![]() ![]() (Credit: dcwcreations/)There are some scary facts about how much we, as ordinary members of the public, know about painkillers. The risk is only about one in a million, but it is a risk. Paracetamol is known to cause liver failure in overdose, but it also causes liver failure in people taking standard doses for pain relief. ![]() Those we have tell us that paracetamol use is associated with increased rates of death, heart attack, stomach bleeding and kidney failure. Partly because paracetamol is such an old drug these studies have largely not been done until recently. If we want to study those rare events, then we need study large numbers of people. Unless the rate of the very bad thing is vanishingly small, the authorities won’t let us buy the drug from a petrol station. Safety boils down to examining really bad things happening to a very small number of people who take a drug. If paracetamol works for you, that’s great. These are robust and trustworthy results. This evidence comes from systematic reviews, often of large numbers of good clinical trials. For postoperative pain, perhaps one in four people benefit for headache perhaps one in ten. For these, reviews from the Cochrane Library show that paracetamol can provide pain relief, but only for a small number of people. This is at the maximum daily dose in trials lasting for three months, so it has been pretty thoroughly tested.Īcute pains are sudden in onset and go away after a while (headache or pain after an operation, for instance). Large, good and independent clinical trials and reviews from the Cochrane Library show paracetamol to be no better than placebo for chronic back pain or arthritis. The evidence is that it probably does not work at all for chronic pain. That’s 35 tonnes per million of population: 35 grams or 70 paracetamol tablets each, every year. For the UK, an estimate of the amount of paracetamol sold is just under 6,300 tonnes a year. Huge amounts of paracetamol are used to treat pain, measured not in how many tablets are used but in the thousands of tons. The trouble is that the conventional view is probably wrong. It’s a view so ingrained that it’s rarely questioned. At least, that’s the conventional view of the drug. ![]() It’s safe and many guidelines recommend it as the go-to treatment. Paracetamol has been around for over 50 years. Andrew Moore, Honorary Senior Research Fellow, University of Oxford ![]()
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