Lower back pain is a common problem for many adults, but new research says that the acetaminophen (found in Tylenol and other brands) we might all rely on to try to manage that pain isn’t actually doing much of anything, really.
The research, conducted by Australian scientists and published this month in The Lancet, is the first double-blind randomized and controlled trial to assess whether the pain relief drug acetaminophen, commonly seen on our shelves as Tylenol and Paracetamol, really does help to lessen the impact of lower back pain. This kind of study is one of the most in-depth available to science and so the findings here are important.
The researchers took 1,652 people with an average age of 45, all of whom had acute lower back pain. The participants were found through 235 primary care centers in Sydney, Australia, and were divided into three groups. Over the course of a four-week period one group was told to take acetaminophen in regular doses three times a day (to a total of 3990 mg per day), while one group was told to take acetaminophen “as needed” (up to 4,000 mg per day), and the last, the placebo group who believed they were on painkillers, were given a similar schedule. The participants received otherwise identical care throughout this period including emotional support sessions, and were followed-up with after three months.
What the researchers found was that there was no significant difference in the number of days it took for those on acetaminophen to recover compared to the placebo group, with the average being about 17 days in the three-times daily group, 17 days in the as-needed group, and 16 days for the placebo group. It’s worth noting that the researchers controlled for things like how faithfully people adhered to their medication schedule, and it was roughly the same across the three groups but some people in the three-times daily group took just 2,660 mg daily, on average. Had they have been taking closer to 4000 mg the results might have been different — so that’s something to keep in mind.
Well, we might say, we don’t take acetaminophen to treat lower back pain, really just to lower the pain experience to at least manageable levels. That’s a fair point, and the researchers looked at short-term pain levels, too, as well as disability, function, sleep quality, and quality of life. They found no significant difference between the three groups.
This matters because, with lower back pain being the leading cause of disability worldwide, clinical guidelines rely on acetaminophen as the go-to prescription. What’s very interesting is that previous studious have shown that acetaminophen probably doesn’t make a significant difference for lower back pain sufferers, and yet clinical guidelines have remained unchanged. This latest study, however, is much harder to ignore.
The researchers behind the study, including lead author Dr Christopher Williams from the George Institute for Global Health at the University of Sydney in Australia, say that this research suggests that support and reassurance, which was the only meaningful treatment given to the placebo group, may be of more use for acute lower back episodes than some common pain relief medications:
“Simple analgesics such as paracetamol might not be of primary importance in the management of acute lower back pain”, Williams says. “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. In view of the quick timeframe in which participants in our trial improved compared with other cohorts, it would be interesting to see whether advice and reassurance (as provided in our trial) might be more effective than pharmacological strategies for acute episodes of low-back pain.”
While this research has been praised, the scientific world is stressing that before clinical recommendations are changed there will need to be more studies like this that show acetaminophen isn’t effective for lower back pain (and, crucially, why that is). It’s also important to state that other analgesics may have more power to at least help to manage lower back pain, and that will also be something for future studies to investigate.
There are currently a range of other treatments for lower back pain, including non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, and the stronger painkiller codeine if pain persists. Some people also find what’s known as hot and cold treatments useful. These can all be discussed with your doctor.
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