Most medications found better than Tylenol for knee pain

February 26, 2015

Most treatments for pain caused by knee osteoarthritis helped alleviate pain better than acetaminophen (Tylenol) – with one exception, according to a study published in the January 6 issue of the Annals of Internal Medicine

Most treatments for pain caused by knee osteoarthritis (OA) helped alleviate pain better than acetaminophen (Tylenol) – with 1 exception, according to a study published in the January 6 issue of the Annals of Internal Medicine.

Researchers, led by Raveendhara Bannuru, director of the Center for Treatment Comparison and Integrative Analysis at Tufts Medical Center and a research assistant professor of medicine, found that the exception was celecoxib, which is prescribed for joint pain.

Using data from 137 studies, the researchers compared the relative efficacy of 5 oral pain pills, including acetaminophen and ibuprofen, 2 injectable drugs, and oral and injectable placebos. They looked at randomized trials of adults with knee OA comparing 2 or more of the following: acetaminophen, diclofenac, ibuprofen, naproxen, celecoxib, intra-articular (IA) corticosteroids, IA hyaluronic acid, oral placebo, and IA placebo.

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“All treatments except acetaminophen showed clinically significant improvement from baseline pain,” Bannuru wrote. “For function, all interventions except IA corticosteroids were significantly superior to oral placebo. Intra-articular treatments were superior to nonsteroidal anti-inflammatory drugs, possibly because of the integrated IA placebo effect. Small but robust differences were observed between active treatments.”

Surprisingly, placebo injectables gave patients pain relief that was comparable to all of the oral pain medications tested. “We found injection placebos have more effect than oral placebos. We really want to explore that,” Bannuru told Medical Xpress. “As physicians, we can't separate the placebo effect from the treatment effect. As a patient, if I get that injection and my knee feels better, I don't really care whether it has active drug or placebo. So now we want to look into other placebos, like topical placebos and sham surgeries and sham acupuncture.”

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