December 9, 2022

Why should I take paracetamol? | Drugs

SDo you suffer from back pain, headache, fever or cold? The pill of choice is usually paracetamol. The drug was introduced to the market in 1956 and GPs issue a staggering 22.9 million prescriptions for paracetamol each year. It is therefore disconcerting to read that it is largely ineffective, according to a blog on Obviously Cochrane.

The solution

Cochrane is the international research group that adds up the evidence for treatments by combining the results of high quality studies, and it has looked at paracetamol quite extensively. The Nice Councils recommend paracetamol as a first-line analgesic for low back pain. Yet Cochrane says that for acute back pain, 4g of paracetamol a day is no better than a placebo. He found no good evidence that it worked for chronic back pain.

For hip and knee pain caused by osteoarthritis, the drug provides so little pain relief that researchers wondered if it actually offered any benefit a person would notice.

If you have a cold, paracetamol may help reduce runny nose, but will not help with sneezing, coughing, discomfort, tiredness or sore throat. For migraines, it’s better than placebo but not as good as other painkillers. Meanwhile, if you have a tension headache, you’re only 10% more likely to feel better than if you had taken a placebo. It can reduce fever in children – but Cochrane says the studies are poor and the sponge had a similar effect in the research it reviewed. The medication seems to reduce the pain caused by having your wisdom teeth removed.

Paracetamol reduces the production of prostaglandins involved in inflammation, and thus makes nerve endings less sensitive to pain. How people break it down and how well it works for them is determined by genetics – it works better for some people than others. It is quite safe, although it can rarely cause liver failure at the maximum standard dose (eight 500 mg tablets per day).

Professor Phillip Conaghan, from the Leeds Institute of Rheumatic and Musculoskeletal Medicine and author of an article on the safety of paracetamol, says we have been limited to three types of painkillers for almost a century, including paracetamol. The other two are nonsteroidal anti-inflammatory drugs (which are associated with stomach ulcers and bleeding, kidney and liver damage) and opioids, including codeine. This latter group causes constipation and a host of other side effects, and can also be addictive.

Conaghan adds that a painkiller isn’t always the answer — for back pain and osteoarthritis, strengthening muscles may work better than relying on painkillers. Headaches can often be avoided by looking away from screens, getting enough rest, and avoiding dehydration. He thinks most people know paracetamol is bad, but if it works for you, keep taking it (but limit your alcohol intake, as together they can damage your liver).