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Paracetamol Co-Analgesic Debate — SCE Palliative Medicine MCQ

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EasyPain ManagementParacetamol Co-Analgesic DebateSCE Palliative Medicine

A 74‑year‑old woman with advanced breast cancer and bone metastases is on strong opioids and a bisphosphonate. She asks whether paracetamol is still worth taking. What is the evidence for paracetamol as a co‑analgesic alongside strong opioids in cancer pain?

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Correct answer: B — Evidence is mixed—paracetamol provides modest analgesic contribution in some patients; a pragmatic approach is to trial withdrawal and reinstate only if pain worsens

Explanation lettering: D = shown as A · C = shown as B · B = shown as C · A = shown as D

Systematic review evidence shows no high‑quality support for additional analgesic benefit from paracetamol when added to strong opioids for cancer pain, with very low‑quality studies showing no difference versus placebo. A UK‑relevant trial summary (PARASTOP) similarly notes no demonstrated benefit and explores withdrawal. Therefore, rather than mandating continuation or blanket discontinuation, a pragmatic individual trial of withdrawal with re‑introduction only if pain worsens is most defensible. Option A is too absolute; B overstates by denying any patient‑specific benefit; D is incorrect—no safety hazard; E is incorrect and unsupported.

Reference: PARASTOP trial summary (Health Research Authority) and Wiffen et al., Cochrane review 2017 (oral paracetamol for cancer pain), https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/parastop-paracetamol-with-strong-opioids-in-moderate-to-severe-cancer-pain/