NSAIDs Over Acetaminophen for Arthritis Pain
Study finds that the NSAID diclofenac may be a better option for arthritis pain than Tylenol.
What medication should you reach for when you are experiencing aches and pains in your hands or knees?
When it comes to the pain and stiffness of osteoarthritis, researchers of a new study are now recommending you reach for a nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) or diclofenac, rather than acetaminophen (Tylenol).
"Regardless of dose, the prescription drug diclofenac is the most effective drug among painkillers in terms of improving pain and function in osteoarthritis," said Sven Trelle, MD, co-director of clinical trials at the University of Bern, Switzerland, and lead researcher of the new study published in The Lancet.
Osteoarthritis is the most common form of arthritis, affecting approximately 27 million Americans aged 25 and older, primarily those over the age of 65. It causes pain, swelling, and reduced motion in any joint, but usually it affects hands, knees, hips or spine. It can impair physical activity, and that increases the risk of obesity, heart disease, diabetes and general poor health, the study authors said.
Acetaminophen and NSAIDs are considered a first-line treatment for relieving mild-to-moderate pain among patients with osteoarthritis, though Dr. Trelle and colleagues note in an article in MNT that acetaminophen is more widely used in the long term because it poses fewer side effects than NSAIDs.
Although the study found diclofenac to be the best choice, all of the medications come with side effects and there is a lot of inter-patient variability. "If you are thinking of using a painkiller for osteoarthritis, you should consider diclofenac," Dr. Trelle said, but also keep in mind that like most NSAIDs the drug can increase the chance of a heart attack or stroke, either of which can lead to death, according to the Food and Drug Administration.
Tylenol manufacturer McNeil Consumer Healthcare took issue with the new study, according to a report in MedLinePlus. "We disagree with the authors' interpretation of this meta-analysis and believe acetaminophen remains an important pain relief option for millions of consumers, particularly those with certain conditions for which NSAIDs may not be appropriate -- including cardiovascular disease, gastrointestinal bleeding, and renal [kidney] disease," the company said in a prepared statement.
"The safety and efficacy profile of acetaminophen is supported by more than 150 studies over the past 50 years," the company added.
The current research was a restrospective review of 74 trials published between 1980 and 2015. These trials included more than 58,000 patients. The studies compared how well various doses of acetaminophen and 7 different NSAIDs relieved arthritis pain.
The researchers found that acetaminophen was only slightly better than placebo. But they added that taken by itself, acetaminophen has no role in treating osteoarthritis, regardless of dose. [Note: acetaminophen is often combined ith NSAIDs, and with opioid medications].
Not surprising, the maximum daily dose of diclofenac (150 mg daily) was the most effective treatment for pain and disability, the new study showed. The researchers also found diclofenac was better than the maximum doses of NSAIDs, including ibuprofen, naproxen (Aleve) and celecoxib (Celebrex).
According to Mary Lynn McPherson, PharmD, acetaminophen is commonly used to reduce a fever and to treat both acute pain (such as headache, toothache, sprains or muscle strains) and chronic pain (back pain).
But acetaminophen does carry risks. Based on current research, doses up to 3,000 mg per day, or 4,000 mg per day under a doctor’s supervision, are considered safe. However, taking more than 4,000 mg per day may cause liver damage, either as one large dose, or excessive doses over weeks or months, noted Dr. McPherson. In addition, acetaminophen overdose is a leading cause of acute liver failure.
For these reasons, some doctors prefer short-term use of NSAIDs, which targets inflammation, to acetaminophen for chronic pain conditions like osteoarthritis.