Role of Acetaminophen in Chronic Pain Management: Benefits, Risks, and Considerations

Author(s): Ofelia Loani Elvir-Lazo, Zufan Woldemariam, Alicia L. Romero-Navarro, Roya Yumul, Paul F. White

Chronic pain affects 20-25% of the global population, significantly impacts quality of life and socioeconomic productivity, placing a substantial burden on healthcare systems worldwide, particularly in lowand middle-income countries, and disproportionately affecting vulnerable populations, including older adults and cancer patients. Acetaminophen, a commonly used analgesic and crucial non-opioid alternative in chronic pain management, is frequently a first-line treatment for mild-to-moderate pain (including musculoskeletal pain, osteoarthritis, and headaches) and is often used with opioids for more severe pain. It modulates the central nervous system, primarily by inhibiting COX-2 enzymes to reduce prostaglandin production and pain signaling. In cancer-related pain and palliative care, it serves as an essential adjunct to more potent analgesics, reducing opioid consumption and side effects. As a key component of multimodal pain management, it enhances other medications' analgesic effects and minimizes their side effects. Future research should investigate acetaminophen's long-term effectiveness in more diverse populations (including the elderly and those with complex medication regimens), and its optimal role in multimodal analgesia and opioid-sparing strategies, particularly for cancer-related pain.