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The trial by Case et al¹ adds to the limited evidence that is available on the effectiveness of acetaminophen in OA. To our knowledge, this study is only the second randomized controlled trial comparing acetaminophen with placebo and appears to contradict the results of a previous double-blind crossover trial in 25 patients conducted in the early 1980s.² More recent trials compared traditional nonsteroidal anti-inflammatory drugs with acetaminophen, but did not include a placebo arm.³

The results by Case et al¹ need to be put into a clinical perspective. First, P values are of limited help in clinical decision making. Rather, estimates of the magnitude of treatment effects, the uncertainty associated with these estimates, and assessments of how these effects might translate into "real world practice" should be considered.^4-5 The magnitude of observed pain reductions, usually the main objective of symptomatic treatment of OA, may be expressed using effect sizes,⁶ that . . . [Full Text of this Article]

Marcel Zwahlen, PhD; Peter Jüni, MD; Matthias Egger, MD
Berne, Switzerland

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What Now About Acetaminophen?—Reply
John P. Case, Algis Baliunas, and Joel A. Block
Arch Intern Med. 2003;163(15):1863.
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