The effectiveness of paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) in acute musculoskeletal trauma has been compared in a multi-centre, double-blind, randomised clinical trial conducted in the Netherlands. 547 adults with acute blunt minor musculoskeletal trauma were assigned to one of the following treatments for three consecutive days:

  • Acetaminophen 4,000mg/day (n = 182)
  • Diclofenac 150mg/day (n = 183)
  • Acetaminophen 4,000mg/day + diclofenac 150mg/day (n = 182)

Changes in average numeric rating scale (NRS) pain scores 90 minutes following drug administration were measured in rest/with movement and compared with baseline scores. Participants taking paracetamol alone  demonstrated mean NRS reduction of -1.23 (95% CI –1.50 to –0.95) for rest and –1.72 (95% CI –2.01 to –1.44) with movement. Following pairwise comparison, participants taking diclofenac had a difference of:

  • –0.027 (97.5% CI –0.45 to 0.39) in rest
  • –0.20 (97.5% CI –0.64 to 0.23) with movement

Participants taking paracetamol + diclofenac had a difference of:

  • –0.052 (97.5% CI –0.46 to 0.36) in rest
  • –0.39 (97.5% CI –0.80 to 0.018) with movement

These results suggest that treatment of acute musculoskeletal trauma with paracetamol alone was not inferior to treatment with NSAIDS or paracetamol + NSAIDs (in rest or with movement). These results are important given the potentially serious adverse effects and drug interreactions associated with NSAIDs. Read the full details of the study here.

Contributed by Australian Medication Safety Services Associate – Isabella Singh