Paracetamol: No better than a placebo for easing low back pain?

Most people who have experienced an episode of low back pain will have been told by their GP to take some paracetamol. A recent study in The Lancet Journal recommends that this very common prescription should no longer be given for helping reduce pain in this area.

The study involved 1,643 people with acute low back pain and directly tested paracetamol against a placebo. The subjects took their medicine for up to four weeks as prescribed, and were all given advice and reassurance that they would recover.

Their results showed that paracetamol did not reduce the subjects pain intensity, or improve their quality of sleep or recovery time (an average of 17 days). The researchers main message from this trial is that paracetamol shouldn't be the first line pain relieving medication for acute low back pain.

But this is only half of the story. In my opinion the more powerful message from this study is that the advice and reassurance given to the subjects in this group meant that they all recovered faster than those in other similar studies. This is incredibly important, as by removing the fear of low back pain it is far less likely to become longstanding. It is easy to understand how someone with acute back pain, no knowledge of how long it will take to recover or how to ease it, can make irrational judgements. The intensity of pain can cause deep anxiety in someone who doesn't know that most of the time if you follow the right advice, in a few days you'll be 50% better. For example most people become far less active, when all the evidence recommends you to stay as active as you can and avoid bed rest. Basic advice on the do's and don't's of movement, and how to manage the pain allow the injury to be rationalised.

Hopefully further research will be done to compare whether advice and reassurance is more effective than medication for acute low back pain. In my clinical experience good advice, appropriate medication and high quality rehabilitation is by far the most effective combination.

Watch this space.

Tom Lowes B.Ost MSc (Sports Med)
Registered Osteopath - Sports Injury Rehabilitation

Twitter @SportsMedOsteo