Acetaminophen and Paracetamol: Same Drug, Different Names
Yes, acetaminophen and paracetamol are exactly the same medication—acetaminophen is the name used in the United States and Canada, while paracetamol is used in most other countries including the UK, Europe, and Australia. 1
For Your 60-Year-Old Male Patient with Sciatica
Acetaminophen (paracetamol) is NOT a safer alternative to naproxen for sciatica—in fact, morphine and acetaminophen both provide pain relief for sciatica, but morphine is superior to acetaminophen, and there is insufficient evidence that acetaminophen alone provides adequate relief for sciatica pain. 2
Evidence-Based Treatment Algorithm for Sciatica in This Patient
First-line approach:
- Start with naproxen 500 mg twice daily for up to 10 days, as this is the NSAID specifically being studied in placebo-controlled trials for sciatica and has established efficacy for nerve root pain 3
- Acetaminophen can be used as rescue medication if naproxen provides insufficient relief 3
Key safety considerations for naproxen in a 60-year-old male:
- Assess cardiovascular risk factors (history of MI, stroke, hypertension) before prescribing, as NSAIDs including naproxen are associated with increased myocardial infarction risk 1
- Evaluate gastrointestinal risk factors (history of peptic ulcer disease, concurrent corticosteroid use) as these increase risk of upper GI bleeding and perforation 1
- Check renal function, as naproxen is substantially excreted by the kidney and elderly patients have higher risk of NSAID-induced renal toxicity 4
- Consider co-administration with a proton-pump inhibitor if GI risk factors are present 1
Why Acetaminophen Alone Is Insufficient for Sciatica
The evidence clearly demonstrates acetaminophen's limitations:
- In a randomized controlled trial of 300 sciatica patients, acetaminophen (1g IV) provided significantly less pain relief than morphine at 30 minutes, with a difference of 25 mm on the visual analog scale 2
- 18% of acetaminophen patients required rescue medication (fentanyl) compared to only 6% in the morphine group 2
- Most international guidelines recommend NSAIDs for sciatica pain relief, not acetaminophen as first-line therapy 5
When Acetaminophen IS Appropriate as First-Line
Acetaminophen up to 4,000 mg/day should be first-line only if:
- The patient has contraindications to NSAIDs (active peptic ulcer disease, severe renal insufficiency with GFR <30, recent MI or stroke, uncontrolled hypertension) 1, 6
- The pain is mild and non-neuropathic in nature 1
Alternative Considerations for Sciatica
If NSAIDs are contraindicated or ineffective:
- Consider gabapentin starting at 300 mg once daily, titrated up to 900 mg three times daily, as it has demonstrated efficacy for sciatica pain and addresses the neuropathic component 7
- Opioid analgesics (morphine, tramadol) are options for severe, disabling pain not controlled by acetaminophen and NSAIDs, but should be used judiciously with time-limited courses 1
Critical Pitfall to Avoid
Do not assume acetaminophen and NSAIDs have equivalent efficacy for sciatica—while acetaminophen is comparable to NSAIDs for osteoarthritis and non-specific low back pain 1, sciatica involves nerve root inflammation and neuropathic pain mechanisms that respond better to NSAIDs and neuropathic pain medications 7, 2. The American College of Physicians guidelines recommending acetaminophen as first-line apply to non-specific low back pain, not sciatica specifically 1.