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Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1225 (Published 31 March 2015) Cite this as: BMJ 2015;350:h1225

Rapid Response:

Re: Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of high quality?

In a recently published systematic review and meta-analysis in BMJ-Open on the efficacy of Paracetamol (PCM) in patients with low back pain, the authors conclude that their study supports “reconsidering recommending the use of paracetamol for patients suffering with low back pain in clinical practice guidelines” (1).
These rather dramatic conclusions are based upon a grand total of 2 RCT’s (2,3), of which the study by Wetzel et al., recently was retracted from the European Journal of Anaesthesiology by the authors (2). It would therefore appear to be inappropriate to use the designation “systematic review”.To undertake a meta-analysis based upon one study is also highly unusual. Notwithstanding the quality and the conclusions of the RCT in question it is most certainly premature to arrive at any conclusions as regards undertaking changes in international clinical guidelines. The authors should exclude the section on PCM and Low Back Pain in their paper until a sound conclusion can be made based on data from an appropriate number of high quality RCT`s on this subject. We feel that in the present study the title, methods, conclusions and recommendations are misleading.
Additionally, in the future International Scientific Research Fora should set minimal requirements as regards data quantity and quality required prior to meaningful systematic reviews and metaanalyses being carried out in different health care areas.

1. Machado GC, Maher CG, Ferraira PH, Pinheiro MB, Lin CC, Day RO, McLachlan AJ, Ferraira ML. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: Systematic review and metaanalysis of randomized placebo controlled trials. BMJ 2015; 350: h1225.

2. Wetzel L, Zadrazil M, Paternostro-Sluga T, Authried G, Kozek-Langenecker S, Scharbert G. 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.

3. Williams CM, Maher CG, Latimer J, McLachlan AJ, Hancock MJ, Day RO, Lin CCL. Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial. The Lancet 2014; 384. 1586-1596.

Competing interests: No competing interests

25 April 2015
Claus Manniche
MD, Rheumatology Specialist, Professor, DrMed
Søren Glud Skousgaard, MD, Occupational Medicine Specialist, PhDc
Spinecentre of Southern Denmark, University of Southern Denmark
Oestre Hougvej 55, 5500 Middelfart, Denmark