GPS write out millions of prescriptions for the painkiller every year and buy millions of packs over the counter. It is generally considered cheap, safe and effective. But before we pop another pill, should we give it a second thought?
Many GPS are starting to use paracetamol in this more nuanced way. Two years ago, the Royal College of general Practitioners was one of the loudest complaints when Nice considered withdrawing its support for the drug as the preferred treatment for chronic osteoarthritis pain. Now, however, Dr Martin Johnson, of the RCGP, says it no longer makes sense to drive GPS to give paracetamol to millions of these patients on a long-term basis.
“If you look at asthma or diabetes, these are well-managed diseases because people are empowered, but we’re not used to the concept of self-managing pain. In fact, patients should not habitually use paracetamol. Instead, they should take them when they are in pain and when they are going to do something that normally causes pain, such as a long walk. They should also consider other pain management methods, such as hot baths and stretching exercises.”
Dixon agrees that there has been a difficult shift in the mindset of doctors and patients about how to use acetaminophen and other painkillers. “Doctors traditionally say, ‘No, you shouldn’t have pain, and we’ll give you something to stop it,'” he said. “What we have to communicate to people is that pain itself doesn’t do any harm, it’s not something you can cure, and sometimes it makes sense not to do anything about it. We must learn to control pain proportionally.
“It’s not easy because it’s a cultural issue, but my view is that within five years we will no longer be prescribing paracetamol for chronic pain.”