Analgesic medication is the most frequently prescribed treatment for low back pain (LBP), of which paracetamol (acetaminophen) is recommended as the first choice medication.
Paracetamol is
most commonly used pain reliever and fever reducer. As per this article, for
acute low-back pain, regular paracetamol is recommended as the first-line
analgesic, but no high-quality evidence supports this recommendation.
Analgesic
medication is the most frequently prescribed treatment for low back pain (LBP),
of whichs paracetamol (acetaminophen) is recommended as the first choice
medication. However, there is uncertainty about the efficacy of paracetamol for
LBP. To investigate the efficacy and safety of paracetamol for non-specific
LBP.
We conducted
searches on the Cochrane Central Register of Controlled Trials (CENTRAL, which
includes the Back and Neck Review Group trials register), MEDLINE, EMBASE,
CINAHL, AMED, Web of Science, LILACS, and IPA from their inception to 7 August
2015. We also searched the reference lists of eligible papers and trial
registry websites (WHO ICTRP and ClinicalTrials.gov). We only considered randomised
trials comparing the efficacy of paracetamol with placebo for non-specific LBP.
The primary outcomes were pain and disability. We also investigated quality of
life, function, adverse effects, global impression of recovery, sleep quality,
patient adherence, and use of rescue medication as secondary outcomes. Two
review authors independently performed the data extraction and assessed risk of
bias in the included studies. We also evaluated the quality of evidence using
the GRADE approach. We converted scales for pain intensity to a common 0 to 100
scale. We quantified treatment effects using mean difference for continuous
outcomes and risk ratios for dichotomous outcomes. We used effect sizes and 95%
confidence intervals as a measure of treatment effect for the primary outcomes.
When the treatment effects were smaller than 9 points on a 0 to 100 scale, we
considered the effect as small and not clinically important.
Our searches
retrieved 4449 records, of which three trials were included in the review
(n=1825 participants), and two trials were included in the meta-analysis. For
acute LBP, there is high-quality evidence for no difference between paracetamol
(4 g per day) and placebo at 1 week (immediate term), 2 weeks, 4 weeks, and 12
weeks (short term) for the primary outcomes. There is high-quality evidence
that paracetamol has no effect on quality of life, function, global impression
of recovery, and sleep quality for all included time periods. There were also
no significant differences between paracetamol and placebo for adverse events,
patient adherence, or use of rescue medication. For chronic LBP, there is very
low-quality evidence (based on a trial that has been retracted) for no effect
of paracetamol (1 g single intravenous dose) on immediate pain reduction.
Finally, no trials were identified evaluating patients with subacute LBP.
We found that
paracetamol does not produce better outcomes than placebo for people with acute
LBP, and it is uncertain if it has any effect on chronic LBP.
Cochrane Database of Systemic Reviews
Paracetamol for low back pain
Bruno T Saragiotto et al.
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