New research from Australia has found that paracetamol (acetaminophen) doesn’t work when it comes to reducing pain, disability or improving quality of life for patients with low back pain or osteoarthritis of the hip or knee. This study, a review of 13 randomized controlled trials, also found that acetaminophen may cause problems for the liver.
Avoid Acetaminophen? New Study Questions Effectiveness, Safety
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According to the study, just published in the British Medical Journal, paracetamol is no better at treating low back pain than a placebo. Lead author, Gustavo Machado—of The George Institute and the University of Sydney—says the results of this systematic review provide cause to review guidelines that endorse paracetamol for back pain and osteoarthritis.
“Use of paracetamol for low back pain and osteoarthritis was also shown to be associated with higher risk of liver toxicity in patients, ” said Machado in the March 31, 2015 news release. “Patients were nearly four times more likely to have abnormal results on liver function tests compared to those taking placebo pills.”
Senior author Associate Professor Manuela Ferreira of the George Institute for Global Health and the University of Sydney said, “…For example, last year The George Institute showed that paracetamol does not speed recovery or reduce pain for acute low back pain.” “This latest research, the most comprehensive systematic review of its kind, reaffirms this with an even larger, global patient base, and has for the first time also established that the effects of paracetamol for knee and hip osteoarthritis are too small to be of clinical importance.”
Machado told OTW, “Low back pain and lower limb osteoarthritis are the major causes of disability worldwide and paracetamol is commonly prescribed for these conditions. In addition, paracetamol is the most used over-the-counter medication to treat back pain and osteoarthritis. Our study revealed that paracetamol is ineffective for patients with low back pain and only provides small benefits for osteoarthritis in terms of pain reduction and improvement of function. These results were quite surprising considering that clinical guidelines often recommend paracetamol as the first line analgesic medication based on the view that it is a safe, effective and a cheap medicine.”
“We believe that our results provide a strong argument to reconsider the endorsement of paracetamol in clinical guidelines of back pain and osteoarthritis. Future research therefore should focus on the effects of this medication in other disabling conditions.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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