Author Topic: is there really any evidence acetaminophen works for pain  (Read 2188 times)

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Offline jgeller

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is there really any evidence acetaminophen works for pain
« on: December 02, 2017, 04:07:09 PM »
HI,
Long time podcast listener....  just joined today...  I am a physician and I recently was made aware that there is little evidence that tylenol is more effective than placebo for pain.  I am did not conduct a thorough evaluation, but i couldn't find anything of substance to support tylenol for back pain.  Has anyone taken a look at this before?  Another concern is that many other pain therapies frequently compare themselves to tylenol so if tylenol's efficacy is not valid there could be a house of cards effect...

thanks
Jeff 

Offline daniel1948

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Re: is there really any evidence acetaminophen works for pain
« Reply #1 on: December 02, 2017, 04:18:18 PM »
Welcome to the forums, jgeller.

I have no evidence, but I believe that acetaminophen provides me with some relief of pain when I have a headache. This could be placebo effect, but I do think it actually helps. For joint pain, not so much. I use Ibuprofen or naproxen for joint pain. Nothing much seems to help me for back pain other than stretching. I imagine opioids would work, though I've never taken opioids for back pain. I have not had access to them the times I've had back pain that lasted long enough for me to be that desperate.

BTW, you posted this in "Member Creations." It should have been posted in Health, Fitness, Nutrition, and Medicine.

I'd suggest emailing a mod to move it.
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Offline Tatyana

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Re: is there really any evidence acetaminophen works for pain
« Reply #2 on: December 02, 2017, 06:03:48 PM »
Paracetamol is a known prostagladin inhibitor (COX-2). Google 'mechanism of action of paracetamol' if you want more detail than that.

https://www.ncbi.nlm.nih.gov/pubmed/15662292

Just as a side note, not all drugs work on everyone due to the biochemical individuality of organisms, you may be a non-responder to paracetamol.

Offline daniel1948

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Re: is there really any evidence acetaminophen works for pain
« Reply #3 on: December 02, 2017, 06:21:56 PM »
For folks in the U.S., paracetamol is another name for acetaminophen. In Mexico and Spain it's paracetamol. I don't know where else this is the case.
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Re: is there really any evidence acetaminophen works for pain
« Reply #4 on: December 02, 2017, 07:48:53 PM »
For folks in the U.S., paracetamol is another name for acetaminophen. In Mexico and Spain it's paracetamol. I don't know where else this is the case.

Heard the guys on Skeptics with a K use that term, I think they use it in the UK
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Offline jt512

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Re: is there really any evidence acetaminophen works for pain
« Reply #5 on: December 02, 2017, 07:54:59 PM »
I haven't read beyond the abstract, but a recent Cochrane review found that there was no effectiveness for acute lower back pain and uncertain effectiveness for chronic lower back pain.

1. Cochrane Database Syst Rev. 2016 Jun 7;(6):CD012230. doi: 10.1002/14651858.CD012230.

Paracetamol for low back pain.

Saragiotto BT(1), Machado GC, Ferreira ML, Pinheiro MB, Abdel Shaheed C, Maher CG.

Author information:
(1)Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia.

BACKGROUND: Analgesic medication is the most frequently prescribed treatment for low back pain (LBP), of which paracetamol (acetaminophen) is recommended as the first choice medication. However, there is uncertainty about the efficacy of paracetamol for LBP.
OBJECTIVES: To investigate the efficacy and safety of paracetamol for non-specific LBP.
SEARCH METHODS: We conducted searches on the Cochrane Central Register of Controlled Trials (CENTRAL, which includes the Back and Neck Review Group trials register), MEDLINE, EMBASE, CINAHL, AMED, Web of Science, LILACS, and IPA from their inception to 7 August 2015. We also searched the reference lists of eligible papers and trial registry websites (WHO ICTRP and ClinicalTrials.gov).  SELECTION CRITERIA: We only considered randomised trials comparing the efficacy of paracetamol with placebo for non-specific LBP. The primary outcomes were pain and disability. We also investigated quality of life, function, adverse effects, global impression of recovery, sleep quality, patient adherence, and use of rescue medication as secondary outcomes.
DATA COLLECTION AND ANALYSIS: Two review authors independently performed the data extraction and assessed risk of bias in the included studies. We also evaluated the quality of evidence using the GRADE approach. We converted scales for pain intensity to a common 0 to 100 scale. We quantified treatment effects using mean difference for continuous outcomes and risk ratios for dichotomous outcomes. We used effect sizes and 95% confidence intervals as a measure of treatment effect for the primary outcomes. When the treatment effects were smaller than 9 points on a 0 to 100 scale, we considered the effect as small and not clinically important.
MAIN RESULTS: Our searches retrieved 4449 records, of which three trials were included in the review (n = 1825 participants), and two trials were included in the meta-analysis. For acute LBP, there is high-quality evidence for no difference between paracetamol (4 g per day) and placebo at 1 week (immediate term), 2 weeks, 4 weeks, and 12 weeks (short term) for the primary outcomes.  There is high-quality evidence that paracetamol has no effect on quality of life, function, global impression of recovery, and sleep quality for all included time periods. There were also no significant differences between paracetamol and placebo for adverse events, patient adherence, or use of rescue medication. For chronic LBP, there is very low-quality evidence (based on a trial that has been retracted) for no effect of paracetamol (1 g single intravenous dose) on immediate pain reduction. Finally, no trials were identified evaluating patients with subacute LBP.
AUTHORS' CONCLUSIONS: We found that paracetamol does not produce better outcomes than placebo for people with acute LBP, and it is uncertain if it has any effect on chronic LBP.

DOI: 10.1002/14651858.CD012230
PMID: 27271789  [Indexed for MEDLINE]

« Last Edit: December 02, 2017, 08:02:07 PM by jt512 »
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Offline lonely moa

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Re: is there really any evidence acetaminophen works for pain
« Reply #6 on: December 02, 2017, 07:55:44 PM »
I thought paracetamol and interspersed with morphine did a reasonable job during and post radiotherapy.  Sort of dealt with two systems of pain.  Until nothing worked, of course. 
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Offline The Latinist

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Re: is there really any evidence acetaminophen works for pain
« Reply #7 on: December 02, 2017, 11:29:45 PM »
Yeah, my understanding is that for musculoskeletal pain acetaminofennis pretty useless, a fact which jibes with my experience using it: it does pretty much nothing for my pain.  It’s a pretty good antipyretic, but ibuprofen works as well without near the risk of liver toxicity.  Ibuprofen works well for me on muscle pain, but for headache and inflammation I want naproxen.

The only time I’d personally use acetaminophen was if I was concerned about needing surgery and therefore wanted to avoid the blood-thinning properties of NSAIDs. I give my children ibuprofen for pain or fever.
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Offline jt512

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Re: is there really any evidence acetaminophen works for pain
« Reply #8 on: December 02, 2017, 11:53:20 PM »
Yeah, my understanding is that for musculoskeletal pain acetaminofennis pretty useless, a fact which jibes with my experience using it: it does pretty much nothing for my pain.  It’s a pretty good antipyretic, but ibuprofen works as well without near the risk of liver toxicity.  Ibuprofen works well for me on muscle pain, but for headache and inflammation I want naproxen.

The only time I’d personally use acetaminophen was if I was concerned about needing surgery and therefore wanted to avoid the blood-thinning properties of NSAIDs. I give my children ibuprofen for pain or fever.


I use ibuprofen for pain too.  During my rock climbing days, vitamin I was practically a macronutrient.  I've always quipped that acetaminophen was just a placebo.  Maybe that was closer to the truth than I'd thought.  But the risk to the liver of acetaminophen is practically nil unless you take an overdose or consume a large amount of alcohol with it.  The risk of a cardiac event with any NSAID, including ibuprofen, on the other hand is substantial, at least for an adult.
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Offline arthwollipot

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Re: is there really any evidence acetaminophen works for pain
« Reply #9 on: December 03, 2017, 01:51:59 AM »
For folks in the U.S., paracetamol is another name for acetaminophen. In Mexico and Spain it's paracetamol. I don't know where else this is the case.
It's paracetamol in Australia.
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Offline daniel1948

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Re: is there really any evidence acetaminophen works for pain
« Reply #10 on: December 03, 2017, 09:31:34 AM »
... During my rock climbing days, vitamin I was practically a macronutrient. ...

What's vitamin I? Wikipedia redirects to the Vitamin B complex.

For folks in the U.S., paracetamol is another name for acetaminophen. In Mexico and Spain it's paracetamol. I don't know where else this is the case.
It's paracetamol in Australia.

I suspect that may be the case everywhere except in the U.S. I wonder of it's a metric vs imperial thing. ;D
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Offline st3class

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Re: is there really any evidence acetaminophen works for pain
« Reply #11 on: December 03, 2017, 01:04:08 PM »
... During my rock climbing days, vitamin I was practically a macronutrient. ...

What's vitamin I? Wikipedia redirects to the Vitamin B complex.


It's a nickname for ibuprofen. The joke being that you take it every day like a vitamin.
It's always more complicated than that.

Offline The Latinist

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Re: is there really any evidence acetaminophen works for pain
« Reply #12 on: December 03, 2017, 01:18:53 PM »
The U.S. and the rest of the world have separate agencies charged with setting generic names for medications—the United States Adopted Names Council (USAN) and the WHO’s International Non-proprietary Names Expert Group (INN). Today, the two groups coordinate and the USAN will only adopt a name in consensus with the INN, but in the past they sometimes adopted different names. Acetaminofen and paracetamol are one example; salbutamol and albuterol are another.
« Last Edit: December 03, 2017, 01:28:07 PM by The Latinist »
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Re: is there really any evidence acetaminophen works for pain
« Reply #13 on: December 03, 2017, 02:12:30 PM »
... During my rock climbing days, vitamin I was practically a macronutrient. ...

What's vitamin I? Wikipedia redirects to the Vitamin B complex.

For folks in the U.S., paracetamol is another name for acetaminophen. In Mexico and Spain it's paracetamol. I don't know where else this is the case.
It's paracetamol in Australia.

I suspect that may be the case everywhere except in the U.S. I wonder of it's a metric vs imperial thing. ;D

We name a lot of medicine differently which make life confusing when you hear about foreign medicine.

It is "interesting" to see where this medicine gets it's two different names from. They start with the same compund name, para-acetylaminophenol

acetaminophen = para-acetylaminophenol
paracetamol = para-acetylaminophenol

Why they chose these different letters? F*** knows  ???

Offline daniel1948

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Re: is there really any evidence acetaminophen works for pain
« Reply #14 on: December 03, 2017, 03:52:46 PM »
... During my rock climbing days, vitamin I was practically a macronutrient. ...

What's vitamin I? Wikipedia redirects to the Vitamin B complex.


It's a nickname for ibuprofen. The joke being that you take it every day like a vitamin.

Thank you. There have been summers when I had to take ibuprofen daily during hiking season. It's rough, because NSAIDs do a number on my stomach. But better that, than be unable to hike. Most seasons I only need to take it once in a  while.

I wish I could get a total body transplant. Like when the mad scientist switches two people's brains. Put my brain in a healthy, athletic, 20-year-old body with good balance and coordination. (Though the coordination could be a brain thing and might be unreasonable to hope for.) :sigh:
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