title: The role of paracetamol in chronic pain: an evidence-based approach.
abstract: Chronic pain is a significant public health burden. Several international guidelines and influential reviews recommend the use of paracetamol (acetaminophen) as the first-line analgesic of choice for the management of chronic pain. These recommendations are based largely on the balance of evidence, which favorably demonstrates the efficacy, safety, and low cost of paracetamol relative to other analgesics.A decade ago, March et al suggested that because of the dangers associated with conventional nonsteroidal antiinflammatory (NSAID) use, particularly in the elderly, they should ideally not be used without an individual n-of-1 trial to show that they are more effective than paracetamol. Today, the results of our investigations into the individualization of pain management options continue to support this suggestion. Based on the data available to date, it still seems prudent to use NSAIDs only in those patients in whom there is good evidence of improved efficacy over paracetamol. In patients with chronic pain, paracetamol can play an important role as an NSAID sparer, with resultant benefits in terms of reduced adverse effects and cost savings.
authors.affiliation: Discipline of General Practice, The University of Queensland, Herston, Herston, Queensland 4006, Australia. j.nikles@uq.edu.au
authors.forename: C Jane
authors.initials: CJ
authors.lastname: Nikles
authors.forename: Michael
authors.initials: M
authors.lastname: Yelland
authors.forename: Chris
authors.initials: C
authors.lastname: Del Mar
authors.forename: David
authors.initials: D
authors.lastname: Wilkinson
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D010003:Osteoarthritis / Q000150:complications / Q000188:drug therapy*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D010349:Patient Compliance; D016032:Randomized Controlled Trials as Topic
chemical_list: D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen