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Paracetamol, ibuprofen, or a combination of both drugs against knee pain: an excellent new randomised clinical trial answers old questions and suggests new therapeutic recommendations
  1. Kay Brune1,
  2. Burkhard Hinz2
  1. 1Department of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
  2. 2Institute of Toxicology and Pharmacology, University of Rostock, Rostock, Germany
  1. Correspondence to Dr Kay Brune, Department of Experimental and Clinical Pharmacology and Toxicology, Friedrich-Alexander-University Erlangen-Nuremberg, Fahrstrasse 17, 91052 Erlangen, Germany; brune{at}

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At first glance, the title of the article published by Doherty et al1 (see page 1534) does not promise much. Who would be interested in reading an investigation comparing two old well-known analgesics with each other or combinations of both? At a second glance, however, this cautious and excellent long-term study reveals many new and important findings which should be the basis for reconsideration of the treatment of musculoskeletal conditions with over-the-counter (OTC) analgesics. It may turn out that many of our widely-held beliefs and assumptions are wrong and that the recommendation for our patients needs to be changed.

Doherty et al investigate whether the combination of ibuprofen and paracetamol is better than the active components alone. To answer this question the authors compared the efficacy and safety of paracetamol and ibuprofen as well as that of two combinations of these drugs in community-derived patients aged >40 years with chronic knee pain. In a randomised, double-blind, four-arm parallel-group active controlled trial, the short-term (day 10) and long-term (week 13) benefits and side effects of four different therapeutic regimens were analysed:

  1. ibuprofen (400 mg three times a day);

  2. paracetamol (1000 mg three times a day);

  3. one fixed-dose combination tablet (ibuprofen 200 mg/paracetamol 500 mg (low-dose) three times a day);

  4. two fixed-dose combination …

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