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For Low-Back Pain, Acetaminophen is No Better Than Placebo

Despite being widely recommended as a first-line intervention in low-back pain, acetaminophen does no better than placebo, according to a Lancet study.

Some 1650 patients with acute low back pain at 235 primary care practices in Sydney, Australia, were randomized to receive up to 4 weeks' treatment with daily paracetamol (acetaminophen; 4000 mg/day); as-needed paracetamol (up to 4000 mg/day); or placebo. All groups received advice to remain active and reassurance that the prognosis was good.

By 3 months' follow-up, roughly 85% of patients in each group had achieved sustained recovery. The time from starting therapy to recovery (the primary outcome) was nearly identical for all three groups — about 17 days. In addition, the groups did not differ in pain or function at any point during follow-up.

Commentators write: "If patients do make the decision to take paracetamol for their back pain, they might be advised to monitor closely if they indeed experience sufficient pain relief. If not, they could decide to stop taking analgesics or try an NSAID."

Source: NEJM Journal Watch, By Joe Elia