Is it time to reconsider acetaminophen for back pain?

Acetaminophen provided a small benefit in the reduction of pain and disability in patients with osteoarthritis of the hip or knee and provided no benefit in reducing pain in patients with lower back pain.

Is it time to reconsider acetaminophen for back pain?
Is it time to reconsider acetaminophen for back pain?

HealthDay News — Acetaminophen does not appear to help ease lower back pain and offers little relief for the most common form of arthritis, according to a study published in The BMJ.

“Guidelines consistently recommend the prescription of acetaminophen as the first line analgesic for these conditions,” noted Gustavo C Machado, of the University of Sydney in Australia, and colleagues.

“There has, however, been controversy about keeping acetaminophen in the most recent guidance on osteoarthritis from the National Institute for Health and Care Excellence, mainly because of previous studies reporting small effects of acetaminophen compared with placebo.”

To investigate the efficacy and safety of acetaminophen in the management of spinal pain and osteoarthritis of the hip or knee, the investigators conducted a systematic review and meta-analysis from 13 studies.

Looking at the pooled data, the study authors found that for people with lower back pain, acetaminophen was ineffective in either reducing patient disability or enhancing quality of life. In patients with osteoarthritis of the hip or knee, acetaminophen provided only a small, not clinically important benefit in the reduction of pain and disability.

McNeil Consumer Healthcare, the maker of Tylenol, countered that acetaminophen has a long history of effectiveness. In a statement, the company said that before clinical guidelines are changed, "it is important to comprehensively look at the body of evidence. The safety and efficacy profile of acetaminophen is supported by more than 150 studies over the past 50 years."

In an accompanying editorial published in The BMJ, however, Christian Mallen, PhD, of Keele University in the United Kingdom, and colleagues noted that the findings from Machado and colleagues "encourage us to reassess the role of [acetaminophen] as the key analgesic in managing osteoarthritis and spinal pain.”

References

  1. Machado GC et al. The BMJ. 2015; doi: http://dx.doi.org/10.1136/bmj.h1225
  2. Mallen C et al. The BMJ. 2015; doi: http://dx.doi.org/10.1136/bmj.h1352
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