Paracetamol for low back pain: the state of the research field

ABSTRACT

Introduction

Paracetamol is one of the most frequently used analgesics for people with low back pain, but despite its frequent use there is still debate regarding its efficacy and safety for this indication.

Areas covered

We describe the origin of paracetamol and its proposed mechanisms of action. We focus in on low back pain and describe the evidence it has on the efficacy of paracetamol (taken by patients orally) and current insights on its side-effects. When searching for relevant publications we focused mainly on recent Cochrane reviews and published RCTs. We found that there is increasing evidence that shows paracetamol is not more effective than placebo in patients with acute low back pain. Concerning patients with subacute and chronic back pain, the evidence for or against the efficacy of paracetamol vs placebo is lacking and would need more research.

Expert opinion

We argue that we still need better evidence on the efficacy of paracetamol for acute and chronic back pain. Until that evidence becomes available paracetamol should still be considered as an option for patients with back pain. However, we suggest that a strategy focusing on non-pharmacological management as the first treatment option in low back pain may be equally effective with less side effects.

KEYWORDS:

• Paracetamol
• low back pain
• effect
• review

Article highlights

• Paracetamol is one of the most frequently used analgesic

• The efficacy and safety of paracetamol are still under debate

• There is increasing evidence that paracetamol is not more effective than placebo for people with acute low back pain

• The efficacy of paracetamol for people with subacute or chronic low back pain is unknown

• NSAIDS do not appear to be significantly more effective than paracetamol for people with back pain

• A non-pharmacological treatment strategy as first treatment choice for people with back pain is advised.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer declarations

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.