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Acetaminophen (Paracetamol) for Chronic Pain

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Updated September 22, 2009

Acetaminophen for Pain Management:

Most people know acetaminophen, also called paracetamol, as the active ingredient in Tylenol. However, acetaminophen is also an ingredient in many other over-the-counter and prescription drugs. It is a non-opioid analgesic that is effective in the treatment of musculoskeletal aches and pains such as arthritis and headaches. Some people use acetaminophen along with their prescription pain medications to manage breakthrough pain. Acetaminophen may also be combined in prescription medications with certain opioids, such as codeine and hydrocodone.

Acetaminophen is Not an NSAID:

Though they may be on the shelf together, NSAIDs and acetaminophen are two different classes of drugs. NSAIDs relieve pain both by blocking certain pain-associated enzymes. They also reduce swelling, which can be a component of pain. How acetaminophen works to relieve pain, on the other hand, is not completely understood.

Acetaminophen vs. NSAIDs :

Both are available over the counter and in prescription form. Both can be used for musculoskeletal pain. Acetaminophen works to reduce pain and fever. However, it does not reduce swelling like an NSAID. Therefore, it may be less effective in management of chronic soft tissue pain. Despite this, acetaminophen may be used in place of NSAIDs for individuals who have higher risk of gastrointestinal complications, such as those with ulcers or hypotension. Acetaminophen is also considered safer for children than NSAIDs.

Risks Associated with Acetaminophen:

Even in doses barely over the recommended daily allowance (4 grams), acetaminophen carries a risk of liver damage. Sometimes, misuse can be fatal. While you might not think of acetaminophen when you think of a typical drug overdose, it happens more often than you think. You are at a greater risk of liver failure associated with acetaminophen if you already have liver damage, have kidney disease or if you drink alcohol moderately.

Taking Acetaminophen Safely:

Don’t take more than the recommended amount of acetaminophen, even if you are still having pain. Be mindful of how much alcohol you drink when taking acetaminophen, as more than 3 to 4 drinks per day can increase your risk of fatal liver damage. If you take other over-the-counter products, such as those for colds or flu, check first to see if they contain acetaminophen. If you experience symptoms such as appetite loss or nausea and vomiting after taking acetaminophen, call your doctor. These can be early warning signs of liver failure.

Sources:

American Chronic Pain Association. APCA Medications and Chronic Pain: Supplement 2007. Accessed 6/21/09. http://www.theacpa.org/documents/ACPA%20Meds%202007%20Final.pdf

The Merck Manuals Online Medical Library. Pain: Treatment. Accessed 7/3/09. http://www.merck.com/mmhe/sec06/ch078/ch078d.html

U.S. Food and Drug Administration. Acetaminophen and Liver Injury: Q & A for Consumers. Accessed 7/6/09. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm168830.htm

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