Article Recommended by Dr. Rachael Duncan: Model-Based Meta-Analysis Supporting the Combination of Acetaminophen and Topical Diclofenac in Acute Pain: A Therapy for Mild-to-Moderate Osteoarthritis Pain?

 A recent meta-analysis published in Pain and Therapy found that treating acute pain with tylenol and topical diclofenac may result in better pain control than tylenol alone in addition to having a more pronounced opioid sparing effect. A total of 11 RCT’s and 1396 patients were included in the meta-analysis. Of note, 10 of these studies were in the post-op period, where only 1 study investigated acute musculoskeletal pain. Analysis of this data indicated that there were greater pain score reductions in patients who received tylenol and topical diclofenac versus tylenol monotherapy. Noting that the statistical significance of the data was susceptible to confounders, the researchers conducted a robust statistical analysis of 5 of the RCTs (353 patients) to analyze the difference in opioid PCA pump use in patients receiving tylenol and topical diclofenac versus tylenol or diclofenac alone. 

Opioid-sparing effect was most pronounced in those receiving tylenol and diclofenac. Future RCTs should analyze this directly to further investigate this effect. 

Key Takeaway: 

Tylenol paired with a topical NSAID such as diclofenac  may be a more effective way to manage MSK pain and post-operative pain than tylenol alone. Furthermore, this combination might have a greater opioid sparing effect compared to tylenol alone. Future research should investigate this via RCT.

https://link.springer.com/article/10.1007/s40122-023-00569-z#change-history