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Paracetamol review raises big questions about the must-have pain reliever

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One of the authors of a new review on the effectiveness of paracetamol said UKTN the widely used pain reliever would not be approved if it were put on the market today.

Paracetamol is Australia’s gold standard for pain relief and is commonly prescribed for many childhood conditions and postoperative pain – but the University of Sydney review found there was no evidence strong that the drug is actually effective against many conditions.

Professor Chris Maher, lead author of the report, said TND there was no evidence that paracetamol worked better than a placebo in treating most ailments, even a sore throat.

Prof Maher said the evidence for the drug’s effectiveness in most applications was so poor that it would not be approved by the Therapeutic Goods Administration “if it hits the market today.”

Paracetamol has been available in Australia since 1956.

“It entered into force before the current regulatory framework,” he said.

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What did the study find?

This systematic review looked at 36 studies involving more than 19,000 participants.

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Of 44 different pain conditions routinely treated with paracetamol, only four were found to be supported by strong evidence that the drug relieved pain. They were:

  • Osteoarthritis of the knee and hip
  • Tension headache
  • Perineal pain after childbirth
  • Craniotomy, where a section of bone is removed from the skull to accommodate swelling in the brain.

At the other end of the spectrum, the evidence was low quality or inconclusive as to whether paracetamol provided pain relief for common complaints such as:

  • People who are recovering from most surgeries, including dental procedures
  • Common cold-related body pain or headache or sore throat
  • Migraine
  • Cancer pain
  • Rheumatoid arthritis
  • Middle ear infections in children.

However, as noted in previous research, there is strong evidence that paracetamol does not relieve acute back pain.

Further studies are needed

Most of the reports did say the drug was a dud.

What researchers at the University of Sydney are actually saying is that they don’t know one way or the other.

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“We’re not saying the drug is ineffective … What we’re saying is that for the majority of painful conditions, we just lack definitive evidence as to whether it works or not,” the researchers said in a statement responding. to the cover.

In other words, high quality studies are needed to determine when paracetamol is useful as a pain reliever and when it is not.

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Further studies are ‘unlikely’

Professor Maher said TND it was “highly unlikely” that paracetamol manufacturers would fund these studies.

He said there was good reason for the government to pressure drug companies to establish that paracetamol offers the benefits advertised.

It’s worth clarifying that the study only looked at pain relief, not fever – and that the World Health Organization classifies paracetamol as “an essential drug.”

And that’s not about to change any time soon.

In the meantime, despite the uncertainty, the researchers advise people to keep taking paracetamol – “except for back pain, because it doesn’t work.”

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Professor Chris Maher said people should “use paracetamol for a short time, following the advice of their pharmacist or GP… because you can harm yourself if you take the wrong dose and take too much. long time. He killed people who took too much ”.

Paracetamol is the substance most frequently implicated in overdoses in Australia, and some researchers are calling for access to the drug – available in supermarkets and convenience stores – to be limited.

Paracetamol sales have increased by more than 75% since the codeine rescheduling decision in 2018.

Since then, its market share has grown from 44.9% of all over-the-counter pain reliever packs to 60.1%.

Prof Maher said other pain treatments have been shown to be effective, including physical and psychological therapies, and drug therapies such as nonsteroidal anti-inflammatory drugs (NSAIDs), which include aspirin and ibuprofen. anti-inflammatory.

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