Is Paracetamol still the Number 1 Painkiller?
Tuesday, 23 June 2015 | Editor
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Pain relief or not?In medicine, as with other scientific disciplines, tacit forms of knowledge grounded in clinical experience and common sense have, over the past thirty years, become increasingly marginalised in favour of the objectively – and statistically – demonstrable. The results, almost notoriously, tend to be inconsistent and contradictory, with even the best attested of treatments and interventions judged "ineffective”.
Thus, the merits of Paracetamol as a cheap, remarkably safe and moderately potent analgesic for arthritic-type pain might seem self-evident to the millions who have taken it for this indication over the past hundred years. But their impression of its efficacy is apparently mistaken.
Rather, a systematic review of the findings of 12 relevant clinical trials in patients with low back pain or arthritis in the joints concluded that Paracetamol neither reduced the severity of pain, nor improved their quality of life. Now, it may be that more potent painkillers such as codeine or even morphine may be necessary for those immobilised with, for example, excruciating sciatica. But, as family doctor Diane Asker tartly observes, she "counts herself lucky” that Paracetamol allows her to attend her physiotherapy sessions and swim in the local pool – on which her rehabilitation from her severe back problems depend.
It is a more serious matter when the negative conclusions of these objective methods of evaluation deny the merits of surgery for potentially crippling conditions – as with the recent finding from two clinical trials that surgical reconstruction "confers no benefit over non-operative alternatives” in those with the common sports injuries of a ruptured meniscus or torn ligament of the knee. Hang on a moment, notes Cambridge orthopaedic surgeon Jai Chaitnavis: how come when he asks his patients directly about the outcome, most respond: "Yes, thanks, my knee is now stable and does not hurt any more” (or words to that effect). And when, as happens, they go on to develop the same problem in the other knee, how come they return to have it operated on?
The central problem, acknowledged in the British Medical Journal last week, is that the small size and poor quality of most clinical trials inevitably renders their findings unreliable – and aggregating several together only compounds the bias where, as has been observed, "incomplete data is passed through computer programmes of bewildering complexity to produce results of implausible precision”.
Daily Telegraph 15/6/15
ED. Often pain is caused by inflammation. many people have found that taking Serrapeptase is more effective than conventional painkillers.