Parac­eta­mol no bet­ter than placebo for low back pain: Study

The Political and Business Daily - - EDIT - KATE KEL­LAND

PARAC­ETA­MOL, a painkiller uni­ver­sally rec­om­mended to treat peo­ple with acute low back pain, does not speed re­cov­ery or re­duce pain from the con­di­tion, ac­cord­ing to the re­sults of a large trial pub­lished on Thurs­day.

A study pub­lished in The Lancet med­i­cal jour­nal found that the pop­u­lar pain medicine was no bet­ter than placebo, or dummy, pills for has­ten­ing re­cov­ery from acute bouts of low back pain or eas­ing pain lev­els, func­tion, sleep or qual­ity of life.

Re­searchers said the find­ings chal­lenge the uni­ver­sal en­dorse­ment of parac­eta­mol as the first choice painkiller for lower back pain.

"We need to re­con­sider the uni­ver­sal rec­om­men­da­tion to pro­vide parac­eta­mol as a first-line treat­ment," said Christo­pher Wil­liams, who led the study at the Univer­sity of Sydney in Aus­tralia.

Lower back pain is the lead­ing cause of dis­abil­ity world­wide. In the United States alone, costs re­lat­ing to the con­di­tion are es­ti­mated to be more than $100 bil­lion a year.

Cur­rently, ev­ery back pain treat­ment guide­line in the world rec­om­mends parac­eta­mol as the first-line anal­gesic and Wil­liams said this was de­spite the fact that no pre­vi­ous stud­ies have pro­vided ro­bust ev­i­dence that it works in this con­di­tion.

Tim Salomons, a pain ex­pert at Bri­tain's Univer­sity of Read­ing whose own re­search has found that cog­ni­tive be­hav­ioral ther­apy could be used to treat chronic pain, said this lat­est study showed the chal­lenge of treat­ing the con­di­tion.

"It is vi­tally im­por­tant we con­tin­u­ously chal­lenge con­ven­tional wis­dom about treat­ing pain," he said in an emailed com­ment. "Even though parac­eta­mol has a good safety pro­file, ev­ery drug has side ef­fects. If the drug is not do­ing what it is be­ing pre­scribed to do, pain pa­tients might be bet­ter off with­out."

In Wil­liams' trial, 1,652 peo­ple from Sydney with acute low back pain were ran­domly as­signed to re­ceive up to four weeks of parac­eta­mol, ei­ther in reg­u­lar doses three times a day, or as needed, or to re­ceive place­bos. All those in­volved re­ceived ad­vice and re­as­sur­ance and were fol­lowed up for three months.

The re­sults showed no dif­fer­ence in the num­ber of days to re­cov­ery be­tween the treat­ment groups - with the av­er­age time to re­cov­ery com­ing out at 17 days for each of the groups given parac­eta­mol, and at 16 days for the placebo group.

Parac­eta­mol had no ef­fect on short­term pain lev­els, dis­abil­ity, func­tion, sleep qual­ity, or qual­ity of life, the re­searchers said, and the num­ber of pa­tients re­port­ing neg­a­tive side ef­fects was sim­i­lar in all groups.

Chris­tine Lin, an as­so­ciate pro­fes­sor at the Ge­orge In­sti­tute for Global Health and the Univer­sity of Sydney who also worked on the study, said the rea­sons for parac­eta­mol fail­ing to work for lower back pain were not well un­der­stood.

"While we have shown that parac­eta­mol does not speed re­cov­ery from acute back pain, there is ev­i­dence that parac­eta­mol works to re­lieve pain for a range of other con­di­tions, such as headaches, some acute mus­cu­loskele­tal con­di­tions, tooth ache and for pain straight af­ter surgery," she said in a state­ment about the find­ings


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