Current NICE guidance pathways recommend regular paracetamol as the ‘first option’ for treating patients with lower back pain, despite a lack of any previous research indicating whether it is an effective way of treating the condition.
In the first large randomised study to assess the efficacy of paracetamol in alleviating lower back pain, a trial from the University of Sydney found that the analgesic had no effect in reducing any of its associated symptoms.
The Paracetamol for Low-Back Pain Study (PACE), published in the Lancet, studied 1,652 Australians with acute lower back pain and took place over four weeks.
A third of the participants were prescribed regular doses of paracetamol three times a day, another third were advised to take doses 'as needed' to manage pain and the remaining third were given a placebo.
No difference in recovery time, short-term pain levels, disability, function, sleep quality or quality of life was observed across each of these groups, suggesting the use of paracetamol was ineffective in alleviating any symptoms associated with lower back pain.
Further study required
The study authors said: ‘Our findings suggest that the efficacy of paracetamol should be carefully considered, with respect to the safe and effective use of medicines for low-back pain.’
They warned it was important for clinicians to wait for the results to be replicated before completely dismissing the use of paracetamol, especially given that alternative treatments have less favourable safety profiles.
They said: ‘Importantly, the safety profile of paracetamol is favourable compared with other analgesics recommended for low-back pain, e.g. NSAIDs. Because these other medicines have not been shown to provide additional benefit beyond that of paracetamol, and are only marginally better than placebo, it is not clear which drug should be preferred for management of low-back pain.’
Lead author Dr Christopher Williams said: ‘The results suggest we need to reconsider the universal recommendation to provide paracetamol as a first-line treatment for low-back pain, although understanding why paracetamol works for other pain states but not low-back pain would help direct future treatments.’
Low back pain is the leading cause of disability worldwide.