Editing Paracetamol (section)

===Pain===
Paracetamol is used for the relief of mild to moderate pain such as headache, muscle aches, minor arthritis pain, toothache as well as pain caused by cold, flu, sprains, and [[dysmenorrhea]].<ref name="pmid17227290">{{cite journal |vauthors=Bertolini A, Ferrari A, Ottani A, Guerzoni S, Tacchi R, Leone S |title=Paracetamol: new vistas of an old drug |journal=CNS Drug Rev |volume=12 |issue=3–4 |pages=250–75 |date=2006 |pmid=17227290 |pmc=6506194 |doi=10.1111/j.1527-3458.2006.00250.x}}</ref> It is recommended, in particular, for acute mild to moderate pain, since the evidence for the treatment of chronic pain is insufficient.<ref name="pmid31892511">{{cite journal |vauthors= Saragiotto BT, Abdel Shaheed C, Maher CG |title=Paracetamol for pain in adults |journal=BMJ |volume=367 |issue= |pages=l6693 |date=December 2019 |pmid=31892511 |doi= 10.1136/bmj.l6693 |s2cid=209524643}}</ref>

====Musculoskeletal pain====
The benefits of paracetamol in musculoskeletal conditions, such as osteoarthritis and backache, are uncertain.<ref name="pmid31892511"/>

It appears to provide only small and not clinically important benefits in [[osteoarthritis]].<ref name="pmid31892511"/><ref name=BMJ2015>{{cite journal|vauthors=Machado GC, Maher CG, Ferreira PH, Pinheiro MB, Lin CW, Day RO, McLachlan AJ, Ferreira ML |title=Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo-controlled trials.|journal=BMJ |date=March 2015| volume= 350| pages= h1225| pmid= 25828856 |doi= 10.1136/bmj.h1225|pmc=4381278 }}</ref> [[American College of Rheumatology]] and [[Arthritis Foundation]] guideline for the management of osteoarthritis notes that the [[effect size]] in [[clinical trial]]s of paracetamol has been very small, which suggests that for most individuals it is ineffective.<ref name="pmid31908149">{{cite journal |vauthors= Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, Callahan L, Copenhaver C, Dodge C, Felson D, Gellar K, Harvey WF, Hawker G, Herzig E, Kwoh CK, Nelson AE, Samuels J, Scanzello C, White D, Wise B, Altman RD, DiRenzo D, Fontanarosa J, Giradi G, Ishimori M, Misra D, Shah AA, Shmagel AK, Thoma LM, Turgunbaev M, Turner AS, Reston J |title=2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee |journal=Arthritis Care & Research |volume=72 |issue=2 |pages=149–162 |date=February 2020 |pmid=31908149 |doi=10.1002/acr.24131 |pmc=11488261 |hdl=2027.42/153772 |s2cid=210043648 |hdl-access=free }}</ref> The guideline conditionally recommends paracetamol for short-term and episodic use to those who do not tolerate nonsteroidal anti-inflammatory drugs. For people taking it regularly, monitoring for liver toxicity is required.<ref name="pmid31908149"/> Essentially the same recommendation was issued by [[European League Against Rheumatism|EULAR]] for hand osteoarthritis.<ref name="pmid30154087">{{cite journal |vauthors=Kloppenburg M, Kroon FP, Blanco FJ, Doherty M, Dziedzic KS, Greibrokk E, Haugen IK, Herrero-Beaumont G, Jonsson H, Kjeken I, Maheu E, Ramonda R, Ritt MJ, Smeets W, Smolen JS, Stamm TA, Szekanecz Z, Wittoek R, Carmona L |title=2018 update of the EULAR recommendations for the management of hand osteoarthritis |journal=Ann Rheum Dis |volume=78 |issue=1 |pages=16–24 |date=January 2019 |pmid=30154087 |doi= 10.1136/annrheumdis-2018-213826 |doi-access=free |title-link = doi }}</ref> Similarly, the ESCEO algorithm for the treatment of knee osteoarthritis recommends limiting the use of paracetamol to short-term rescue analgesia only.<ref name="pmid31126594">{{cite journal |vauthors=Bruyère O, Honvo G, Veronese N, Arden NK, Branco J, Curtis EM, Al-Daghri NM, Herrero-Beaumont G, Martel-Pelletier J, Pelletier JP, Rannou F, Rizzoli R, Roth R, Uebelhart D, Cooper C, Reginster JY |title=An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) |journal=Semin Arthritis Rheum |volume=49 |issue=3 |pages=337–350 |date=December 2019 |pmid=31126594 |doi=10.1016/j.semarthrit.2019.04.008 |doi-access=free |title-link = doi |hdl=10447/460208 |hdl-access=free }}</ref>

Paracetamol is ineffective for acute low back pain.<ref name="pmid31892511"/><ref name="pmid28192789">{{cite journal |vauthors=Qaseem A, Wilt TJ, McLean RM, Forciea MA |title=Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians |journal=Ann Intern Med |volume=166 |issue=7 |pages=514–530 |date=April 2017 |pmid=28192789 |doi=10.7326/M16-2367 |s2cid=207538763|doi-access=free }}</ref> No randomized clinical trials evaluated its use for chronic or [[radicular pain|radicular]] back pain, and the evidence in favor of paracetamol is lacking.<ref name=Saragiotto2016>{{cite journal |vauthors=Saragiotto BT, Machado GC, Ferreira ML, Pinheiro MB, Abdel Shaheed C, Maher CG |title=Paracetamol for low back pain |journal=Cochrane Database Syst Rev |date=June 2016| volume=6| issue=6| page=CD012230 |doi=10.1002/14651858.CD012230 |pmid=27271789 |pmc=6353046}}</ref><ref name=BMJ2015/><ref name="pmid28192789"/>

====Headaches====

Paracetamol is effective for acute migraine:<ref name="pmid25600718">{{cite journal |vauthors=Marmura MJ, Silberstein SD, Schwedt TJ |title=The acute treatment of migraine in adults: the american headache society evidence assessment of migraine pharmacotherapies |journal=Headache |volume=55 |issue=1 |pages=3–20 |date=January 2015 |pmid= 25600718 |doi=10.1111/head.12499 |s2cid=25576700}}</ref> 39% of people experience pain relief at one hour compared with 20% in the control group.<ref>{{cite journal |vauthors= Derry S, Moore RA |title=Paracetamol (acetaminophen) with or without an antiemetic for acute migraine headaches in adults |journal=Cochrane Database Syst Rev |volume=4 |issue= 4|pages= CD008040 |year=2013 |pmid=23633349 |doi=10.1002/14651858.CD008040.pub3 |pmc=4161111}}</ref> The aspirin/paracetamol/caffeine combination also "has strong evidence of effectiveness and can be used as a [[Therapy#Lines of therapy|first-line treatment]] for migraine".<ref name="pmid29671521">{{Cite journal |vauthors=Mayans L, Walling A |date=February 2018 |title=Acute Migraine Headache: Treatment Strategies |url=https://www.aafp.org/pubs/afp/issues/2018/0215/p243.html |journal=Am Fam Physician |volume=97 |issue=4 |pages=243–251 |pmid=29671521}}</ref> Paracetamol on its own only slightly alleviates episodic [[tension headache]] in those who have them frequently.<ref name="pmid27306653">{{cite journal |vauthors=Stephens G, Derry S, Moore RA |title=Paracetamol (acetaminophen) for acute treatment of episodic tension-type headache in adults |journal=Cochrane Database Syst Rev |volume= 2019|issue=6 |pages=CD011889 |date=June 2016 |pmid=27306653 |pmc=6457822 |doi=10.1002/14651858.CD011889.pub2}}</ref> However, the aspirin/paracetamol/caffeine combination is superior to both paracetamol alone and placebo and offers meaningful relief of tension headache: two hours after administering the medication, 29% of those who took the combination were pain-free as compared with 21% on paracetamol and 18% on placebo.<ref name="pmid25406671">{{cite journal |vauthors=Diener HC, Gold M, Hagen M |title=Use of a fixed combination of acetylsalicylic acid, acetaminophen and caffeine compared with acetaminophen alone in episodic tension-type headache: meta-analysis of four randomized, double-blind, placebo-controlled, crossover studies |journal=J Headache Pain |volume=15 |issue= 1|pages=76 |date=November 2014 |pmid=25406671 |pmc=4256978 |doi=10.1186/1129-2377-15-76 |doi-access=free }}</ref> The German, Austrian, and Swiss headache societies and the German Society of Neurology recommend this combination as a "highlighted" one for self-medication of tension headache, with paracetamol/caffeine combination being a "remedy of first choice", and paracetamol a "remedy of second choice".<ref name="pmid21181425">{{cite journal |vauthors=Haag G, Diener HC, May A, Meyer C, Morck H, Straube A, Wessely P, Evers S |title=Self-medication of migraine and tension-type headache: summary of the evidence-based recommendations of the Deutsche Migräne und Kopfschmerzgesellschaft (DMKG), the Deutsche Gesellschaft für Neurologie (DGN), the Österreichische Kopfschmerzgesellschaft (ÖKSG) and the Schweizerische Kopfwehgesellschaft (SKG) |journal=J Headache Pain |volume=12 |issue=2 |pages=201–217 |date=April 2011 |pmid=21181425 |pmc=3075399 |doi=10.1007/s10194-010-0266-4}}</ref>

====Dental and other post-surgical pain====
Pain after a dental surgery provides a reliable model for the action of analgesics on other kinds of acute pain.<ref name="pmid32027199">{{cite journal |vauthors=Pergolizzi JV, Magnusson P, LeQuang JA, Gharibo C, Varrassi G |title=The pharmacological management of dental pain |journal=Expert Opin Pharmacother |volume=21 |issue=5 |pages=591–601 |date=April 2020 |pmid=32027199 |doi=10.1080/14656566.2020.1718651 |s2cid=211046298}}</ref> For the relief of such pain, paracetamol is inferior to ibuprofen.<ref name= "pmid24338830">{{cite journal |vauthors=Bailey E, Worthington HV, van Wijk A, Yates JM, Coulthard P, Afzal Z |title=Ibuprofen and/or paracetamol (acetaminophen) for pain relief after surgical removal of lower wisdom teeth |journal=Cochrane Database Syst Rev |volume= |issue=12 |pages=CD004624 |date=December 2013 |pmid=24338830 |doi= 10.1002/14651858.CD004624.pub2|pmc=11561150 }}</ref> Full therapeutic doses of nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen, [[naproxen]] or [[diclofenac]] are clearly more efficacious than the paracetamol/codeine combination which is frequently prescribed for dental pain.<ref name="pmid32286125">{{cite journal |vauthors=Hersh EV, Moore PA, Grosser T, Polomano RC, Farrar JT, Saraghi M, Juska SA, Mitchell CH, Theken KN |title=Nonsteroidal Anti-Inflammatory Drugs and Opioids in Postsurgical Dental Pain |journal=J Dent Res |volume=99 |issue=7 |pages=777–786 |date=July 2020 |pmid=32286125 |doi=10.1177/0022034520914254 |pmc=7313348 }}</ref> The combinations of paracetamol and NSAIDs ibuprofen or diclofenac are promising, possibly offering better pain control than either paracetamol or the NSAID alone.<ref name="pmid24338830"/><ref name="pmid23904576">{{cite journal |vauthors=Moore PA, Hersh EV |title=Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: translating clinical research to dental practice |journal=J Am Dent Assoc |volume=144 |issue=8 |pages=898–908 |date=August 2013 |pmid=23904576 |doi=10.14219/jada.archive.2013.0207}}</ref><ref name="pmid23794268">{{cite journal |vauthors=Derry CJ, Derry S, Moore RA |title=Single dose oral ibuprofen plus paracetamol (acetaminophen) for acute postoperative pain |journal=Cochrane Database Syst Rev |volume= 2019|issue=6 |pages=CD010210 |date=June 2013 |pmid=23794268 |pmc=6485825 |doi=10.1002/14651858.CD010210.pub2}}</ref><ref name="pmid30245281">{{cite journal |vauthors=Daniels SE, Atkinson HC, Stanescu I, Frampton C |title=Analgesic Efficacy of an Acetaminophen/Ibuprofen Fixed-dose Combination in Moderate to Severe Postoperative Dental Pain: A Randomized, Double-blind, Parallel-group, Placebo-controlled Trial |journal=Clin Ther |volume=40 |issue=10 |pages=1765–1776.e5 |date=October 2018 |pmid=30245281 |doi=10.1016/j.clinthera.2018.08.019 |doi-access=free |title-link = doi }}</ref> Additionally, the paracetamol/ibuprofen combination may be superior to paracetamol/codeine and ibuprofen/codeine combinations.<ref name="pmid23904576"/>

A meta-analysis of general post-surgical pain, which included dental and other surgery, showed the paracetamol/codeine combination to be more effective than paracetamol alone: it provided significant pain relief to as much as 53% of the participants, while the placebo helped only 7%.<ref name="pmid19160199">{{cite journal |vauthors= Toms L, Derry S, Moore RA, McQuay HJ |title=Single dose oral paracetamol (acetaminophen) with codeine for postoperative pain in adults |journal=Cochrane Database Syst Rev |volume= 2009|issue=1 |pages=CD001547 |date=January 2009 |pmid=19160199 |pmc=4171965 |doi=10.1002/14651858.CD001547.pub2}}</ref>

====Other pain====

Paracetamol fails to relieve procedural pain in [[newborn babies]].<ref name="pmid32257982">{{cite journal |vauthors=Allegaert K |title=A Critical Review on the Relevance of Paracetamol for Procedural Pain Management in Neonates |journal=Front Pediatr |volume=8 |issue= |pages=89 |date=2020 |pmid=32257982 |pmc=7093493 |doi= 10.3389/fped.2020.00089 |doi-access=free |title-link = doi }}</ref><ref>{{cite journal |vauthors = Ohlsson A, Shah PS |title = Paracetamol (acetaminophen) for prevention or treatment of pain in newborns |journal = The Cochrane Database of Systematic Reviews |volume = 1 |pages = CD011219 |date = January 2020 |issue = 1 |pmid = 31985830 |pmc = 6984663 |doi = 10.1002/14651858.CD011219.pub4 }}</ref> For [[perineum|perineal]] pain [[postpartum period|postpartum]] paracetamol appears to be less effective than [[Nonsteroidal anti-inflammatory drug|nonsteroidal anti-inflammatory drugs]] (NSAIDs).<ref name="pmid33427305">{{cite journal |vauthors=Wuytack F, Smith V, Cleary BJ |title=Oral non-steroidal anti-inflammatory drugs (single dose) for perineal pain in the early postpartum period |journal=Cochrane Database Syst Rev |volume=1 |issue= 1|pages=CD011352 |date=January 2021 |pmid=33427305 |doi= 10.1002/14651858.CD011352.pub3 |pmc=8092572}}</ref>

The studies to support or refute the use of paracetamol for cancer pain and neuropathic pain are lacking.<ref name="pmid28700092">{{cite journal |vauthors=Wiffen PJ, Derry S, Moore RA, McNicol ED, Bell RF, Carr DB, McIntyre M, Wee B |title=Oral paracetamol (acetaminophen) for cancer pain |journal=Cochrane Database Syst Rev |volume=7 |issue= 2|pages=CD012637 |date=July 2017 |pmid=28700092 |pmc=6369932 |doi=10.1002/14651858.CD012637.pub2}}</ref><ref name="pmid28027389">{{cite journal |vauthors= Wiffen PJ, Knaggs R, Derry S, Cole P, Phillips T, Moore RA |title=Paracetamol (acetaminophen) with or without codeine or dihydrocodeine for neuropathic pain in adults |journal=Cochrane Database Syst Rev |volume=12 |issue= 5|pages=CD012227 |date=December 2016 |pmid=28027389 |pmc=6463878 |doi=10.1002/14651858.CD012227.pub2}}</ref> There is limited evidence in favor of the use of the intravenous form of paracetamol for acute pain control in the emergency department.<ref>{{cite journal |vauthors = Sin B, Wai M, Tatunchak T, Motov SM |title = The Use of Intravenous Acetaminophen for Acute Pain in the Emergency Department |journal = Academic Emergency Medicine |volume = 23 |issue = 5 |pages = 543–53 |date = May 2016 |pmid = 26824905 |doi = 10.1111/acem.12921 |doi-access = free |title-link = doi }}</ref> The combination of paracetamol with caffeine is superior to paracetamol alone for the treatment of acute pain.<ref>{{cite journal |vauthors = Derry CJ, Derry S, Moore RA |title = Caffeine as an analgesic adjuvant for acute pain in adults |journal = The Cochrane Database of Systematic Reviews |volume = 3 |issue = 3 |pages = CD009281 |date = March 2012 |pmid = 22419343 |doi = 10.1002/14651858.CD009281.pub2 |s2cid = 205199173 |veditors = Derry S }}</ref>