Old fashioned may be the safest bet: Monash researchers find that paracetamol works best for pain relief

Research by the Centre for Medicine Use and Safety at Monash University in collaboration with the Department of Emergency Medicine, Auckland Hospital in New Zealand has found that paracetamol alone is just as effective as combining opioids and over-the-counter painkillers for short-term musculoskeletal injuries.

In a paper published in Annals of Emergency Medicine, a team of researchers involving CMUS Masters of Clinical Pharmacy student Jiayi Gong and Professor Carl Kirkpatrick have collaborated with a team of clinical researchers in Auckland Hospital. The team have identified that multidrug painkiller therapy consisting of ibuprofen, codeine and paracetamol is no more effective than taking paracetamol alone for pain relief for acute musculoskeletal injuries.


Existing data from the Health Quality and Safety Commission New Zealand demonstrates a spike in opioid use, with fentanyl use more than doubling since 2011. Almost half of those dispensed a strong opioid had a ‘trigger event’ in a public hospital in the week prior, suggesting these prescriptions are generated in hospital.

Mr Gong’s research compares paracetamol effectiveness against a combination of NSAIDS, paracetamol and opioids for moderate to severe pain in emergency hospital departments. In a study involving over 100 adults at Auckland Hospital, patients were randomly assigned to two groups, one group received a combination of paracetamol, ibuprofen and codeine; the other only paracetamol.

According to Mr Gong, this research demonstrates that pain relief does not always require prescription medications such as codeine or similar opioids.

“Opioids definitely play an important role in managing pain. However, plain old-fashioned paracetamol is a well-established medication and one that still seems to be effective for managing short-term pain,” Mr Gong said.

‘Pain relief differ between patient to patient. What we have demonstrated is that for short-term injury, the routine ‘all or nothing’ approach using a combination of drugs with an opioid is no better than giving a single agent (paracetamol), with potential for more harm’ he said.

“This study can hopefully encourages others to work to mitigate the number of unnecessary opioid dispensing in acute settings such as hospitals,” he said.

Monash University ranked #3 in the world for pharmacy and pharmacology in the 2018 QS World University Rankings by Subject.

Contact: Divya

Phone: 0466910111

Email: divya.krishnan@monash.edu