Deprescribing paracetamol in pain conditions: A scoping review

Thomas Gabriel Patterson; Paula Beckenkamp; Manuela Ferreira; Justin Turner; Danijela Gnjidic; Yanyu Chen; Carlos Ivan Mesa Castrillion; Paulo Ferreira

doi:10.1016/j.sapharm.2021.11.008

Deprescribing paracetamol in pain conditions: A scoping review

Res Social Adm Pharm. 2022 Aug;18(8):3272-3283. doi: 10.1016/j.sapharm.2021.11.008. Epub 2021 Nov 23.

Authors

Thomas Gabriel Patterson¹, Paula Beckenkamp², Manuela Ferreira³, Justin Turner⁴, Danijela Gnjidic⁵, Yanyu Chen⁶, Carlos Ivan Mesa Castrillion⁷, Paulo Ferreira⁸

Affiliations

¹ Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. Electronic address: tpat9766@uni.sydney.edu.au.
² Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. Electronic address: paula.beckenkamp@sydney.edu.au.
³ Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. Electronic address: manuela.ferreira@sydney.edu.au.
⁴ Faculty of Pharmacy, University of Montreal, Quebec, Canada. Electronic address: justin.turner@umontreal.ca.
⁵ Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. Electronic address: ana.sallesdosreis@sydney.edu.au.
⁶ Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. Electronic address: yche2845@uni.sydney.edu.au.
⁷ Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. Electronic address: cmes2692@uni.sydney.edu.au.
⁸ Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. Electronic address: paulo.ferreira@sydney.edu.au.

PMID: 34911668
DOI: 10.1016/j.sapharm.2021.11.008

Abstract

Objective: To examine evidence on deprescribing paracetamol in pain conditions and inform future strategies for paracetamol deprescription.

Design: Scoping review.

Participants: Adults with pain conditions, taking paracetamol.

Results: After two independent teams of reviewers screening for titles, abstracts, and then full texts, 16 original articles were included. Deprescribing strategies were grouped into 5 categories: (1) Pharmacological, (2) Psychological, (3) Physiological, (4) Policy, and (5) Combination. We found strategies were predominately consumer-focused, conducted in community settings and involved individuals experiencing musculoskeletal pain (such as low back pain and osteoarthritis). A total of twelve studies investigated interventions targeting dose reduction and four studies examined interventions focusing on discontinuation of paracetamol. The most common strategies used to deprescribe paracetamol in pain conditions were physiological strategies, followed by psychological strategies. All included studies demonstrated some level of effectiveness to deprescribe paracetamol in a pain conditions through dose reduction or discontinuation, although the effectiveness of deprescribing strategies were highly variable, ranging from the majority of participants discontinuing their paracetamol use, to less than 10% reducing their paracetamol use upon the latest follow-up.

Conclusions: There are clear opportunities for prospective trials to be designed more purposely and primarily focused to influence reduction and cessation of paracetamol for specific pain conditions where deprescription is appropriate.

Keywords: Deprescribing; Medication; Pain; Paracetamol; Scoping review.

Publication types

Review

MeSH terms

Acetaminophen* / therapeutic use
Adult
Deprescriptions*
Humans
Pain / drug therapy
Prospective Studies

Substances

Acetaminophen