Most Patients Prefer Anti-Inflammatories Over Acetaminophen

From the WebMD Archives

March 10, 2000 (Minneapolis) -- People with chronic joint or muscle pain see aspirin and other medications designed to reduce inflammation as more effective than acetaminophen (Tylenol), according to a study published in a recent issue of Arthritis & Rheumatism.

The study looked at a group of anti-inflammatories that are called non-steroidal anti-inflammatory drugs, or NSAIDs, to distinguish them from the powerful anti-anflammatory drugs corticosteroids. NSAIDs include aspirin and ibuprofen as well as the newer Cox-2 inhibitors, which are prescription drugs.

Through mailed questionnaires, the researchers surveyed nearly 1,800 patients who had one of three diseases characterized by either joint or muscle pain: osteoarthritis, rheumatoid arthritis, or fibromyalgia.

"There was a considerable and statistically significant preference for NSAIDs compared with acetaminophen among the [three] groups of ? patients," the authors write. They say that this preference was found among all types of patients studied, and was not altered by the severity of their diseases. "If safety and cost are not issues, there would hardly ever be a reason to recommend acetaminophen over NSAIDs, since patients generally preferred NSAIDs," the authors say.

The American College of Rheumatology has recommended that people with these conditions take acetaminophen before progressing to NSAIDs, study author Frederick Wolfe, MD, tells WebMD. This is based on two concerns. First, physicians have been concerned for some time about side effects on the stomach and intestines associated with NSAIDs, including ulceration, bleeding, perforation of the stomach, even death. Second, previous studies have shown that acetaminophen and NSAIDs may be equally effective.

"Although an earlier study suggested that acetaminophen and NSAIDs were equally effective ? I didn't see patients who thought they were equally effective," Wolfe says. "The preference for NSAIDs held up across disease categories, even when adverse reactions were considered." Wolfe is a rheumatologist and clinical professor of medicine at the University of Kansas in Wichita, where he is the director of the National Databank for Rheumatic Diseases at the Arthritis Research Center Foundation.

Over 60% of the surveyed patients who had taken acetaminophen reported that it was either not effective at all or only slightly effective. About the same percentage thought that acetaminophen was less effective than NSAIDS, while about 12% felt that that it was more effective.


The preference for NSAIDs over acetaminophen found in the survey is borne out in practice, says Andrew S. Rokito, who reviewed the study for WebMD. "The attraction to acetaminophen is that it's deemed relatively safe, compared to NSAIDs," he says. "However, acetaminophen is only an analgesic [a pain reliever]. NSAIDs, while having an analgesic effect, [may] have a therapeutic effect as well, because they address underlying causes as opposed to masking symptoms." Rokito is the associate director of sports medicine in the department of orthopaedic surgery at New York University Hospital for Joint Diseases.

Both Rokito and Wolfe say that some of NSAIDs' effects on the stomach may be lessened with the new Cox-2 inhibitors. However, because the new medications cost more, patients with milder disease may want to try acetaminophen first.

This study was funded in part by a grant from the National Institutes of Health.

Vital Information:

  • According to a recent survey, patients who suffer from diseases characterized by joint or muscle pain prefer NSAIDs to acetaminophen.
  • Recommendations have encouraged patients to try acetaminophen before progressing to NSAIDs because it is associated with fewer side effects.
  • Researchers suggest that NSAIDs may have a therapeutic effect against the underlying disease, in addition to an analgesic effect, which may explain why patients prefer them.
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