Paracetamol ineffective for most conditions: study

It is the most used pain medication in the world but a new study has found paracetamol is little better than a dummy pill for most conditions.

In Australia, sales of the over-the-counter drug have soared more than 75 per cent since codeine became prescription only in 2018.

The drug is on the World Health Organisation's List of Essential Medicines and is commonly recommended as the first line treatment for pain.

But Australian researchers, who investigated its effectiveness in 44 painful conditions, have found there is only strong evidence it works in four of these conditions.

There was high-quality evidence that paracetamol provided modest pain relief for people with knee or hip osteoarthritis and after a craniotomy.

There was moderate evidence it helped tension-type headache and perineal pain soon after childbirth.

"Evidence regarding efficacy in other examined conditions was of very low quality or inconclusive," the authors said.

And, there was high-quality evidence that paracetamol did nothing to help acute low back pain, the authors report in the Medical Journal of Australia.

There are questions over whether paracetamol relieves pain. Picture istock
There are questions over whether paracetamol relieves pain. Picture istock

The review also found moderate-level evidence that people using the drugs had elevated liver enzymes two weeks to three months after taking it.

The researchers called for further high quality clinical trials of the medication to reduce uncertainty about its value in relieving common pain conditions.

They found only low quality evidence paracetamol helped 11 painful conditions such as dental procedures, major surgery (including abdominal, neurosurgical, gynaecological, and orthopaedic surgery), acute migraine in adults, ear ache in children, orbital surgery, renal colic, metastatic breast cancer, common cold headache.

And the drug was determined to be no better than a dummy pill for relieving the pain of sore throat in people with common cold infections, migraine in children and adolescents, pain in newborns, dental surgery in children, uterine cramping after birth, or reconstructive vaginal surgery.

Paracetamol was determined to be no better than a dummy pill for relieving the pain of sore throat in people with common cold infections.
Paracetamol was determined to be no better than a dummy pill for relieving the pain of sore throat in people with common cold infections.

The study also found there was "very low quality evidence (inconclusive or no evidence)" of the value of paracetamol in 21 pain conditions including: chronic lower back pain, post-caesarean delivery pain, neuropathic pain, prevention of post-operative pain, cancer pain in adults, endodontic surgery pain, knee and hip arthroplasty, abdominal surgery, rheumatoid arthritis, non-cancer pain in children and adolescents, hip fracture, tonsillectomy in adults, laparoscopic cholecystectomy, catheter-related bladder discomfort, myringotomy in children, bariatric surgery, cardiac surgery, and diverse post-operative pain conditions (thyroidectomy, lower extremity, lumbar disk, nephrolithotomy).

Lead author on the study, Dr Christina Abdel Shaheed, of the University of Sydney, said paracetamol was considered a very safe medicine at recommended doses.

"In the absence of direct or strong evidence, people should be guided by their personal experience," she said.

"If it appears to be working for them, and they notice the pain is noticeably worse if it's not used, then they can continue to use paracetamol within the recommended daily dose."

However, people should not use paracetamol for more than a few days at a time unless specifically advised to by a doctor or pharmacist.

"This is the very clear recommendation from Australia's Therapeutic Goods Administration," Dr Abdel Shaheed said.

Originally published as Paracetamol ineffective for most conditions: study



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