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Meta-Analysis
. 2016 Jun 7;2016(6):CD012230.
doi: 10.1002/14651858.CD012230.

Paracetamol for low back pain

Bruno T Saragiotto  1 , Gustavo C Machado, Manuela L Ferreira, Marina B Pinheiro, Christina Abdel Shaheed, Christopher G Maher
Affiliations
Meta-Analysis

Paracetamol for low back pain

Bruno T Saragiotto et al. Cochrane Database Syst Rev. .

Abstract

Background: Analgesic medication is the most frequently prescribed treatment for low back pain (LBP), of which paracetamol (acetaminophen) is recommended as the first choice medication. However, there is uncertainty about the efficacy of paracetamol for LBP.

Objectives: To investigate the efficacy and safety of paracetamol for non-specific LBP.

Search methods: We conducted searches on the Cochrane Central Register of Controlled Trials (CENTRAL, which includes the Back and Neck Review Group trials register), MEDLINE, EMBASE, CINAHL, AMED, Web of Science, LILACS, and IPA from their inception to 7 August 2015. We also searched the reference lists of eligible papers and trial registry websites (WHO ICTRP and ClinicalTrials.gov).

Selection criteria: We only considered randomised trials comparing the efficacy of paracetamol with placebo for non-specific LBP. The primary outcomes were pain and disability. We also investigated quality of life, function, adverse effects, global impression of recovery, sleep quality, patient adherence, and use of rescue medication as secondary outcomes.

Data collection and analysis: Two review authors independently performed the data extraction and assessed risk of bias in the included studies. We also evaluated the quality of evidence using the GRADE approach. We converted scales for pain intensity to a common 0 to 100 scale. We quantified treatment effects using mean difference for continuous outcomes and risk ratios for dichotomous outcomes. We used effect sizes and 95% confidence intervals as a measure of treatment effect for the primary outcomes. When the treatment effects were smaller than 9 points on a 0 to 100 scale, we considered the effect as small and not clinically important.

Main results: Our searches retrieved 4449 records, of which three trials were included in the review (n = 1825 participants), and two trials were included in the meta-analysis. For acute LBP, there is high-quality evidence for no difference between paracetamol (4 g per day) and placebo at 1 week (immediate term), 2 weeks, 4 weeks, and 12 weeks (short term) for the primary outcomes. There is high-quality evidence that paracetamol has no effect on quality of life, function, global impression of recovery, and sleep quality for all included time periods. There were also no significant differences between paracetamol and placebo for adverse events, patient adherence, or use of rescue medication. For chronic LBP, there is very low-quality evidence (based on a trial that has been retracted) for no effect of paracetamol (1 g single intravenous dose) on immediate pain reduction. Finally, no trials were identified evaluating patients with subacute LBP.

Authors' conclusions: We found that paracetamol does not produce better outcomes than placebo for people with acute LBP, and it is uncertain if it has any effect on chronic LBP.

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Conflict of interest statement

Bruno T Saragiotto: No relevant interests.

Gustavo C Machado: No relevant interests.

Manuela L Ferreira: No relevant interests.

Marina B Pinheiro: No relevant interests.

Christina Abdel Shaheed: No relevant interests.

Christopher G Maher is an author of the PACE trial, which was included in this review, however he did not participate in the 'Risk of bias' assessment or data extraction in this review. PACE was an investigator‐initiated trial, funded by the National Health and Medical Research Council of Australia and GlaxoSmithKline (a manufacturer of paracetamol).

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Forest plot of comparison: 1 Acute low back pain ‐ paracetamol versus placebo, outcome: 1.1 Pain.
4
4
Forest plot of comparison: 1 Acute low back pain ‐ paracetamol versus placebo, outcome: 1.2 Disability
1.1
1.1. Analysis
Comparison 1 Acute low back pain ‐ paracetamol versus placebo, Outcome 1 Pain.
1.2
1.2. Analysis
Comparison 1 Acute low back pain ‐ paracetamol versus placebo, Outcome 2 Disability.
1.3
1.3. Analysis
Comparison 1 Acute low back pain ‐ paracetamol versus placebo, Outcome 3 Quality of life, physical component.
1.4
1.4. Analysis
Comparison 1 Acute low back pain ‐ paracetamol versus placebo, Outcome 4 Quality of life, mental component.
1.5
1.5. Analysis
Comparison 1 Acute low back pain ‐ paracetamol versus placebo, Outcome 5 Function.
1.6
1.6. Analysis
Comparison 1 Acute low back pain ‐ paracetamol versus placebo, Outcome 6 Adverse events.
1.7
1.7. Analysis
Comparison 1 Acute low back pain ‐ paracetamol versus placebo, Outcome 7 Global impression of recovery.
1.8
1.8. Analysis
Comparison 1 Acute low back pain ‐ paracetamol versus placebo, Outcome 8 Poor sleep quality.
1.9
1.9. Analysis
Comparison 1 Acute low back pain ‐ paracetamol versus placebo, Outcome 9 Patient adherence.
1.10
1.10. Analysis
Comparison 1 Acute low back pain ‐ paracetamol versus placebo, Outcome 10 Use of rescue medication.
See this image and copyright information in PMC

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