Study Says Acetaminophen ‘Not Clinically Effective’ for Osteoarthritis Pain


A new study reveals that some popular over-the-counter pain relievers may not be an effective solution for those battling with osteoarthritis. A study published in The Lancet found that paracetamol, known as acetaminophen, or Tylenol in the United States, is not effective at reducing pain or improving movement in patients with osteoarthritis of the knee and hip.

Osteoarthritis is the most common form of arthritis. Also known as degenerative joint disease or degenerative arthritis, osteoarthritis involves the break-down of the cartilage which acts as a cushion between bones and joints.

The study was conducted so researchers could learn more about the effectiveness of varying types and doses of pain relievers for treating the pain associated with the condition. They looked at 74 randomized trials published between 1980 and 2015, involving 58,556 patients with osteoarthritis.

They also examined 22 different treatments, including several different dose levels of Tylenol and 7 different non-steroidal anti-inflammatory drugs (NSAIDs), a class of drugs that includes aspirin and ibuprofen (Advil).

Tylenol proved to be more effective than placebo, but just barely. The researchers said the difference was not clinically significant.

Sven Trelle, lead author of the meta-analysis and a researcher at the University of Bern in Switzerland, said:

“Our results suggest that paracetamol at any dose is not effective in managing pain in osteoarthritis.”

The study summarized:

“In a large-scale analysis of pain-relief medication for osteoarthritis, researchers found that paracetamol does not meet the minimum standard of clinical effectiveness in reducing pain or improving physical function in patients with knee and hip osteoarthritis. Although paracetamol was slightly better than placebo, researchers conclude that, taken on its own, paracetamol has no role in the treatment of patients with osteoarthritis, irrespective of dose.”

The team noted acetaminophen, whether prescription or over-the-counter (OTC), is generally marketed as the safest painkiller, because it has the fewest side effects. Arthritis expert Dr. Bashir Zikria, an assistant professor of orthopedic surgery at the Johns Hopkins University School of Medicine, explained:

“Tylenol is publicized as being the safest one. It doesn’t bother your kidneys and stomach.”

But according to Zikria, Tylenol can harm the liver at high doses. It is also relatively easy to overdose on the drug.

Source: ProPublica

The “big winners” of the study were 150 mg a day of diclofenac (Voltaren), followed by 60 mg a day of etoricoxib (Arcoxia), and 25 mg a day of rofecoxib (Vioxx), as reported by Forbes.

The study interpretation reads:

“On the basis of the available data, we see no role for single-agent paracetamol for the treatment of patients with osteoarthritis irrespective of dose. We provide sound evidence that diclofenac 150 mg/day is the most effective NSAID available at present, in terms of improving both pain and function. Nevertheless, in view of the safety profile of these drugs, physicians need to consider our results together with all known safety information when selecting the preparation and dose for individual patients.”

In 2004 Merck & Co. recalled Vioxx, once a blockbuster drug for the pharmaceutical company, after a clinical trial showed the medication significantly increased patients’ risk for stroke and heart attack.

In 2007 a Food and Drug Administration (FDA) advisory committee voted 20-1 against recommending approval of Merck’s etoricoxib due to cardiovascular safety concerns.

Potential Alternatives for Arthritis Pain

As is usually the case, nature may have a solution for osteoarthritis pain. Researchers at Tabriz University of Medical Sciences said in 2013 that 40 mg of powdered sesame seeds a day was found to be as effective as 2 daily 500 mg doses of Tylenol. That equals about 4 Tablespoons of whole sesame seeds. The researchers crushed the seeds into a powder to aid absorption. This can be accomplished using a coffee bean grinder, or a mortar and pestle.

There are several supplements recommended by the Arthritis Foundation as well, including:

  • Sam-e (S-adenosylmethionine)
  • Boswellia Serrate (Indian frankencense
  • Capsaicin
  • Turmeric/curcumin
  • Avocado-soybean Unsaponifiables
  • Cat’s claw
  • Omega-3 fish oil
  • Gamma Linolenic acid
  • Ginger
  • Pine bark extract

Gentle weight training and aerobic exercise has been shown to ease osteoarthritis pain, especially water exercise. Some osteoarthritis patients have too much pain to do land-based exercises, but aquatic exercises provide a way of exercising without putting too much stress on the joints.

Heat and ice can also be helpful. Ice should be used for acute pain, while chronic pain should be treated with moist heat.

Vegetables, whole grains, fish, and healthy fats are all anti-inflammatory foods that have been shown to help the pain of osteoarthritis. Among other foods and herbs for arthritis is tart cherries, which have an extremely high anti-inflammatory profile.

Source: Harvard Health Publications

Other potentially useful methods of treating osteoarthritis pain include:

  • Acupuncture
  • Massage therapy
  • Spa therapy (hydrotherapy and sulfur-rich mud baths)
  • Orthotics to realign and support the joints
  • Yoga and tai chi
  • TENS (transcutaneous electrical nerve stimulation)


Everyday Health


Harvard Health Publications