Considerations when selecting first-line analgesics

Morgan Liotta

27/06/2022 4:12:02 PM

SPONSORED: What should GPs be aware of when deciding whether to recommend paracetamol or another analgesic to patients?

Good quality evidence remains for paracetamol use in headache and toothache, among other painful conditions.

Paracetamol is the most commonly used analgesic medicine in Australia, and its low cost and availability without prescription also makes it the most frequently taken form of self‐prescribed pain relief medication. 
The drug is also listed as one of the World Health Organization’s essential medicines as efficacious, safe and cost‐effective.
However, a University of Sydney study published in the April 2021 edition of Medical Journal of Australia (MJA) generated some media reports questioning the value of paracetamol (N-acetyl-para-aminophenol) (APAP) as a molecule.
So, what do GPs need to be aware of when deciding whether to recommend paracetamol or another analgesic to patients?
Professor Andrew McLachlan is Head of School and Dean of Pharmacy at the University of Sydney’s Pharmacy School, as well as a co-author of the MJA paper.
He told newsGP that the study reconfirms the evidence behind registered indications for APAP as a safe molecule, and paracetamol remains an effective and safe medicine for many – but not all – painful conditions.
‘The real-world experience has demonstrated that paracetamol is well tolerated by most patients when used at recommended doses … especially where a person experiences mild-to-moderate pain,’ Professor McLachlan said.
‘[But] recent studies and systematic reviews of available evidence – and now guidelines – demonstrate that paracetamol has limited efficacy in people with acute low-back pain, and only modest efficacy in people with hip and knee osteoarthritis.
‘However, there remains good quality evidence for paracetamol use in headache and toothache. And combining paracetamol with non-steroidal anti-inflammatory drugs [NSAIDs] and opioid analgesics for some moderately painful conditions has been shown to be an effective analgesic combination.’
When selecting an appropriate analgesic medicine for patients, Professor McLachlan said it is essential to consider medical and medication history.
‘The best guide to effective analgesia is usually found in the patient’s history,’ he said.
‘If a person has previously used and had benefit from paracetamol then it makes sense that it should be used as a first-line analgesic. Patients should be advised to use an adequate daily dose of paracetamol which will provide pain relief.’  
Contraindications should also be considered, Professor McLachlan says, especially when a patient’s comorbid health problems like renal impairment and cardiovascular disease exclude the use of other medicines.
‘Importantly, paracetamol has limited potential to cause adverse effects and drug interactions, especially when compared to other commonly used analgesics such as NSAIDs and opioid analgesics,’ he said.
‘[It] should be used with caution in people with chronic liver disease, due to increased risk of liver damage, but use in pregnancy and breastfeeding is safe.
‘There are multiple brands of paracetamol, so patients should be encouraged to avoid using more than one product containing paracetamol at the same time due to the risk of liver damage.’
More information can be found in a Pharmaceutical Society of Australia-hosted clinical speakers session, which discusses the safety and efficacy of acute indications that paracetamol is registered for, with the aim of reinforcing confidence in recommending APAP as a first step.
This article has been commissioned and paid for by GSK Australia.
Log in below to join the conversation.

acetaminophen analgesics pain management paracetamol

newsGP weekly poll As an international medical graduate, what was your primary reason for wanting to practise in Australia?

newsGP weekly poll As an international medical graduate, what was your primary reason for wanting to practise in Australia?



Login to comment

Rodney Jones   28/06/2022 8:55:58 AM

I recently came across a patient who reports allergy ( angioedema symptoms ,throat). This is the first time I have come across an allergy to paracetamol in 50 years of practice

Dr Uma Bhatta Prasad   30/06/2022 5:54:28 PM

I have quite a few patients using the extended release Paracetamol for their OA pain. Unfortunately not all get adequate benefit and their age and fraility limits the use of opioids and NSAIDs .