Paracetamol for Multimodal Analgesia

Abstract

Pain and related disability remain a major social and therapeutic problem. Comorbidities and therapies increase drug interactions and side effects making pain management more compounded especially in the elderly who are the fastest-growing pain population. Multimodal analgesia consists of using two or more drugs and/or techniques that target different sites of pain, increasing the level of analgesia and decreasing adverse events from treatment. Paracetamol enhances multimodal analgesia in experimental and clinical pain states. Strong preclinical evidence supports that paracetamol has additive and synergistic interactions with anti-inflammatory, opioid and anti-neuropathic drugs in rodent models of nociceptive and neuropathic pain. Clinical studies in young and adult elderly patients confirm the utility of paracetamol in multimodal, non-opioid or opioid-sparing, therapies for the treatment of acute and chronic pain.

Plain language summary

Opioid and anti-inflammatory drugs are essential medications to relief pain; however, they may pose a serious health risk especially in elderly patients and in patients with medical conditions. Doctors are studying ways to reduce or eliminate their use. We wanted to see how well paracetamol works together with other painkillers to manage pain. Paracetamol (or acetaminophen) is one of the most prescribed medication for fever and pain. We found strong evidence that paracetamol given in association with other analgesic drugs enhances the pain relief in adult patients and in elderly adult patients, even though more studies are warranted in the latter. The use of paracetamol in combination with other analgesics is recommended by physicians and surgeons of different specialties.

Keywords::

• analgesia
• multimodal analgesia
• paracetamol

Financial & competing interests disclosure

An unconditional grant for this study and the journal’s publication fee were provided by Angelini Pharma, Milan, Italy. The funder played no role in the design and conduct of the study; data collection, analysis, and interpretation; preparation and submission of the manuscript. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Additional information

Funding

An unconditional grant for this study and the journal’s publication fee were provided by Angelini Pharma, Milan, Italy. The funder played no role in the design and conduct of the study; data collection, analysis, and interpretation; preparation and submission of the manuscript. The author has no other relevant affiliations or financial involvement with any organization or entity with financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.