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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

WORLD EMERGENCY MEDICINE SOCIETIES

Cranial Nerve VI Palsy Emergency

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lunes, 15 de agosto de 2016

Paracetamol and pain

Resultado de imagen de European journal of hospital pharmacy
Moore RA, Moore N. Eur J Hosp Pharm Month 2016 Vol 0 No 0
 doi:10.1136/ejhpharm-2016-000952. Editorial
..."In terms of efficacy, an overview review that examined paracetamol efficacy across acute and chronic conditions6 has been complemented with more recent data. What we now know about paracetamol and pain is that:
  • Paracetamol at doses between 500 and 1000 mg is in the least effective quartile of drugs for treating acute postoperative pain.7
  • Paracetamol 1000 mg has modest efficacy in migraine and tension-type headache.
  • Paracetamol at doses up to 4000 mg daily is ineffective in back pain.8 ,9
  • Paracetamol at doses up to 4000 mg daily is practically ineffective in arthritis. Though marginally better than placebo, paracetamol has little chance of achieving clinically meaningful benefit in osteoarthritis.8 ,10–12
  • No review evidence that paracetamol works for dysmenorrhoea, neck pain, rheumatoid arthritis or cancer pain.
We have considerable evidence that as well as not being particularly effective, neither is it particularly safe.
  • A systematic review of observational studies found that compared with people not taking paracetamol, paracetamol use, especially at higher doses, was associated with increased mortality, cardiovascular adverse events (fatal or non-fatal myocardial infarction, stroke or fatal coronary heart disease), gastrointestinal adverse events (gastroduodenal ulcers and complications such as upper gastrointestinal haemorrhage) and estimated glomerular filtration rate decrease of at least 30 mL/min/1.73 sq m.13
  • Acute liver failure leading to registration for transplantation was twice as common in non-overdose paracetamol-exposed patients than with NSAIDs in a large case-population study.14
  • In clinical trials in chronic pain, patients taking paracetamol were four times more likely to have abnormal results on liver function tests than those taking placebo.8
  • Paracetamol had very similar adverse event rates to ibuprofen over 3 months in patients with arthritis,15 and was not better tolerated than ibuprofen for short-term relief of common pain.16
  • Reports of patients with any adverse event in acute pain studies were the same for paracetamol (up to 1000 mg) and placebo.17"