits. And they should be aware that this review shows that acetaminophen should not be recommended as a first line analgesic for these conditions.”
Yep, good point Hawk
I think a "little" acetaminophen is prob better - certainly for pain relief. Given that neither is very good for one's liver, I wonder how the Tylenol made it to the Tell Them to Take Tylenol list?
I think a "little" acetaminophen is prob better - certainly for pain relief. Given that neither is very good for one's liver, I wonder how the Tylenol made it to the Tell Them to Take Tylenol list?
Tylenol never worked for me but aspirin does.
Don't forget Tylenol can be very damaging to livers and was almost taken off the market due to that little advertised fact. Yes, the problem seems to be from people who take more than the recommended dosage but still !
Think about it.
Don't forget Tylenol can be very damaging to livers and was almost taken off the market due to that little advertised fact. Yes, the problem seems to be from people who take more than the recommended dosage but still !
Think about it.
Geeez if we were all in that study taking 3-4,000 milligrams a day it's doubtful we would make it out alive!
I have CAD including 4 stents and take 1 81 mg aspirin.
Avoid taking ibuprofen if you are taking aspirin to prevent stroke or heart attack...
For more warnings see
http://www.drugs.com/ibuprofen.html
You should not use oxycodone if you have severe asthma or breathing problems, or a blockage in your stomach or intestines.
For other warnings see
http://www.drugs.com/oxycodone.html
Avoid taking ibuprofen if you are taking aspirin to prevent stroke or heart attack...
For more warnings see
http://www.drugs.com/ibuprofen.html
You should not use oxycodone if you have severe asthma or breathing problems, or a blockage in your stomach or intestines.
For other warnings see
http://www.drugs.com/oxycodone.html
I also use ibuprofen. Tylenol never worked for me. Before I was cured of HCV I was told I could take up to 2000 mg of tylenol a day. I didn't take it as it did nothing for me.
Once I was cured, my doctor told me I could once again take ibuprofen. I limit as much as I am able. I guess you have to weigh the risks against the benefits.
Good article, thank you :)
Once I was cured, my doctor told me I could once again take ibuprofen. I limit as much as I am able. I guess you have to weigh the risks against the benefits.
Good article, thank you :)
In the USA most prescription narcotic pain meds contain acetaminophen. Oxycontin and morphine are two exceptions but doctors are reluctant to prescribe those. When I had double hernia surgery in Canada and was in a hospital for a week they had pure codeine pills along with oral demerol and a slew of other options for pain control while there. They are not poisoning the population in Canada. IMO acetaminophen should be pulled from the market like darvocet was. It's approved for us heppers because it is the lesser of the evils with a compromised liver.
It's challenging, right?
My doc says no to anything but acetaminophen and no more than 1000 mg a day and I reluctantly agree because I worry about further liver damage
Back in the day, I used to eat handfuls of Advil (OK, that's an exaggeration) - it's the wonder drug for pain, muscle soreness or inability to sleep. And it was recommended by my doctors!!
I currently am taking nothing at all but try to utilize relaxation techniques and Cognitive-behavioral therapy or TENS
I'm inclined to stop taking acetaminophen altogether now that I see that is essentially worthless. My sister, an ER administrator, says that they never use it to control pain
Sounds like you have a good plan and an excellent doctor
My doc says no to anything but acetaminophen and no more than 1000 mg a day and I reluctantly agree because I worry about further liver damage
Back in the day, I used to eat handfuls of Advil (OK, that's an exaggeration) - it's the wonder drug for pain, muscle soreness or inability to sleep. And it was recommended by my doctors!!
I currently am taking nothing at all but try to utilize relaxation techniques and Cognitive-behavioral therapy or TENS
I'm inclined to stop taking acetaminophen altogether now that I see that is essentially worthless. My sister, an ER administrator, says that they never use it to control pain
Sounds like you have a good plan and an excellent doctor
Acetaminophen never really helped my pain. In 2008 had my gastro talk to my primary and was switched from 7.5 mg hydrocodone with acetaminophen to 5 mg. oxycodone - 1 morning 1 afternoon and 2 evening as needed for pain. Still works when needed. I'm careful not to take more because that could increase tolerance, higher dosage and risk addiction.
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