Research shows paracetamol doesn't work for neck and back pain

Lars Veldwijk of Utrecht holds his back in pain during the Eredivisie match between FC Utrecht and SC Excelsior Rotterdam at Stadion Galenwaard Utrecht, Netherlands. Dean Mouhtaropoulos/Getty Images

Paracetamol doesn’t work for neck and back pain and has only negligible benefits for sufferers of osteoarthritis, according to an Australian study published in The BMJ today.

Current clinical guidelines recommend the use of paracetamol first for sufferers of lower back pain.

However, researchers say evidence supporting this is weak and there are possible dangers taking the full dosage of 4000 milligrams a day.

Spinal pain, which includes neck and lower back pain, and osteoarthritis, the most common form of arthritis, are leading causes of disability worldwide.

A recent move by the National Institute for Health and Care Excellence (NICE) to continue to recommend paracetamol for osteoarthritis was considered controversial.

Lead author Gustavo Machado from the George Institute for Global Health at the University of Sydney investigated the effectiveness and safety of paracetamol for lower back pain and osteoarthritis of the hip or knee.

The study included 13 randomised controlled studies: 10 trials included 3,541 patients and evaluated the use of paracetamol for osteoarthritis of the hip or knee, and three trials included 1,825 patients for lower back pain.

For lower back pain, paracetamol had no effect in the study and did not reduce disability or improve quality of life compared with a placebo.

For osteoarthritis, the researchers found small but not clinically important benefits in the reduction of pain and disability.

Paracetamol use for osteoarthritis was also shown to increase the likelihood of having abnormal results on liver function tests by almost four times.

The researchers say “these results support the reconsideration of recommendations to use paracetamol for patients with low back pain and osteoarthritis of the hip or knee”.

In a linked editorial, Christian Mallen and Elaine Hay from Keele University write that this latest study re-opens the debate on the effectiveness and safety of paracetamol.

They say that taking paracetamol off existing guidelines will lead to an increase in the use other prescribed drugs, such as opioids, with new associated health problems.

They call for the use of safe and effective alternative treatments, especially non-drug options such as exercise.

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