Researchers have found that use of paracetamol as a long-term pain-reliever could expose patients to other health conditions including gastrointestinal problems, malfunctioning kidneys among other things. The research has also questioned the use of paracetamol to treat the chronic pain associated with the joint pain of osteoarthritis and acute lower back pain.
Paracetamol is the most widely used over-the-counter and prescription analgesic worldwide and is the primary recommendation of doctors and medical care professionals to those suffering from acute and chronic painful conditions. Paracetamol is also dubbed a lot safer than other commonly used analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) or opiates.
But analgesic benefits of the drug have been questioned lately in the management of acute lower back pain and the chronic painful condition of osteoarthritis. Further there have been no estimates on risk of standard paracetamol doses and to address this a UK team of researchers, led by Professor Philip Conaghan of the Leeds Institute of Rheumatic and Musculoskeletal Medicine, set out to conduct a systematic review of existing studies of prior research that analysed the association between chronic use of paracetamol and major adverse events in the general adult population.
“We believe the true risk of paracetamol prescription to be higher than that currently perceived in the clinical community,” the researchers concluded in a study published in the British Medical Journal. “Given its high usage and availability as an over-the-counter analgesic, a systematic review of paracetamol’s efficacy and tolerability in individual conditions is warranted.”
Researchers identified a total of eight prior studies that fit their needs. Of two studies that showed mortality, one found a dose-response and reported there had been an increased relative rate of mortality from 0.95 to 1.63 for increasing standard doses of paracetamol when comparing patients who had been prescribed paracetamol with those who had not.
Of four studies reporting cardiovascular adverse events, all showed a dose-response with one study reporting an increased risk ratio of all cardiovascular adverse events from 1.19 to 1.68.
One study reporting gastrointestinal adverse events reported a dose-response with a higher relative rate of events or bleeds from 1.11 to 1.49.
Finally, of four studies reporting renal adverse events, three reported a dose-response with one reporting a more likely decrease in estimated glomerular filtration rate – a test used to check how well the kidneys are working – from 1.40 to 2.19.
Researchers said that the findings demonstrate a key and consistent dose-response relationship between paracetamol at standard analgesic doses and adverse events typical of those often observed with non-steroidal anti-inflammatory drugs including increasing incidence of mortality, cardiovascular, gastrointestinal and renal adverse events, though the overall risks of these problems remained small.
“Based upon the data presented above, we believe the true risk of paracetamol prescription to be higher than that currently perceived in the clinical community. Given its high usage and availability as an over-the-counter analgesic, a systematic review of paracetamol’s efficacy and tolerability in individual conditions is warranted”, the researchers concluded.
