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Evidence summaries

Paracetamol for Low Back Pain

Paracetamol is no better than placebo for relieving acute low back pain (LBP). There is insufficient evidence on the effect of paracetamol in chronic LBP. Level of evidence: "A"

Summary

A Cochrane review [Abstract] 1 included 3 studies with a total of 1825 subjects. Two trials included participants with acute back pain and one participants whose pain lasted for longer than six weeks (chronic). Most of the people in the study (90%) were middle-aged and came from a single trial that looked at acute back pain. The treatments ranged from a single 1g dose (given intravenously) up to 4g in a 24 hour period for up to four weeks (oral tablets). Participants were followed between one day and 12 weeks. Two trials were included in the meta-analysis.

In acute LBP, paracetamol (4g per day) was no better than placebo for relieving acute LBP in either the short or longer term. It also worked no better than placebo on the other aspects studied, such as quality of life and sleep quality. About one in five people reported side effects, and there was no difference between intervention and control groups. The reported serious adverse events were unrelated to the study treatment (for example asthma attack, bleeding bowel, infection, hernia, severe back pain, or scheduled surgery)

There appears to be no difference between paracetamol and placebo in immediate reduction of chronic LBP, although the evidence is of very low quality, and the single study on which it is based has been withdrawn by the journal.

Paracetamol compared with placebo for acute low back pain

OutcomeRelative effect(95% CI)Assumed risk - control=placeboCorresponding risk - intervention=paracetamolNumber of participants (studies)
Pain1 week (immediate term)(NRS 0 to 100) The mean pain in the control group was36 pointsThe mean pain in the intervention group was1.49 higher(1.30 lower to 4.28 higher)1520 (1 study)
Pain12 weeks (short term)(NRS 0 to 100 The mean pain in the control group was13 pointsThe mean pain in the intervention group was0.50 lower(2.92 lower to 1.92 higher)1526 (1 study)
Disability1 week (immediate term)(RMDQ 0 to 24) The mean disability in the control group was8.3 pointsThe mean disability in the intervention group was0.45 lower(1.15 lower to 0.25 higher)1511 (1 study)
Disability12 weeks (short term)(RMDQ 0 to 24) The mean disability in the control group was2.4 pointsThe mean disability in the intervention group was0.10 higher(0.39 lower to 0.59 higher)1522 (1 study)
Any adverse eventsup to 12 weeks' follow-upRR 1.07(0.86 to 1.33)107 per 1000115 per 1000 (92 to 142)1624 (1 study)
Serious adverse eventsup to 12 weeks' follow-upRR 0.90(0.30 to 2.67)90 per 100091 per 1000 (90 to 93)1643 (1 study)

Clinical comments

Note

Date of latest search: 2015-08-01

References

  • Saragiotto BT, Machado GC, Ferreira ML et al. Paracetamol for low back pain. Cochrane Database Syst Rev 2016;(6):CD012230. [PubMed]

Primary/Secondary Keywords