Paracetamol no better than placebo for lower back pain

July 24, 2014, Lancet

Paracetamol is no better than placebo at speeding recovery from acute episodes of lower back pain or improving pain levels, function, sleep, or quality of life, according to the first large randomised trial to compare the effectiveness of paracetamol with placebo for low-back pain. The findings, published in The Lancet, question the universal endorsement of paracetamol as the first choice painkiller for low-back pain, say the authors.

Low-back is the leading cause of disability worldwide. National clinical guidelines universally recommend as the first choice analgesic for acute low-back pain, despite the fact that no previous studies have provided robust evidence that it is effective in people with low-back pain.

The Paracetamol for Low-Back Pain Study (PACE) randomly assigned 1652 individuals (average age 45 years) with acute low-back pain from 235 primary care centres in Sydney, Australia to receive up to 4 weeks of paracetamol in regular doses (three times a day; equivalent to 3990 mg per day), paracetamol as needed (maximum 4000 mg per day), or placebo. All participants received advice and reassurance and were followed-up for 3 months.

No differences in the number of days to recovery were found between the treatment groups—median time to recovery was 17 days in the regular paracetamol group, 17 days in the as-needed paracetamol group, and 16 days in the placebo group. Paracetamol also had no effect on short-term pain levels, disability, function, sleep quality, or quality of life. The number of participants reporting adverse events was similar between the groups.

"Simple analgesics such as paracetamol might not be of primary importance in the management of acute ", said lead author Dr Christopher Williams from the George Institute for Global Health at the University of Sydney in Australia. "The results suggest we need to reconsider the universal recommendation to provide paracetamol as a first-line treatment for low-back pain, although understanding why paracetamol works for other pain states but not low-back pain would help direct future treatments."

He adds, "In view of the quick timeframe in which participants in our trial improved compared with other cohorts, it would be interesting to see whether advice and reassurance (as provided in our trial) might be a more effective than pharmacological strategies for of low-back pain."

Writing in a linked Comment, Bart Koes and Wendy Enthoven from Erasmus MC, University Medical Center in Rotterdam, Netherlands say, "Williams and colleagues are to be applauded for tackling this research question on a topic that has been without debate and evidence for such a long time…Although the findings from this high-quality trial are clear, the content of guidelines should not be changed on the basis of a single trial; more robust and consistent evidence, including verification of the results in other populations, is needed…Furthermore, efforts to establish if prescription of other simple analgesics has additional benefit to advice and reassurance of the favourable prognosis for acute low-back pain are very welcome."

Explore further: Low back pain? Don't blame the weather

Related Stories

Low back pain? Don't blame the weather

July 10, 2014
Australian researchers reveal that sudden, acute episodes of low back pain are not linked to weather conditions such as temperature, humidity, air pressure, wind direction and precipitation. Findings published in Arthritis ...

Stopping liver failure from painkiller overdose

February 3, 2014
(Medical Xpress)—University of Adelaide researchers have identified a key step for the future prevention of liver failure resulting from taking too much of the everyday painkiller paracetamol (also known as acetaminophen).

Ibuprofen no good in treating colds or sore throats

November 4, 2013
Questions have been raised about the advice given to patients with a cold and sore throat, in research published in the British Medical Journal.

Back pain improves in first six weeks but lingering effects at one year

May 14, 2012
For people receiving health care for acute and persistent low-back pain, symptoms will improve significantly in the first six weeks, but pain and disability may linger even after one year, states a large study published in ...

Paracetamol improves exercise endurance in the heat

September 19, 2013
Paracetamol has a significant effect on exercise performance and the body's ability to cope with the thermal challenge of exercise in the heat, shows a study published today [20 September] in Experimental Physiology.

Recommended for you

Get a grip: What your hand strength says about your marriage prospects and mortality

April 26, 2018
Researchers at Columbia University's Mailman School of Public Health and the Columbia Aging Center found men with a stronger grip were more likely to be married than men with weaker grips. Grip strength was not a factor in ...

Community efforts to prevent teen problems have lasting benefits

April 26, 2018
Want to prevent kids from using drugs and make it stick into young adulthood? Get the community involved and intervene before they're teens, say researchers from the University of Washington.

Taxing sweet snacks may bring greater health benefits than taxing sugar-sweetened drinks

April 26, 2018
Taxing sweet snacks could lead to broader reductions in the amount of sugar purchased than similar increases in the price of sugar-sweetened beverages (SSBs), according to new research published in BMJ Open.

Hearing aids linked to fewer hospital and ER visits by older adults

April 26, 2018
They cost thousands of dollars, and insurance almost never covers them. But hearing aids may hold the potential to cut older adults' visits to the hospital or emergency room, according to a new study.

Consuming protein supplements with meals may work better for weight control

April 25, 2018
A new systematic review of available evidence appearing in Nutrition Reviews indicates that consuming protein supplements with meals may be more effective at promoting weight control than consuming supplements between meals ...

Hair products for Black women contain mix of hazardous ingredients

April 25, 2018
A new report published today in the journal Environmental Research shows that Black women are potentially exposed to dozens of hazardous chemicals through the hair products they use.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.