Paracetamol and Ibuprofen Under the Spotlight

Paracetamol doesn’t work for lower back pain and is next to useless for osteoarthritis, despite being recommended as the first line drug treatment for both conditions.

An Australian study in The BMJ provides new evidence that the drug is no better than placebo for the first condition and its effect on osteoarthritis of the hip or knee is too small to be clinically worthwhile.

The findings come months after another systematic review and meta-analysis questioned the routine use of paracetamol as a first line analgesic in preference to ibuprofen or other analgesics.

That study, published in the European Journal of Pain, shows that ibuprofen is usually superior to paracetamol for a range of conditions, including osteoarthritis.

“In osteoarthritis, some, but not all, people taking standard ibuprofen doses will have adequate pain relief; most of those taking paracetamol will not,” write the researchers from Oxford University.

Their study also shows ibuprofen may be better than placebo for back pain, although the evidence is weak.

However, they note cardiovascular events with NSAIDs are a concern.

This is supported in the TGA’s latest Medicines Safety Update that states NSAIDs should not be used in patients with cardiovascular disease and should only be used with caution in people with cardiac risk factors.

Nonetheless, the Oxford University researchers conclude that ibuprofen “provides more patients with a degree of pain relief that patients feel worthwhile”.

“Paracetamol may well be a useful analgesic in combination with others, but it has limited efficacy on its own,” they say.

They conclude that “neither of the drugs will be effective for everyone, and both are needed”.