The following article contains general information and should not be used in place of medical advice from practitioners. If you or anyone you know is experiencing pain or looking to take painkillers, please consult with your doctor. 

New research coming out from the University of Nottingham has found that repeated use of common over-the-counter painkiller paracetamol in people aged 65 or over can lead to an increased risk of gastrointestinal, cardiovascular, and renal complications.

The study was published in Arthritis Care and Research and highlighted that extra care should be taken when repeated doses of acetaminophen – more commonly known as paracetamol – are required for patients with painful conditions such as osteoarthritis.

The study was led by Professor Weiya Zhang, from the NIHR Biomedical Research Centre in the School of Medicine at the University of Nottingham. Professional Zhang and researchers reviewed the health records of 180,483 people over the age of 65 who were registered with a UK general practice for at least 12 months between 1998 and 2018, and who had been prescribed paracetamol repeatedly (more than two prescriptions in six months). They compared their health outcomes to 402,478 people who had never been prescribed paracetamol repeatedly. 

The findings showed that despite its perceived safety, prolonged paracetamol use was associated with several serious complications including an increased risk of peptic ulcers, hypertension, heart failure, and chronic kidney disease. 

“Whilst further research is now needed to confirm our findings, given its minimal pain-relief effect, the use of paracetamol as a first-line pain killer for long-term conditions such as osteoarthritis in older people needs to be carefully considered,” Professor Zhang said. 

For those studying or who have been qualified through an MBA to DNP or similar pathway, and other medical and health professionals, this research might mean a change in the recommendations made to patients for pain relief.

How does paracetamol work?

Paracetamol has been commercially available since the 1950s and is one of the world’s most widely used drugs. It is often the first-line therapy for those with mild to moderate fever and pain. Paracetamol is available over the counter in pharmacies, supermarkets, and other stores.

Despite being in use for more than 70 years, the exact way paracetamol works is still not fully understood. The most likely scenario, however, is it works by blocking the chemical messengers in the brain that inform your body you have pain. It can also reduce a high temperature by the same method – altering the chemical messengers in the area of the brain that regulates body temperature. 

Paracetamol takes effect approximately 30 minutes after administration and lasts about four to six hours. Paracetamol can come in many forms, including tablets, capsules, suppositories, soluble powders, and liquids. 

For those suffering from osteoarthritis, a modified-release paracetamol is generally what has been recommended. This type of paracetamol may also be referred to as controlled-release paracetamol, extended-release paracetamol, slow-release paracetamol, or sustained-release paracetamol. Modified-release paracetamol has a higher dose of paracetamol than standard paracetamol tablets and is released more slowly into the body. You would generally take modified-release paracetamol less often throughout the day. 

Alternatives to paracetamol for osteoarthritis

Osteoarthritis is a degenerative joint disease that causes pain, tenderness, swelling, redness, and reduced flexibility in the affected joint. While Osteoarthritis cannot be reversed, there are treatments aside from paracetamol that can reduce pain and allow you to move better. These alternatives to paracetamol include:

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Over-the-counter NSAIDs such as ibuprofen, Advil, and Motrin IB can provide pain relief for osteoarthritis. They can also, however, cause upset stomachs, cardiovascular problems, bleeding issues, and liver and kidney damage. NSAID gels are a good alternative to tablets, with fewer side effects while still offering effective pain relief. 

Cortisone injections

Corticosteroid injections can relieve pain in the short term for up to a few weeks. The area around the affected joint is numbed, and a needle is placed into the space between the joints to help with lubrication. Corticosteroid injections can be had three to four times a year. 

Topical treatments

Topical treatments such as capsaicin, salicylates, counterirritants, and anesthetics can help relieve osteoarthritis pain. Hot and cold therapies can also assist with pain, with heat increasing the flexibility and blood flow of a stiff joint, and cold numbing the nerves and reducing inflammation. 

Physical therapy

Exercising can help strengthen the muscles around the joint, and increase flexibility which can result in reduced pain. A physical therapist can teach you exercises, or gentle exercises you do on your own such as walking or swimming can also be beneficial. 

Gentle exercise such as swimming can help with osteoarthritis. Photo by Antonio Araujo on Unsplash.

Occupational therapy

Occupational therapists can help address issues you face completing everyday tasks due to osteoarthritis. This could involve simple adjustments such as teaching you to use your whole arm to turn a doorknob rather than just the wrist, recommending assistive devices such as a cane or grabber, or making adaptations to your home such as adding a stair lift to reduce strain on affected joints. 

Transcutaneous electrical nerve stimulation (TENS) machines

TENS machines use low-voltage electrical currents to relieve pain and can provide short-term relief for pain associated with osteoarthritis. 

Realigning bone surgery

There are circumstances where surgery can be the right option to manage osteoarthritis. If you have one knee that is more damaged than the other for example, a surgeon may elect to cut across the bone either above or below the knee and add or remove a wedge of bone. This shifts your body weight from the damaged and worn-out area of your knee. 

Joint replacement surgery

Joint replacement surgery involves removing your damaged joint surfaces and replacing them with plastic, ceramic, or metal parts called prostheses. The prosthesis is designed to replicate the movement of a healthy joint and can last many years before needing to be replaced. For those with chronic pain or disability, total joint replacement may be recommended.

DISCLAIMER – “Views Expressed Disclaimer: This article is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. Always seek the guidance of your doctor or other qualified health professional with any questions you may have regarding your health. Views and opinions expressed are those of the authors and do not reflect the official position of any other author, agency, organization, employer or company, including NEO CYMED PUBLISHING LIMITED, which is the publishing company performing under the name Cyprus-Mail…more