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Does paracetamol ease back pain?

Wednesday April 1st, 2015

Paracetamol is not as effective as previously thought for spinal pain, researchers say today.

The findings apply to neck and lower back pain, and osteoarthritis.

Low back and neck pain (spinal pain) are leading causes of disability worldwide, and osteoarthritis of the hip or knee is the 11th highest contributor to global disability, say Gustavo Machado of the University of Sydney, Australia, and colleagues.

Guidelines consistently recommend the use of paracetamol as the first line painkiller for these conditions. But this guidance has been questioned by the UK National Institute for Health and Care Excellence, as paracetamol does not consistently outperform placebo. Furthermore, there are some concerns over the safety of the full recommended dose.

The team investigated further by analysing 13 randomised controlled trials comparing paracetamol against placebo for spinal pain and osteoarthritis of the hip or knee. This showed "high quality evidence that paracetamol is ineffective for reducing pain intensity and disability for people with low back pain". It is also ineffective at improving their quality of life, the team state. For osteoarthritis paracetamol appeared to provide a "significant, although not clinically important, effect on pain and disability".

In terms of adverse events, paracetamol was not significantly more risky than placebo, but it carried nearly four times the risk of abnormal results on liver function tests. The clinical importance of this effect is uncertain, the team write in The BMJ.

They conclude: "Paracetamol is ineffective in the treatment of low back pain and provides minimal short term benefit for people with osteoarthritis. These results support the reconsideration of recommendations to use paracetamol for patients with low back pain and osteoarthritis of the hip or knee in clinical practice guidelines."

Machado, G. C. et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta analysis of randomised placebo controlled trials. BMJ 1 April 2015 doi: 10.1136/bmj.h1225 [abstract]

Tags: Australia | Brain & Neurology | Pain Relief | Pharmaceuticals

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