Scimex: An Australian study has found paracetamol doesn't work in the treatment of neck and back pain and has only negligible benefits for sufferers of osteoarthritis. Current clinical guidelines recommend the use of paracetamol first for sufferers of lower back pain, but any evidence supporting this is weak, along with the possible dangers of taking the full dosage of 4000 milligrams a day, the authors say.
Paracetamol is not effective in the treatment of spinal pain and provides negligible benefits for osteoarthritis.
pain, which includes neck and lower back pain, and osteoarthritis, the
most common form of arthritis, are leading causes of disability
Clinical guidelines recommend paracetamol as the first
line drug treatment for both conditions, but the evidence to support
this recommendation is weak and inconsistent and there are safety
concerns with the recommended full dosage (up to 4000 mg/day).
these reasons, the recent move by the National Institute for Health and
Care Excellence (NICE) to continue to recommend paracetamol for
osteoarthritis has been considered controversial.
Gustavo Machado from The George Institute for Global Health at the
University of Sydney carried out a systematic review and meta-analysis
to examine the efficacy and safety of paracetamol for lower back pain
and osteoarthritis of the hip or knee.
The study included 13
randomised controlled studies that looked at the effects of paracetamol
use compared with a placebo: 10 trials included 3,541 patients and
evaluated the use of paracetamol for osteoarthritis of the hip or knee,
and 3 trials included 1,825 patients on the use of paracetamol for lower
The following outcomes were analysed: reduction of
pain intensity and improvement of disability and quality of life as well
as safety and patient adherence.
The study showed that for lower
back pain, paracetamol had no effect and did not reduce disability or
improve quality of life compared with the use of a placebo. For
osteoarthritis, they found small, but not clinically important benefits
in the reduction of pain and disability compared with the use of a
Paracetamol use for osteoarthritis was also shown to
increase the likelihood of having abnormal results on liver function
tests by almost four times compared with a placebo, but the clinical
relevance of this is still not certain, explain the authors.
side effects varied across all of the trials, but no differences were
found in terms of the number of patients using paracetamol reporting
these or being withdrawn from studies due to adverse events compared to
those using a placebo.
Similarly, adherence to treatment schedule
rates were similar between those taking paracetamol compared with those
using a placebo.
The trials evaluated paracetamol and placebo
usage in the short term, with the longest follow-up being 6 months so
more research is needed to determine effects over a longer period of
Nevertheless, the authors conclude that "these results
support the reconsideration of recommendations to use paracetamol for
patients with low back pain and osteoarthritis of the hip or knee in
clinical practice guidelines."
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.
explain that if paracetamol is taken off existing guidelines this will
lead to an increase in the use other prescribed drugs, such as, opioids,
and this will present new associated health problems.
they call for the use of safe and effective alternative treatments,
especially non-drug options, such as exercise, which has clear benefits
in the management of spinal pain and osteoarthritis.