Paracetamoli has no effect for back pain

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

The clinical guidelines recommend Paracetamol as the first line treatment for both disorders, but the evidence to support this recommendation is weak and contradictory and has security concerns with the recommended dose (up to 4,000 mg/day).

For these reasons the recent action of National Institute for Health and Care Excellence (NICE) to continue with the recommendation of the Paracetamoli for osteoarter is considered controversial.

The lead author Gustavo Machado of The George Institute for Global Health at Sydney University conducted a systematic revision and metanalysis to examine the efficiency and safety of the Paracetamol for lower back pain and hip osteoarthritis or knee.

The study included 13 random studies that looked at the effects of precetamol use compared to placebon: 10 evidence included 3.541 patients and assessed the use of precetamol for hip or knee osteoarter, and 3 included 1,825 patients on the use of precetamol for lower back pain.

The following results were analyzed: reducing the intensity of the pain and improving limited capacity and quality of life, as well as the patient's safety and conveyance.

The study showed that for lower back pain, paracetamol had no effect and did not reduce its limited ability or improve the quality of life compared with the use of placebo. For osteoarter, they found small, but not clinically important benefits in reducing pain and disability compared to using placebo.

Precetamol use for osteoarter has also been shown to increase the likelihood of having abnormal results in liver function tests for almost four times compared to placebo, but the clinical survey of this is not yet safe, the authors explain.

The negative side effects varied through all the evidence, but no differences have been found in terms of the number of patients using paracetamol and reporting that these have been withdrawn from studies due to negative events compared to those used by placebo.

Similarly, conveying treatment standards was similar among those who received paracetamols compared with those with placebo.

The evidence appreciated the use of paracetamoli and placebos in the short term, with the longest re-evaluation of six months, so more research is needed to determine the effects over a longer period of time.

However, the authors conclude that “these results support reviewing recommendations to use paracetamol for lower back pain patients and hip or knee osteoporosis in clinical practice guidelines. ”

In an editorial, Christian Maglen and Elaine Hay from Keele University write that this latest study of “popularized debate” on the effectiveness and safety of the Paracetamol.

They explain that if the paracetamoli is taken without existing guidelines it would lead to an increase in the use of other envisioned drugs, such as opioids, and this would present new health-related problems.

Instead, they call for the use of safe and effective alternative treatments, especially non-drug options such as exercise, which have clear benefits in controlling spinal and osteoarthritis. /Telegraphy/