A major piece of research has indicated that Paracetamol is no more effective in the treatment of acute low back pain than a placebo or or simple exercise, either in terms pain relief or recovery time. The study demonstrated being treated with Paracetamol for pain relief gave no evidence of either. These findings fly in the face of general first line advice in the treatment of back pain throughout the world.
It is estimated that some 80% of adults will be affected by back pain, often triggered by bad posture, bending awkwardly or lifting incorrectly. In most cases it gets better within 12 weeks, with sufferers taking pain killers and keeping mobile. In the UK the cost of treating the condition in the NHS alone is over £1000m per annum, the majority of which is chronic lower back pain. In addition It’s estimated that the NHS spent £61m alone in 2011, on Paracetamol issued by GPs
Paracetamol, an analgesic or pain killer, is said to work by blocking the production of prostaglandins, making the body less aware of pain or injury, and is recommended universally as the first line treatment for acute low back pain or sciatica. In the UK it is recommended by NICE in their 2009 guidelines for the early management of non specific low back pain, and is therefore prescribed by most GP’s initially..
This study, conducted between 2009 and 2013 and funded by the National Health and Medical Research Council of Australia and GlaxoSmithKline Australia, was reported in The Lancet this month. The research was carried out by Sydney University on the basis that there was no high level research or evidence to support the use of Paracetamol,with the aim being to establish to effectiveness of Paracetamol, either taken regularly, or as needed to aid recovery from pain, compared with a placebo, in sufferers of low back pain.
The methodology was by randomised control group trial (RCGT), over a four week intervention, comprising 1652 acute back pain sufferers volunteers across primary care centres around Sydney, who were divided into three groups on a 1:1:1 ratio.
The first group were prescribed regular doses of Paracetamol (upto 3900mg per day) for up to four weeks, the second group were instructed to take “as and when” (up to 4000mg per day), with the third group receiving a placebo (sugar pill)
The researchers found little difference in recovery time between the three groups, although surprisingly, the placebo group exhibited an average recovery time of 16 days, a day faster than the other two groups. There was also no discernible indicators that the Paracetamol also had any impact on short-term pain levels, disability, function, sleep quality or quality of life.
Indeed the research suggests advice and reassurance be as beneficial as regular doses of paracetamol for back pain patients.
The study leader Dr Christopher Williams, from Sydney University, suggested that although paracetamol was effective in treating some acute pain such as tooth extraction and post-operative pain, the study findings threw into doubt its role in treating low back pain. ‘Simple analgesics such as paracetamol might not be of primary importance in the management of acute lower back pain” he said. ‘The results suggest we need to reconsider the universal recommendation to provide paracetamol as a first-line treatment for low back pain, although understanding why paracetamol works for other pain states but not low back pain would help direct future treatments.
However, Dutch experts Bart Koes and Wendy Enthoven, from Erasmus University Medical Centre in Rotterdam, also writing in The Lancet, considered it too early to change clinical guidelines. More inclusive trials need to be carried out.