Paracetamol is a universally recommended painkiller for people with lower back pain, the number one global cause of disability. Every treatment plan recommends using paracetamol as the first line of defense against pain. In the US, acetaminophen is its equivalent.
A large trial conducted in Australia shows that the drug is virtually a placebo when it comes to back pain. In other words, that bottle of Tylenol painkillers in the cupboard that is used for lower back pain might not be working at all.
Researchers at the University of Sydney led by Christopher Williams conducted the trial, which looked at 1,652 people with acute low back pain. The participants were split into two groups: one group received regular doses of paracetamol three times a day or as recommended for their level of pain, and the other group received placebos. The experiment was done over four weeks and researchers followed up with the participants for three months after the treatments.
Williams and colleagues found no difference in the amount of time needed for recovery-the paracetamol group averaged at 17 days and the placebo group averaged at 16 days.
Participants reported no effects by paracetamol on short-term pain, disability, function, sleep or quality of life. The negative side effects reported were similar between the paracetamol and placebo groups.
As per Christine Lin, an associate professor at the University of Sydney who was involved in the study, the reasons for the failure of paracetamol/acetaminophen to relieve pain in the lower back are not known. Williams adds that there is a possibility that paracetamol and other simple analgesics don't affect back pain, specifically, because such pain operates differently and with different mechanisms.
"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," Lin said.
Williams says he is interested in the possibility that reassurance and counsel might aid those with lower back pain more than paracetamol and other painkillers. The study provided advice and reassurance to both paracetamol and placebo participants in an attempt to measure such effects. Williams' study, however, was too short to test the effectiveness of verbal comfort as a replacement for pharmacological treatments.
Other scientists responding to the study, which was published in The Lancet, commended Williams and his colleagues for studying what no one had studied before and asking the question of whether a universally recommended drug is actually effective. As the leading cause of disability in the world, lower back pain deserves a proper treatment to alleviate symptoms.
