For Low-Back Pain, Acetaminophen Is No Better than Placebo — Physician’s First Watch

Medical News |
July 24, 2014

For Low-Back Pain, Acetaminophen Is No Better than Placebo

By Joe Elia

Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, FASAM

Despite being widely recommended as a first-line intervention in low-back pain, acetaminophen does no better than placebo, according to a Lancet study.

Some 1650 patients with acute low back pain at 235 primary care practices in Sydney, Australia, were randomized to receive up to 4 weeks' treatment with daily paracetamol (acetaminophen; 4000 mg/day); as-needed paracetamol (up to 4000 mg/day); or placebo. All groups received advice to remain active and reassurance that the prognosis was good.

By 3 months' follow-up, roughly 85% of patients in each group had achieved sustained recovery. The time from starting therapy to recovery (the primary outcome) was nearly identical for all three groups — about 17 days. In addition, the groups did not differ in pain or function at any point during follow-up.

Commentators write: "If patients do make the decision to take paracetamol for their back pain, they might be advised to monitor closely if they indeed experience sufficient pain relief. If not, they could decide to stop taking analgesics or try an NSAID."

Reader Comments (10)

Eric Physician, Emergency Medicine

I agree. I haven't had successful with paracetamol for low back pain.

Benton DC Physician, Los Angeles

Chiropractic manipulation is one of the best and fastest ways to alleviate back pain - often due to spinal misalignment.

FABER WHITE Physician, Emergency Medicine

It is possible that the real story here isn't the ineffectiveness of acetaminophen, but rather the remarkable effectiveness of placebo?

William DeMedio MD Physician, Family Medicine/General Practice, Office

I have found acetaminophen to be highly useful as an adjunct in treating most types of pain, including low back pain. However, I do not believe there is any medication that can speed functional recovery time.

Functional recovery does not mean pain relief.

JAMES RICHARDSON Physician, Geriatrics, St. Agnes Hospital, Baltimore, Maryland

The headline really should be "85% in each group achieved sustained recovery." Maybe we can educate patients about the prognosis of back pain so that they won't insist on multiple imaging studies.

Leo Offerhaus MD PhD Physician, Pharmacology/Pharmacy, retired

Does not suprise me at all. Paracetamol is ineffective in any form of joint pain, and part of its mechansim of action is central

Eletta A P M D, Physician, Otolaryngology, Fed Med Centre , Bida,Niger State ,Nigeria. West Africa.

Some of the patients with low back pain responded well with proper posturing and lying flat supine on hard surface in addition to short course of acetaminophen ,while small population required specialist referral in the setting where i practice.

David Foster, MD Physician

The headline misstates the result. APAP did not speed healing (no surprise there) but nothing in the study suggested it did not improve comfort DURING healing. The study could have found "oxycodone no better than placebo" since analgesics do not accelerate recovery rates.

Ivan Barros Resident, Geriatrics

I agree.

THOMAS RICHARDSON Physician, Emergency Medicine, HRH

Absolutely what I was thinking.

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