Acetaminophen (Paracetamol) No Better than Than Placebo For Back Pain

MedicalResearch.com Interview with:
R Chris Williams PhD
Honorary Fellow, Musculoskeletal Division
The George Institute for Global Health
Sydney NSW 2000 Australia

Medical Research: What are the main findings of the study?

Dr. Williams: We found that in addition to advice and reassurance, ‘regular’ or ‘as needed’ paracetamol did not improve recovery time for people with low back pain, compared to placebo. We also found the pain intensity and a range of other relevant measures, such as patient’s physical function was not different between the treatment groups.


Medical Research: Were any of the findings unexpected?

Dr. Williams: We thought that patients needed to take paracetamol regularly to benefit from it; and that the common infrequent dosing would be ineffective. So we were very surprised that both methods of taking paracetamol were ineffective.

Medical Research: What should clinicians and patients take away from your report?

Dr. Williams: Our findings show that the emphasis should be on reassurance and advice to remain active and we should consider downgrading the contribution of pain relief medicines in helping people manage their acute low back pain. If people haven’t started treatment and are making a decision on what to do with their low back pain now, our study shows that paracetamol will not help them recover quicker or dull their pain, so there is no justification to recommend it to them. However, if people are currently taking paracetamol for acute low back pain and they feel that it is helping them, we would recommend that they continue the treatment.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Williams: Most participants in our study completely recovered by just over two weeks, despite no effect of the paracetamol. This is much faster than other studies suggest and points to the need for patients to be encouraged to stay active, avoid bed rest and to be reassured that they are likely to have a favourable recovery. While guidelines do recommended this, we know from research that patients often miss out on this aspect of care. And it may be that this is the most important part of helping patients with low back pain. So, we think future studies and guidelines could focus on how best to communicate these key messages to patients.

Another area of research relates to the mechanisms of low back pain as these are not well understood. For instance, while we have shown that paracetamol does not speed recovery from acute back pain, there is evidence that paracetamol works to relieve pain for a range of conditions, such as headaches, some acute musculoskeletal conditions, tooth ache and for pain straight after surgery. This is likely to mean the mechanisms of back pain are different from other pain conditions, and this is an area that we need to study more.

Citation:

Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial

Christopher M Williams, Christopher G Maher, Jane Latimer, Andrew J McLachlan, Mark J Hancock, Richard O Day, Chung-Wei Christine Lin

www.thelancet.com
Published online July 24, 2014 http://dx.doi.org/10.1016/S0140-6736(14)60805-9