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Fifteen studies of moderate to high quality were reviewed and provide the best evidence we have today. The studies tested almost 6000 people with osteoarthritis of the hip or knee. The studies compared people who took 4000 mg of acetaminophen (Tylenol, Paracetamol) a day to people who took a placebo (fake pill) or non‐steroidal anti‐inflammatory drugs (NSAIDs). Most studies lasted on average about 6 weeks.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 25, 2006

To see how well paracetamol works for non‐specific low back pain (LBP). Non‐specific LBP is back pain for which there is no identified disease or condition.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: June 6, 2016

This review found that few people with two to 14 tension‐type headaches a month get good pain relief from taking paracetamol 1000 mg. There are questions about how studies of this type of headache are conducted. These questions involve the type of people chosen for the studies, and the types of outcomes reported. This limits the usefulness of the results, especially for people who just have an occasional headache.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: June 16, 2016

Dental pain is common after dental procedures and can lead to increased fear of dental treatment, avoidance of dental treatment and other associated problems. Reduction of pain is important, particularly in children and adolescents. One way of managing this might be to give painkillers before treatment so that the painkillers can start to work right away.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: August 8, 2016

This Rapid Response report aims to review the recent evidence on the clinical efficacy of acetaminophen 1000 mg versus 600/650 mg for pain and fever.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: June 17, 2016

Bibliographic details: Carson S M.  Alternating acetaminophen and ibuprofen in the febrile child: examination of the evidence regarding efficacy and safety. Pediatric Nursing 2003; 29(5): 379-38214651311

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2003

There is no evidence from randomised controlled trials to support or refute the suggestion that paracetamol (acetaminophen) in any dose will provide pain relief for chronic non‐cancer pain in children or adolescents.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: August 2, 2017

There is no evidence to show that paracetamol is useful in treating people with cancer pain, either alone or combined with a morphine‐like drug. Nor is there evidence to disprove that it is useful. There are no good studies evaluating paracetamol for management of cancer pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: July 12, 2017

Bibliographic details: Das RR, Arora K, Naik SS.  Efficacy and safety of paracetamol versus ibuprofen for treating patent ductus arteriosus in preterm infants: a meta-analysis. Journal of Clinical Neonatology 2014; 3(4): 183-190

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Patient-controlled analgesia (PCA) is a mainstay in the control of pain after major surgery. The drug most commonly used with PCA is morphine, but its administration can result in adverse effects, most commonly nausea and vomiting. Paracetamol (acetaminophen), non-steroidal anti-inflammatory drugs (NSAIDs) and cyclo-oxygenase 2 (COX-2) inhibitors are commonly used in conjunction with morphine following major surgery with the aim of reducing morphine consumption and the associated adverse effects. These non-opioids also have their own adverse effects. NSAIDs are associated with prolonged bleeding time and adverse gastrointestinal effects amongst other outcomes. The use of COX-2 inhibitors has been associated with increased thromboembolic events such as myocardial infarction and stroke, although these associations tend to be seen only with long-term use.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2010

Osteoarthritis refers to a clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life. It is the most common form of arthritis, and one of the leading causes of pain and disability worldwide. The most commonly affected peripheral joints are the knees, hips and small hand joints. Although pain, reduced function and effects on a person’s ability to carry out their day-to-day activities can be important consequences of osteoarthritis, pain in itself is of course a complex biopsychosocial issue, related in part to person expectations and self-efficacy, and associated with changes in mood, sleep and coping abilities. There is often a poor link between changes on an X-ray and symptoms: minimal changes can be associated with a lot of pain and modest structural changes to joints oftencan occur without with minimal accompanying symptoms. Contrary to popular belief, osteoarthritis is not caused by ageing and does not necessarily deteriorate. There are a number of management and treatment options (both pharmacological and non-pharmacological), which this guideline addresses and which offer effective interventions for control of symptoms and improving function.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: February 2014

Bibliographic details: Jones S, Merrill A.  Effectiveness of intravenous acetaminophen for pain management in orthopedic surgery patients: a systematic review. JBI Library of Systematic Reviews 2012; 10(37): 2490-2513 Available from: http://www.joannabriggslibrary.org/index.php/jbisrir/article/view/34

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

OBJECTIVE: To evaluate the antipyretic effects and safety of ibuprofen compared with acetaminophen in febrile children.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

INTRODUCTION: This study's objective was to systematically review the literature to assess analgesic outcomes of intravenous (IV) acetaminophen for acute postoperative pain in adults.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

OBJECTIVE: To determine the risk: benefit of paracetamol combined with caffeine in the short-term management of acute pain conditions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

OBJECTIVE: To assess the best available evidence for efficacy of paracetamol (acetaminophen) in the treatment of osteoarthritis (OA).

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

Paracetamol (acetaminophen) is the most common drug taken in overdose in the UK, accounting for 48% of poisoning admissions to hospital and being involved in an estimated 100-200 deaths per year. In 1998, the UK government introduced legislation that reduced the maximum pack size of all non-effervescent tablets and capsules containing aspirin (acetylsalicylic acid) or paracetamol that can be sold or supplied from outlets other than registered pharmacies from 25 to 16 tablets or capsules. This article reviews the literature to determine the effectiveness of the legislation, focusing specifically on paracetamol poisoning. Seventeen studies on this subject were identified. Three studies found reductions in mortality rates; one study found an increase in mortality rates, while one found an initial reduction followed by an eventual increase; three found no significant difference in mortality rates before and after introduction of the legislation. Five studies found reductions in admissions to liver units, three of these finding a reduction in liver transplantation rates; two further studies found no change in liver function tests and rates of paracetamol-induced acute liver injury or failure. Four studies found a sustained decrease in hospital admissions, while two found an initial decrease followed by an eventual increase. One study found a decline in admissions for paracetamol poisoning and an increase in admissions for non-paracetamol poisoning. Sales data are conflicting, with two studies finding no significant difference in paracetamol sales before and after the introduction of the legislation and one reporting a decline. The severity of overdose appears to have decreased since the maximum permitted packet size was reduced, with five studies reporting a reduction in the number of severe overdoses (measured by numbers of tablets ingested, serum paracetamol concentrations and usage of antidotes). Only two studies reported an increase in the number of severe overdoses.Paracetamol-associated mortality rates, admissions to liver units/liver transplants, hospital admissions and the severity of paracetamol overdose appear to have been decreasing since 1998. However, one study showed that the reductions in mortality and hospital admissions began in 1997; therefore, the contribution of the 1998 legislation to the observed changes is unclear. Most of the studies are based on short-term follow-up so it is difficult to draw any conclusions regarding long-term trends. Many of the studies were also restricted to relatively small areas of the UK; this, combined with a variety of outcome measures, makes it difficult to distinguish any conclusive trends. The studies also suffer from a lack of comparison and control groups. Some studies do not clearly differentiate between the paracetamol preparations covered by the legislation and those not. The limited number of studies to date, combined with a variety of outcome measures, make it difficult to determine with accuracy whether or not the legislation has been a success. More long-term studies are needed to fully assess the impact of the legislation.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

BACKGROUND: Paracetamol (acetaminophen) toxicity remains the leading cause of acute liver failure (ALF) in the developed world. In the UK, the recently modified King's College Criteria are used to list patients for emergency liver transplantation, but these criteria have been criticized for their low sensitivity and for spectrum bias in their application.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

As many as 50% of premenopausal women regularly suffer from menstrual pain. Many of these women may be incapacitated for one to three days during each menstrual cycle. Primary dysmenorrhoea (PD) is where women suffer from menstrual pain but lack any pathology in their pelvic anatomy. A wide range of treatments are available and some of these, such as beta2‐adrenoceptor agonists, have been used to treat women with primary dysmenorrhoea but their effects are unclear. Five studies involving 187 females with an age range of 15 to 40 years were included in this review. Oral isoxsuprine was examined in two studies; terbutaline oral spray, ritodrine chloride and oral hydroxyphenyl‐orciprenalin were compared with placebo in a further three studies. All of the studies were conducted over 30 years ago and none were of high quality. None of these medications, other than isoxsuprine combined with acetaminophen and caffeine, were reported to have any beneficial effect. Side effects with these medications were reported in up to a quarter of the participants and included nausea, vomiting, dizziness, quivering, tremor and palpitations. At present there is insufficient evidence to allow confident decision‐making about the use of beta2‐adrenoceptor agonists for dysmenorrhoea.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: May 16, 2012

Caffeine is found in various plant products, and may be ingested in drinks like tea, coffee, and some soft drinks and energy drinks. Caffeine is a stimulant, and can improve alertness and prevent tiredness over short periods. It may disturb sleep in some people if taken before bed. Ordinary consumption of caffeine (less than 500 milligrams daily) is not harmful to health. Caffeine is commonly used in pain‐relieving medicines available from pharmacies without a prescription. An adjuvant is something that is added to a medicine to make it work better.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: December 11, 2014

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