Read on: danhwilliams.com

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Up until I saw Valerie (the 73-year-old Scillonian woman from #012) the advice that she’d been given was to rest when she had pain and take painkillers. In increasing doses and strength.

That’s the traditional approach to joint pain that leads to people thinking…
 
'I should rest and take painkillers.'


We unpicked the first part of that traditional approach in newsletters #009 and #010. When it comes to chronic joint pain, activity is best, not rest.

So, it might not surprise you to read that, when it comes to chronic osteoarthritic joint pain, the short answer to ‘do painkillers work?’ is…

‘Well, not really’.

 
Acute injury pain

Now, don’t get me wrong, for an acute injury, painkillers are wonderful.

I broke both bones in my forearm playing rugby half a lifetime ago. I missed a catch (not unusual for me!) and landed with my right forearm bent in the middle. Bent to 90 degrees.

It really didn’t look right. Even I could tell it was broken.

That picture of my bent forearm is etched into my memory. But I don’t remember much pain. Breaking those bones was not immediately painful.

Any movement in the moments afterwards however... was EXCRUCIATING.

But then healthcare came to my rescue and my really excellent treatment was largely pain-free.

Pain-free thanks to a cocktail of painkillers prescribed before, during and after both bones in my forearm  were fixed straight with two metal plates and screws.

I cannot imagine what that would have been like without pain medication. So, I’m a big fan of painkillers. At the right time, in the right place…
 

Chronic joint pain

For joint pain, paracetamol is the first line painkiller.

As time goes by, patients are typically then prescribed a non-steroidal anti-inflammatory (NSAIDs), like ibuprofen or diclofenac...

And tramadol might be added in if those are thought to be not working.

Often people walk through my clinic door already taking that triple cocktail of pain medications. Paracetamol. Ibuprofen. Tramadol.

People have been taking them for many months, and they’re not much better.
 
It’s often assumed they’re no better because their pain has got worse. But could it be because the...


Painkillers are having little or no real effect? 

We know that paracetamol or ibuprofen is good for a headache or acute, short-lived pain. But have we stopped to consider if these tablets are effective in people with longer term hip or knee osteoarthritis?

We have!

Well, the authors of two recent Cochrane reviews have. Cochrane, who gave us definitive answers to the activity v rest question, is an international organisation, legally registered as a charity in the UK.

Importantly, it does not accept commercial or conflicted funding.

At latest count there were 11,000 members and over 68,000 supporters from more than 130 countries. Cochrane’s mission is to promote evidence-informed health decision-making by producing high-quality, relevant, accessible systematic reviews of evidence. A bit long-winded, but...

It’s a good place to look for answers to these sorts of questions.

 
Paracetamol

The Cochrane group analysed 10 randomised controlled trials (RCTs) including 3541 people with hip or knee osteoarthritis. That’s a decent number.

The ‘C’ in RCT or control group in these trials all took a placebo or equivalent of a ‘sugar pill’ with no active ingredient.

Importantly, none of the participants knew whether they were taking paracetamol or a ‘sugar pill’.

Picture people in the trial thinking ‘I’m taking tablets every day that may or may not be working...’