Regularly Scheduled Acetaminophen for Pain in Long-Term Care: Systematic Review and Meta-Analysis

J Am Med Dir Assoc. 2026 Oct 7;27(11):106432. doi: 10.1016/j.jamda.2026.106432. Online ahead of print.

ABSTRACT

OBJECTIVE: Pain is common among long-term care (LTC) residents, and acetaminophen is often recommended as first-line therapy. We aimed to determine whether regularly scheduled acetaminophen, compared with any comparator, improves pain outcomes in LTC.

DESIGN: Systematic review and meta-analysis.

SETTING AND PARTICIPANTS: Residents in LTC METHODS: MEDLINE, EMBASE, CINAHL, and Scopus were searched from inception to June 9, 2026. Risk of bias (RoB) was assessed using the Cochrane RoB1 tool. The primary outcome was pain, with secondary outcomes including quality of life and adverse events. Pain outcomes were pooled using standardized mean differences with inverse-variance weighting and a random-effects model. The certainty of evidence was evaluated using GRADE (Grading of Recommendations, Assessment, development and evaluation).

RESULTS: Four randomized controlled trials conducted in the United States and Europe met inclusion criteria, enrolling 482 LTC residents with mild-to-moderate pain at baseline and moderate-to-severe dementia. Acetaminophen was administered 3 to 4 times daily at total daily doses of 2500 to 3000 mg, with follow-up ranging from 4 to 13 weeks. Comparators included placebo (n = 3) and usual care (n = 1). Pain was assessed using MOBID-2 (Mobilization-Observation-Behavior-Intensity-Dementia-2 Pain Scale) and DS-DAT (Discomfort Scale-Dementia of the Alzheimer's Type) scales. Overall RoB was low, with the main concerns related to incomplete reporting of study methods and outcomes. There was no statistically significant reduction in pain with regularly scheduled acetaminophen compared with placebo or usual care (standardized mean difference, -0.14; 95% CI, -0.39 to 0.11; I² = 6%; moderate-certainty evidence). One study evaluated quality of life and found no statistically significant differences between groups. Adverse event reporting was limited and inconsistent among studies.

CONCLUSIONS AND IMPLICATIONS: Regularly scheduled acetaminophen probably does not improve pain in LTC residents with moderate-to-severe dementia and mild-to-moderate pain. These findings suggest that regularly scheduled acetaminophen for pain management in LTC may need to be reconsidered.

PMID:42843009 | DOI:10.1016/j.jamda.2026.106432