The treatment of osteoarthritis has long been dominated by aspirin, ibuprofen (Motrin, Advil, etc.), indomethacin (Indocin), naproxen (Naprosyn, Aleve), piroxicam (Feldene), and other nonsteroidal anti-inflammatory drugs (NSAIDs). They relieve pain, stiffness, and muscle spasms.
Tylenol vs. NSAIDs
In a study conducted three years ago, acetaminophen (Tylenol) was shown to be an effective pain reliever with fewer side effects, compared to one of the most popular NSAIDs–ibuprofen. The study was conducted by John D. Bradley, M.D., and colleagues at the Indiana School of Medicine at Indianapolis and published in The New England Journal of Medicine (11 July 1991).
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The investigators noted that the dosages for NSAID treatment of osteoarthritis have risen over the last 13 years, so have prescription drug costs and the risks of adverse effects, particularly gastrointestinal blood loss and gastric erosions. The purpose of the study was to challenge the prevailing medical dogma that high-dose NSAIDs are the superior treatment for osteoarthritis because of their anti-inflammatory properties.
The investigators contend that the contribution of inflammation to both joint pain and the progression of cartilage breakdown in osteoarthritis is unclear. Furthermore, there is little evidence that analgesic drugs with no anti-inflammatory activity (e.g., acetaminophen, or Tylenol, Panadol, Anacin-3, etc.) are any less effective than NSAIDs for the treatment of osteoarthritis.
For the University of Indiana study, 126 people with chronic knee pain due to osteoarthritis were given either 2,400 or 1,200 mg of ibuprofen per day, or 4,000 mg of acetaminophen per day. The two different doses of ibuprofen were evaluated because doctors frequently prescribe the higher dose to compensate for its weak anti-inflammatory effects. At a dose of 2,400 mg per day ibuprofen’s anti-inflammatory effect is similar to that of anti-inflammatory doses of the prescription drugs, fenoprofen, tolmetin, and naproxen.
All participants were evaluated after a washout period (no drugs) of three to seven days before the beginning of the study, and again after four weeks of treatment. No placebo group was included in this study because the purpose was not to prove efficacy for each regimen but to detect differences.
In fact, there were no significant differences noted among the three groups after four weeks of treatment. In terms of pain relief and improvement of function, all the study participants showed similarly significant improvement over the four-week treatment period.
Dr. Bradley and colleagues noted that their findings are consistent with three earlier similar studies and would thus call into question the common pratice of prescribing high doses (i.e., anti-inflammatory) of ibuprofen for osteoarthritis of the knee.
Of course, there’s a downside to routine use of acetaminophen. When taken over the long term, it causes a small but significant decrease in kidney function. But, the investigators note, when given in doses commonly used to treat osteoarthritis, acetaminophen is generally well tolerated and safe, and superior to the placebo.
This study was supported by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases.
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