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Paracetamol helps with four conditions, little evidence for others

A new review of paracetamol has revealed it has only been proven to relive pain in four conditions.

The University of Sydney systematic review, published this week in the Medical Journal of Australia, held that for most conditions, evidence regarding the effectiveness of paracetamol is insufficient for drawing firm conclusions.

It found evidence of effectiveness for just four conditions studied – knee or hip osteoarthritis, tension headache (though not migraine), perineal pain after childbirth and craniotomy.

And while paracetamol is often taken for lower back pain, the study found it provided no better outcomes than placebo.

For other conditions explored in the study – like abdominal pain, pain during dental procedures, migraines and middle ear infection – the authors said it was unclear whether paracetamol relieved pain.

The systematic review covered 36 reviews across 44 pain conditions.

Co-lead author Dr Christina Abdel Shaheed said: “For tension headache we know paracetamol works better than placebo - but for most other conditions we simply lack the evidence to be able to make strong or definitive statements about paracetamol’s effectiveness.”

Senior author Professor Chris Maher said it was easy to mistakenly attribute pain relief with the use of paracetamol.

“From research we know the biggest contributor to the improvement in low back pain is probably natural history; in other words, back pain often gets better by itself. Even with a chronic condition like osteoarthritis it does fluctuate and if you seek care when it is bad, it is likely to improve anyway; this is precisely why we need controlled trials,” Maher said.

Abdel Shaheed said that people should not be relying on pain medicines as a standalone treatment for pain relief.

“Any pain medicine should be considered as part of a holistic care plan, alongside strategies such as exercise, physiotherapy, or other lifestyle changes. A conversation with the doctor or pharmacist can be a good way to help people know what alternatives, subsidised or not, are available for them,” she said.

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