The role of paracetamol in pain management
Paracetamol is a first-line analgesic in adults and children because of its favourable adverse effect profile. It is used for acute nociceptive pain, either alone or in combination depending on pain severity. There is limited evidence of paracetamol efficacy for cancer pain, but it is often used. Paracetamol may be trialled as an adjunct to other management strategies for chronic noncancer pain despite limited evidence to support its use. It is ineffective for neuropathic and nociplastic pain.
Paracetamol can be used for a number of musculoskeletal conditions—see here for principles of use and see the Rheumatology guidelines for its use in specific conditions.
Paracetamol alone may not provide adequate analgesia. The combination of paracetamol and a nonsteroidal anti-inflammatory drug (NSAID) is synergistic, and offers improved pain relief than either drug used on its own1. Combining paracetamol with an opioid for acute pain can reduce the opioid requirement by up to 30%; however, there is no evidence that opioid-related adverse effects are also reduced.