If you’re using acetaminophen to ease your osteoarthritis pain, Canadian doctors suggest you’re wasting your time. In a new study, they say drug, commonly known as Tylenol in Canada, is no better than a placebo when it comes to reducing arthritis pain and you’re better off with other options in the short-term.
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While acetaminophen is a first-line therapy to treat arthritis around the world, doctors out of St. Michael’s Hospital say other options such as Voltaren – or diclofenac – works much better. They reaped more benefits but come with risk of serious side effects if they’re used long-term though, lead researcher, Dr. Peter Juni, warned.
Juni was recruited by the Canadian hospital to lead its Applied Health Research Centre. He’s been studying how to manage pain from osteoarthritis for about 10 years. The latest research, published Wednesday, is dubbed the largest analysis of all trials on medicine to alleviate arthritis pain.
Juni said his findings even apply to Tylenol Arthritis, marketed exclusively for treating joint pain.
“The effect we see for osteoarthritis is just next to none…the difference between placebos and Tylenol is just minute, minute, minute, and not worth the while,” Juni told Global News.
Acetaminophen is the first choice to treat many health issues, from headaches to menstrual pain or even aches and pains throughout the body, and it helps, Juni said. It’s just that the medication isn’t effective in treating chronic pain from osteoarthritis, he suggested.
“The fallacy is one size fits all and this is not correct. We know that chronic musculoskeletal pain is a special animal which needs special attention and perhaps this attention hasn’t been given in the last 15 to 20 years,” Juni said.
Keep in mind, the study only considered osteoarthritis and not rheumatoid arthritis. Osteoarthritis sets in when the protective cartilage on the ends of your bones wear down over time. It’s especially prevalent in the hands, knees, hips and spine. Right now, no cure exists.
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Juni’s review is based on data pooled from 74 randomized trials that span from 1980 to 2015. Nearly 59,000 patients with osteoarthritis and about 22 different drugs were considered in the study, including various doses of acetaminophen.
Combing through the data, Juni and his team ranked how effective the medications were in lessening pain and improving mobility in patients with arthritis in their knees, hips and lower back.
Turns out, other medications called NSAIDs – or non-steriodal anti-inflammatory drugs – worked better than acetaminophen.
The three most effective options were:
Etoricoxib, known as Arcoxia as its drugstore labelRofecoxib, or Vioxx or CeoxxAnd diclogenac, or Voltaren
“At the end, there were some drugs that really worked better than others…and showed an effect that was clinically relevant. In [acetaminophen] an effect was clearly irrelevant,” Juni said.
Ultimately, higher doses of these NSAIDs worked better but the trouble is, these drugs aren’t meant to be long-term pain relief options.
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They’re tied to health issues that aren’t trivial. When taken in high doses and for a long time (think, beyond a two-week timeframe), they have been linked to kidney failure, heart failure, strokes and gastrointestinal bleeding, Juni said.
For their part, the makers of Tylenol, McNeil Consumer Healthcare, say they “disagree with the authors’ interpretation” of their findings and stand by their product as a pain relief therapy.
“The safety and efficacy profile of acetaminophen is supported by more than 150 studies over the past 50 years and we are committed to furthering research and education to ensure consumers can make informed choices about their medications based on individual health needs,” a spokesperson said in an emailed statement to Global News.
“If consumers have questions, we encourage them to contact their doctor or pharmacist,” the statement read.
If acetaminophen isn’t effective and NSAIDs are only a Band-Aid solution, what options do osteoarthritis patients have left?
Juni said opioids are another route, but they’re risky because of safety and addiction concerns. Their efficacy is still questionable, too, he said.
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He suggests patients should consider regular physical therapy and gentle exercise, such as walking or water aerobics – exercise that’s easy on the joints. They could also consult with a doctor about joint replacement surgery, such as a knee or hip replacement.
Dr. Cara Tannenbaum, a professor of geriatric pharmacology at the University of Montreal, told Global News the study is “well done” but that there are some issues worth noting.
For starters, reviews depend on the quality of research pulled together in the past. Findings are also open to interpretation.
The analysis, for example, defined a one-point change on the pain scale as “clinically important.” But patients have varying pain thresholds – while one person may report a 9 on a pain scale, another could find the experience much more or much less painful.
Still, Tannenbaum says patients should scale back on medicine if they find the risks outweigh the benefits.
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She said acetaminophen doesn’t have as many side effects, which is how it became such a popular go-to medication for frontline health care workers treating patients.
“The mechanism of Tylenol isn’t as well understood as it hasn’t been tested for one specific condition for one specific indication. It might help some people some of the time but it won’t harm you. That’s why it’s been pushed as a first-line therapy,” she said.
“It probably doesn’t address as much as we thought it did, though.”