Re: Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials
Machado et al [1] state that “paracetamol is ineffective in the treatment of low back pain” and base this conclusion on the analysis of three placebo controlled trials. It is important to note that one of these trials by Wetzel et al [2] has been retracted from the European Journal of Anaesthesiology.[3]
The two remaining trials [4,5] assess the efficacy of paracetamol in younger patients, principally under 55 years of age, with acute moderate to severe low back pain of less than six weeks duration. Care should be taken about generalising these findings to elderly patients and to those with chronic or persistent back pain, in whom satisfactory pain control can be particularly challenging to achieve.
1. Machado G, Maher C, Ferreira P et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ 2015;350:h1225
2. Wetzel L, Zadrazil M, Paternostro-Sluga T, et al. Intravenous nonopioid analgesic drugs in chronic low back pain patients on chronic opioid treatment: a crossover, randomised, double-blinded, placebo-controlled study. Eur J Anaesthesiol 2014;31:35-40
3. Wetzel L, Zadrazil M, Paternostro-Sluga T, et al. Intravenous nonopioid analgesic drugs in chronic low back pain patients on chronic opioid treatment: A crossover, randomised, double-blinded, placebo-controlled study: Retraction. Eur J Anaesthesiol 2015;32:287.
4. Williams C, MAher C, LAtimer J, et al. Efficacy of paracetamol for acute low back pain: a double-blind, randomised controlled trial. Lancet 2014;384:1586-96
5. Nadler SF, Steiner DJ, Erasala GN, et al. Continuous low-level heat wrap therapy provides more efficacy than ibuprofen and acetaminophen for acute low back pain. Spine 2002;27:1012-7
Competing interests:
No competing interests
08 April 2015
Rosalind Adam
General Practitioner (special interest in pain management)
Rapid Response:
Re: Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials
Machado et al [1] state that “paracetamol is ineffective in the treatment of low back pain” and base this conclusion on the analysis of three placebo controlled trials. It is important to note that one of these trials by Wetzel et al [2] has been retracted from the European Journal of Anaesthesiology.[3]
The two remaining trials [4,5] assess the efficacy of paracetamol in younger patients, principally under 55 years of age, with acute moderate to severe low back pain of less than six weeks duration. Care should be taken about generalising these findings to elderly patients and to those with chronic or persistent back pain, in whom satisfactory pain control can be particularly challenging to achieve.
1. Machado G, Maher C, Ferreira P et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ 2015;350:h1225
2. Wetzel L, Zadrazil M, Paternostro-Sluga T, et al. Intravenous nonopioid analgesic drugs in chronic low back pain patients on chronic opioid treatment: a crossover, randomised, double-blinded, placebo-controlled study. Eur J Anaesthesiol 2014;31:35-40
3. Wetzel L, Zadrazil M, Paternostro-Sluga T, et al. Intravenous nonopioid analgesic drugs in chronic low back pain patients on chronic opioid treatment: A crossover, randomised, double-blinded, placebo-controlled study: Retraction. Eur J Anaesthesiol 2015;32:287.
4. Williams C, MAher C, LAtimer J, et al. Efficacy of paracetamol for acute low back pain: a double-blind, randomised controlled trial. Lancet 2014;384:1586-96
5. Nadler SF, Steiner DJ, Erasala GN, et al. Continuous low-level heat wrap therapy provides more efficacy than ibuprofen and acetaminophen for acute low back pain. Spine 2002;27:1012-7
Competing interests: No competing interests