The role of paracetamol in chronic pain: An evidence-based approach

C. Jane Nikles*, Michael Yelland, Chris Del Mar, David Wilkinson

*Corresponding author for this work

Research output: Contribution to journalReview articleResearchpeer-review

77 Citations (Scopus)


Chronic pain is a significant public health burden. Several international guidelines and influential reviews recommend the use of paracetamol (acetaminophen) as the first-line analgesic of choice for the management of chronic pain. These recommendations are based largely on the balance of evidence, which favorably demonstrates the efficacy, safety, and low cost of paracetamol relative to other analgesics. A decade ago, March et al suggested that because of the dangers associated with conventional nonsteroidal antiinflammatory (NSAID) use, particularly in the elderly, they should ideally not be used without an individual n-of-1 trial to show that they are more effective than paracetamol. Today, the results of our investigations into the individualization of pain management options continue to support this suggestion. Based on the data available to date, it still seems prudent to use NSAIDs only in those patients in whom there is good evidence of improved efficacy over paracetamol. In patients with chronic pain, paracetamol can play an important role as an NSAID sparer, with resultant benefits in terms of reduced adverse effects and cost savings.

Original languageEnglish
Pages (from-to)80-91
Number of pages12
JournalAmerican Journal of Therapeutics
Issue number1
Publication statusPublished - Jan 2005


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