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 A study published in The Lancet medical journal found that the
popular pain medicine was no better than placebo, or dummy, pills
for hastening recovery from acute bouts of low back pain or easing
pain levels, function, sleep or quality of life.
Researchers said the findings challenge the universal endorsement of
paracetamol as the first choice painkiller for lower back pain.
"We need to reconsider the universal recommendation to provide
paracetamol as a first-line treatment," said Christopher Williams,
who led the study at the University of Sydney in Australia.
Lower back pain is the leading cause of disability worldwide. In the
United States alone, costs relating to the condition are estimated
to be more than $100 billion a year.
Currently, every back pain treatment guideline in the world
recommends paracetamol as the first-line analgesic and Williams said
this was despite the fact that no previous studies have provided
robust evidence that it works in this condition.
Tim Salomons, a pain expert at Britain's University of Reading whose
own research has found that cognitive behavioral therapy could be
used to treat chronic pain, said this latest study showed the
challenge of treating the condition.
"It is vitally important we continuously challenge conventional
wisdom about treating pain," he said in an emailed comment. "Even
though paracetamol has a good safety profile, every drug has side
effects. If the drug is not doing what it is being prescribed to do,
pain patients might be better off without."
In Williams' trial, 1,652 people from Sydney with acute low back
pain were randomly assigned to receive up to four weeks of
paracetamol, either in regular doses three times a day, or as
needed, or to receive placebos. All those involved received advice
and reassurance and were followed up for three months.
The results showed no difference in the number of days to recovery
between the treatment groups - with the average time to recovery
coming out at 17 days for each of the groups given paracetamol, and
at 16 days for the placebo group.
Paracetamol had no effect on short-term pain levels, disability,
function, sleep quality, or quality of life, the researchers said,
and the number of patients reporting negative side effects was
similar in all groups.
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Christine Lin, an associate professor at the George Institute for
Global Health and the University of Sydney who also worked on the
study, said the reasons for paracetamol failing to work for lower
back pain were not well understood.
"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 other conditions, such as headaches, some acute
musculoskeletal conditions, tooth ache and for pain straight after
surgery," she said in a statement about the findings.
"What this study indicates is that the mechanisms of back pain are
likely to be different from other pain conditions, and this is an
area that we need to study more."
Experts who were not directly involved praised the study but
cautioned that guidelines should nevertheless not be changed on the
basis of a single piece of research.
"More robust and consistent evidence, including verification of the
results in other populations, is needed," Bart Koes and Wendy
Enthoven from the Erasmus Medical Centre in the Netherlands wrote in
a Lancet commentary.
They also called for more studies on whether other simple analgesics
could add extra benefits on top of giving advice and reassurance to
patients.
(Editing by Robin Pomeroy and Catherine Evans)
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