Is Acetaminophen Effective for Osteoarthritis?
For many people, a dose of acetaminophen (sold as Tylenol) has always been the first line of defense against pain of any kind. And while it may be effective for certain conditions, a recent analysis of 74 different studies found that acetaminophen lagged behind other drugs when it came to providing relief to osteoarthritis sufferers.
A team of researchers at the University of Bern in Switzerland studied the effects of 22 different medications prescribed to people with osteoarthritis, a progressive condition that affects about 27 million Americans, according to the Arthritis Foundation. This very common condition is caused by wear and tear on the joints that leads to the breakdown of cartilage and bone-on-bone rubbing. The resulting pain and loss of physical function can hamper daily activity.
What Works for Osteoarthritis?
While Tylenol was found to offer just a bit more pain relief than a placebo, diclofenac—a nonsteroidal anti-inflammatory drug, or NSAID, available by prescription only—had the greatest short term effect on pain.
However, diclofenac, like all NSAIDs, has side effects. According to the U.S. Food and Drug Administration (FDA), NSAIDs, which also include common over-the-counter medications like ibuprofen and naproxen, may cause bleeding in the stomach or other parts of the gastrointestinal tract. The risk is highest in people who use them on a daily basis and/or in high amounts—in those who already have stomach ulcers, and in people who are on blood thinners or corticosteroids.
NSAIDs can also up your chances of a heart attack or stroke. As with gastrointestinal problems, the risk is highest in people who already have heart disease or who take the drugs for long periods. However, the FDA warns these problems can occur in NSAID users who have no known history of cardiac issues. Furthermore, heart attack or stroke could occur during the first weeks of NSAID use.
A Pain Relief Cocktail
Not every medical professional agrees with the Swiss study's findings: "Tylenol is effective for arthritis joint pain," says Joseph Ciotola, MD, an orthopedic surgeon with Mercy Medical Center in Baltimore. However, "If you’re just going to take one [medication,] any NSAID is likely to give you more relief because of its anti-inflammatory properties." (All varieties of arthritis are inflammatory, even if—like osteoarthritis—they are not autoimmune in nature.)
Ciotola uses Tylenol as well as other medications to create what he refers to as a "cocktail regimen" for his patients: "You don’t want to do too much of any one thing," he says, pointing out that both NSAIDs and Tylenol can cause side effects like liver damage when taken in excess. By switching between NSAIDs and Tylenol, or combining them in lower amounts, he helps his patients avoid taking toxic levels of either.
Relief Without Drugs
Want to find relief while limiting your use of painkilling drugs? Focus on exercise and lifestyle modifications, says Melanie Gaeta, PT, OCS, a physical therapist with Mercy Medical Center in Baltimore. For instance, since pain is often present upon waking up, declining as the morning goes on and returning later in the afternoon or evening, Gaeta advises her patients to run errands and chores during what she calls the "sweet spot" of the day, often late morning or early afternoon, when they feel most limber.
In addition, monitoring your movement can help: "I will sometimes recommend an activity tracker, so people can find the step count that feels good—not too many and not too few—and use this to put a cap on their activity day to day," she says. Gaeta also is a fan of low-impact exercises such as walking, biking, and aquatics, in addition to strength training within a patient’s pain-free range of motion.
Joseph Ciotola, MD, and Melanie Gaeta, PT, OCS, reviewed this article.
Ciotola, Joseph, MD. Phone call with source. May 31, 2016.
Gaeta, Melanie, PT, OCS. Email conversation with source. May 30, 2016.
"What is Osteoarthritis?" Arthritis Foundation. Accessed on June 29, 2016.
da Costa, Bruno R, Stephan Reichenbach, Noah Keller, Linda Nartey, Simon Wandel, Peter Juni, Sven Trelle. "Effective of Non-Steroidal Anti-Inflammatory Drugs for the Treatment of Pain in Knee and Hip Osteoarthritis: a Network Meta-Analysis." The Lancet Vol. 387, No. 10033(2016): 2093-2105.
"FDA Drug Safety Communication: FDA Strengthens Warning That Non-Aspirin Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Can Cause Heart Attacks or Strokes." U. S. Food and Drug Administration. July 9, 2015.
"The Benefits and Risks of Pain Relievers: Q & A on NSAIDs With Sharon Hertz, M.D." U.S. Food and Drug Administration. September 24, 2015.
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