Another death knell for paracetamol: What now?

Yet another death knell for the use of paracetamol in OA delivered by a recent Lancet study underscores the need to look at areas where we’re underperforming, experts say.

Writing in Nature Reviews Rheumatology Professor David Hunter and Manuela Ferreira from the Institute of Bone and Joint Research at The Kolling Institute in Sydney were referring to a meta-analysis previously reported by the limbic that confirmed that paracetamol was “not clinically effective” in treating osteoarthritis pain or improving physical function.

In a News and Views article titled Yet another death knell for paracetamol in OA they noted that, historically, paracetamol has been recommended in most guidelines for the management of osteoarthritis (OA) as a first-line analgesic.

However, there was now an “incontrovertible weight of evidence from multiple studies” that suggested this practice should change.

“Whichever way you appraise the existing literature, paracetamol is not the answer for OA pain, irrespective of dose,” they wrote.

“One thing is certain: when looking at options for managing OA we need look no further than the areas in which we are currently underperforming.”

For example the management of OA was frequently inappropriate with ‘marked deficits’ in the uptake of non-pharmacological treatments such as weight loss and exercise.

“Exercise and weight loss prescription should form the core of our management, and we can all do better in reinforcing this message to our patients and providing them the tools to implement these behavioural changes,” they said.

Many therapeutic options were available (see OARSI guidelines) and the decision about how to manage the disease should consider the risks and benefits of a given treatment, as well comorbidities in individual patients.

Nevertheless, they concluded, pain was an unmet need and further work was needed to develop more effective and safer means of delivering better outcomes for patients.

“In the meantime, the weight of evidence damning paracetamol in the context of OA pain is considerable, and the ensuing change in clinical practice is well overdue.”

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