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Common pain relief medicine for acute low back pain does not speed recovery – new research



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“In the world’s first large placebo-controlled trial, we have demonstrated that taking paracetamol does not speed recovery or reduce pain compared to placebo.”

Paracetamol, the pain relief medicine that is universally recommended to treat people with acute low back pain, does not speed recovery or reduce pain for this condition, according to new research published in The Lancet.

Low back pain is the leading cause of disability worldwide. In the United Kingdom, 41 per cent of people , or 26 million people, suffer from low back pain per year. The study was led by The George Institute for Global Health, an international research institute supported by the Oxford Martin School.

Every back pain treatment guideline in the world currently recommends the use of paracetamol , as the first-line back pain analgesic, despite the fact that no previous studies have provided convincing evidence that it is effective in people with low back pain.

“In the world’s first large placebo-controlled trial, we have demonstrated that taking paracetamol does not speed recovery or reduce pain compared to placebo,” said senior author Associate Professor Christine Lin, of The George Institute for Global Health and The University of Sydney. “The effect is the same whether paracetamol is taken regularly or as required.”

“Because low-back pain is the leading cause of disability worldwide, this study shows that improved focus on development of new, effective treatments is warranted.”

Professor Sallie Lamb, director of the Oxford Clinical Trials Unit, said: “Although this study occurred in Australia it involved a large number of patients and was well conducted and there’s no reason to 
believe that the results would be any different for patients in the United Kingdom.  This study may cause us to reconsider the way we treat patients here with acute low back pain.”

Associate Professor Lin said the reasons for paracetamol failing to work for low-back pain are 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. Paracetamol is also effective in reducing fever. What this study indicates is that the mechanisms of back pain are likely to be different from other pain conditions, and this is an area that we need to study more.”

Associate Professor Lin said other ways to ease back pain included remaining as active as possible and avoiding bed rest. “An active approach is probably more important than any therapy you may receive. Heat wraps and heat packs are simple methods you can use to help with your pain. 

“If that simple approach does not help you can talk to your pharmacist or doctor about other pain medicines, but you do need to carefully follow their advice as these medicines can have serious side effects. There is also some evidence that a short course of spinal manipulation can help control pain.   

The study, published today in the prestigious publication The Lancet, looked at 1,643 people experiencing acute, uncomplicated low back pain and presenting to primary care in Australia.


Further information:
Associate Professor Christine Lin emphasises that in this study 50% of all participants fully recovered by two and a half weeks. Researchers were interested in the fact that this improvement was faster than what is observed in people receiving ‘usual care’. 

“Our trial doctors followed the treatment guideline and provided reassurance and advice to stay active to participants. Surprisingly, it may be that it is what the doctor says to a patient with back pain, rather than the analgesic they prescribe, that is most important for aiding recovery.”

As well as recovery time and pain intensity, the study also found that paracetamol has no effect on disability, function, symptom change, sleep or quality of life. 

This study was a collaboration with other prominent researchers such as Professor Andrew McLachlan, School of Pharmacy, The University of Sydney, and Professor Ric Day, rheumatologist and clinical pharmacologist, The University of New South Wales.