Paracetamol best for pain relief in bone, muscle injuries

If you need to tame the pain of a broken bone, sprain or bruising, a new study suggests you’re best to reach for the humble paracetamol.

The Australasian study found that paracetamol alone is just as effective as combining opioids, such as codeine, with over-the-counter painkillers for short-term musculoskeletal injuries.

Researchers hope their findings will lead to less unnecessary use of risk-laden opioids.

Prescribing opioids following for short-term pain has been identified as a risk for later long-term opioid use. Despite this, opioids are commonly used to manage moderate to severe pain caused by factures, sprains, strains and bruising.

Data from the Health Quality and Safety Commission New Zealand reveals a recent spike in opioid use, with fentanyl use more than doubling since 2011. Almost half of patients dispensed a strong opioid had a ‘trigger event’ in a public hospital in the week prior, suggesting these prescriptions were generated in hospital.

Researchers from the Centre for Medicine Use and Safety at Monash University, in collaboration with the University of Auckland and the Department of Emergency Medicine, Auckland Hospital, wanted to see if using a combination of painkillers, including opioids, worked better than paracetamol alone.

They randomly assigned 118 patients who presented at Auckland Hospital’s emergency department with musculoskeletal injuries to one of two groups: paracetamol only, or paracetamol along with ibuprofen and codeine.

Pain relief differed from patient to patient, but after one hour, pain scores overall were comparable between the two groups.

“Opioids definitely play an important role in managing pain. However, plain old-fashioned paracetamol is a well-established medication and one that still seems to be effective for managing short-term pain,” says Monash University Masters of Clinical Pharmacy student Jiayi Gong.

“What we have demonstrated is that for short-term injury, the routine ‘all or nothing’ approach using a combination of drugs with an opioid is no better than giving a single agent (paracetamol), with potential for more harm.”

Mr Gong was supervised by Professor Carl Kirkpatrick at Monash, and Associate Professor Peter Jones at the University of Auckland’s Faculty of Medical and Health Sciences.

Dr Jones says: “Clinicians can be confident that most people do not need multiple analgesics as first line therapy, even when they present with moderate to severe pain related to a soft tissue injury or minor fracture. This has the potential to reduce unnecessary prescriptions of opioids in the ED and other acute care settings.”

The study was published in Annals of Emergency Medicine.

Journal article: Annals of Emergency Medicine: Oral Paracetamol versus Combination Oral Analgesics for Acute Musculoskeletal Injuries

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