New findings contradict existing treatment recommendations

Paracetamol is ineffective in the treatment of back pain. According to a recent study published in the British Medical Journal, the effectiveness of paracetamol is also negligible and clinically insignificant for joint pain ( BMJ 2015;350:h1225).

Back pain is one of the most common causes of disability worldwide. It is caused by pain in the neck, shoulders and shoulders, as well as lower back pain.

Current guidelines recommend paracetamol for both back pain and joint pain. However, the evidence for paracetamol's effectiveness has been weak and contradictory. Furthermore, safety concerns exist with daily doses up to 4000 mg.

The authors, led by Gustavo Machado of the University of Sydney, conducted a systematic meta-analysis. They reviewed existing studies on the efficacy and safety of paracetamol for back pain and degenerative joint pain in the hip and knee.

The study included 13 randomized controlled trials. A prerequisite for inclusion in the analysis was that the studies compared the efficacy of paracetamol with that of placebo. Ten studies included 3,541 patients who examined the efficacy of paracetamol for joint pain, and three studies included 1,825 patients who analyzed the efficacy of paracetamol for lower back pain.

The effectiveness of paracetamol on pain relief, improvement of disability, and quality of life were analyzed.

The study showed that paracetamol is ineffective for back pain. It does not reduce disability caused by pain and does not improve quality of life compared to placebo. For osteoarthritis pain, studies show a small, but clinically insignificant improvement in the reduction of pain and disability compared to placebo.

However, paracetamol showed a higher risk of liver dysfunction. The corresponding liver enzyme levels rose four times higher compared to placebo.

The study examined the use of paracetamol and placebo over a maximum of six months. Therefore, further analyses over longer periods are needed.

Nevertheless, the authors conclude that "the results necessitate a reassessment of treatment recommendations regarding the use of paracetamol for patients with back pain and degenerative joint pain".

In an accompanying editorial, Christian Mallen and Elaine Hay from Keele University write that the study reignites the debate regarding the efficacy and safety of paracetamol.

They explain that if paracetamol is removed from existing guidelines, other active ingredients will be used as alternatives, potentially leading to new health problems. Therefore, they advocate for the use of non-pharmacological therapies instead of solely relying on medication. These include physical activation, exercise therapy, psychological therapy, and information and behavioral interventions, all of which offer numerous benefits in the treatment of back pain and degenerative joint pain.

Hartmut Göbel of the Kiel Pain Clinic, in light of the current findings, states: "Especially with back pain, which often has multiple causes, the combined expertise of several specialists can make a crucial contribution to alleviating pain and improving patients' quality of life. In addition to pain specialists, physiotherapists and behavioral therapists are also involved in patient treatment. This is because, for example, damaged vertebrae or intervertebral discs are usually not the sole cause of back problems. Poor posture, muscle tension, performance pressure, or lack of exercise can also cause and perpetuate back pain.".

Patients should consult their doctor before switching from paracetamol to other pain medications. According to a new study, paracetamol is not an effective treatment for back and joint pain. Numerous medications are available for back pain, including nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids. These can provide better pain relief. However, a number of side effects must also be considered with these medications.

Gustavo Machado, one of the authors of the research project, argues: “Paracetamol is the most widely used drug for self-medication of musculoskeletal pain. Therefore, it is crucial that the current body of research be reviewed for new findings. Our research results show that, in addition to its negligible or non-existent effect, paracetamol for back pain and degenerative joint pain is associated with an increased risk of liver toxicity in treated patients.”.

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