Medical choice of paracetamol for low back pain no better than placebo

AFTER DECADES, THE UNIVERSAL FIRST CHOICE RECOMMENDATION BY WESTERN MEDICINE OF PARACETAMOL FOR LOW BACK PAIN IS FOUND TO BE NO BETTER THAN PLACEBO.

Recent research published in the Lancet1 shows that using paracetamol is no better than a placebo for shortening recovery time from acute episodes of lower back pain, in fact the placebo group recovered a day earlier![1] There was also no advantage of paracetamol over placebo for improving pain levels, function, sleep, or quality of life, according to this first large, randomised trial that compares the effectiveness of paracetamol with a placebo for lower back pain. The authors say that these findings question the universal endorsement by Western medicine of paracetamol as the 1st choice analgesic for cases of low-back pain.

The study split 1652 patients into those who took a placebo, those who took paracetamol whenever they felt pain and a third group who took the medication three times daily as described in the pharmaceutical manufacturer’s directions for use. The University of Sydney researchers who undertook the study when they discovered there had never been a large scale trial comparing paracetamol to a placebo for back pain. It was initially considered that patients who reported experiencing no relief from paracetamol may have been dosing inadequately.

All patients received advice about keeping active, avoiding bed rest and reassurance about their back pain and were followed up at 1, 2, 4 and 12 weeks. They were asked to continue the medicine until they recovered, or for 4 weeks, whichever occurred first. The trial involved people with acute uncomplicated low back pain. None of the participants were absent from work during the study period. Between 72% and 76% of participants were satisfied with the treatment received, and around 30% of participants also used other health services. These health services could indeed have played a large part of the improvement seen but it is unclear of their effect. The researchers anticipated that only the group who dosed the paracetamol 3 times daily would notice improvements, however there were “very surprised” to see that regardless of how you were taking it, there were no discernible differences. It was not clear from the study why paracetamol did not work for back pain.

Worldwide, low back pain is the leading cause of disability. National clinical guidelines universally recommend paracetamol as the 1st choice analgesic for acute low back pain, despite the fact that no previous studies have provided any robust evidence that it’s effective in people with lower back pain.

Low Back Pain Guidelines Should Include Chiropractic

So it seems that the advice from Western medicine about the first choice of therapy for low back pain should now include chiropractic as history has shown for many decades there are numerable studies to support chiropractic’s effectiveness. These studies range from the Ontario Ministry of Health’s Manga Report[2] which concluded “when it comes to management of low back pain, chiropractors do it better and cheaper than doctors.” while Prof Manga also found the doubling of chiropractic use of chiropractic in Ontario would save over CND$2 billion directly and indirectly.

Also there is the more recent study from the NASS’s contemporary concepts in spine care[3]. This study found several randomized controlled trials had been conducted to assess the efficacy of spinal manipulative therapy for acute low back pain using various methods. Results from most studies suggest that 5 to 10 sessions of spinal manipulative therapy administered over 2 to 4 weeks achieve equivalent or superior improvement in pain and function when compared with other commonly used interventions, such as physical modalities, medication, education, or exercise, for short, intermediate, and long-term follow-up. The NASS study said spine care clinicians should discuss the role of spinal manipulative therapy as a treatment option for patients with acute low back pain who do not find adequate symptomatic relief with self-care and education alone.

What we have seen in clinic over a decade is the consistently reproducible relief of lower back pain within a short span of visits. Immediately after therapy, patients commonly report significant and lasting improvement in their lower back pain. So next time you are recommended to take paracetamol for low back pain, simply ask the practitioner what evidence there is that it will help and try chiropractic instead. 

1. Christopher M Williams, Christopher G Maher, Jane Latimer, Andrew J McLachlan, Mark J Hancock, Richard O Day, Chung-Wei Christine Lin. “Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial”. The Lancet, 2014; DOI: 10.1016/S0140-6736(14)60805-9
2.  Enhanced Chiropractic Coverage under OHIP (Ontario Health Insurance Plan) as a Means of Reducing Health Care Costs, Attaining Better Health Outcomes and Achieving Equitable Access to Health Services. Professor Pran Magna Ph.D., Professor Doug Angus. Report to the Ontario Ministry of Health, Feb 1998. (Appendix 6)
3. Dagenais S, Gay RE, Tricco AC, Freeman MD, Mayer JM (2010), "NASS Contemporary Concepts in Spine Care: Spinal manipulation therapy for acute low back pain," Spine J 10 (10): 918–940. doi:10.1016/j.spinee.2010.07.389. PMID 20869008.