A large study, published yesterday in the very fancy journal The Lancet, has found that Paracetamol is not effective for treating back pain.
Here’s a link to an interview with the studies lead researcher and excerpts from the transcript
“CHRIS UHLMANN: The most common pain reliever for back pain, paracetamol, doesn’t work any better than a placebo.
The shocking conclusion that the beneficial effects of such a widely-used drug might be all in the mind are drawn by a paper published this morning in the prestigious medical journal, The Lancet.
Dr Norman Swan of Radio National’s Health Report picked himself up off the floor to get to the story.
NORMAN SWAN: Eighty per cent of us will experience a bad back at some point in our lives and guidelines for doctors around the world advise GPs to tell patients not to lie down to their pain and to take paracetamol to relieve it, but when researchers from George Institute for Global Health in Sydney looked for good scientific evidence that paracetamol worked, they were troubled to find out there was none.
So they carried out a large three-pronged trial and 1,600 patients with acute new onset back pain. They all got the don’t lie down to it advice, but in terms of pain relief, one group received a placebo, another was told to take paracetamol as needed and a third received regular extended release paracetamol three times a day.
Professor Chris Maher was the study leader.
CHRIS MAHER: Surprisingly found that it didn’t really matter whether you gave people placebo as required, paracetamol or time contingent , that is regular paracetamol, there was no difference in any of the outcomes. It didn’t speed time to recovery; it didn’t improve their pain; it didn’t improve their disability.
NORMAN SWAN: Simply extraordinary!
CHRIS MAHER: Yeah, we were very surprised because by hypothesis was that there would be a difference between the people getting the regular paracetamol and placebo and I was expecting that, if you took paracetamol as required, so occasionally taking a tablet it wouldn’t work at all.
NORMAN SWAN: Does paracetamol work for anything? Is it a painkiller?
CHRIS MAHER: The jury’s out on that particular issue, so there is some evidence that it works for things such as dental procedures; it might work for fever, post-operative pain. We’ve looked at some of the trials for paracetamol for osteoarthritis, which is another common indication, and surprisingly when you go and have a very good look at them, we see the effects of paracetamol for osteoarthritis are very small.
NORMAN SWAN: So what about the more toxic forms of painkillers: the non-steroidals, the ibuprofens that can cause stomach ulcers and other problems with your blood pressure and so on. Is there any evidence that they’re actually pain killers?
CHRIS MAHER: These are very commonly prescribed medicines for back pain. If you go and look at the evidence, it’s really quite weak.
The evidence is certainly not robust for the common pain medicines that people are using for back pain.
NORMAN SWAN: So where do you go from here when I next pull my back?
CHRIS MAHER: Well, I think that the strong messages you can take from our trial is that people in the three groups all recovered remarkably quickly. Half the people had recovered by two weeks. And so what we’re thinking is that the interactions between the GP and the patient, the GP carefully guiding the person to resume normal activity; don’t put themselves to bed – maybe that’s the most important part of the therapy.” (Emphasis added)
The only surprise for me is that anyone was surprised! Why would anyone think that taking paracetamol would have any effect on time to recovery for low back pain?
It’s also interesting to note that the reporter interpreted these findings as suggesting that “the beneficial effects of such a widely-used drug might be all in the mind”. I think it would be more accurate to say simply that there were no beneficial effects. The authors say as much in the abstract – “We recorded no difference between treatment groups for time to recovery”
Here’s the final word from the online abstract:
Our findings suggest that regular or as-needed dosing with paracetamol does not affect recovery time compared with placebo in low-back pain, and question the universal endorsement of paracetamol in this patient group.
National Health and Medical Research Council of Australia and GlaxoSmithKline Australia.
Perhaps there’s another little surprise in the note on funding.
Update: There’s now a competition to win an ebook- see the comments below.