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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

Paracetamol-"Bashing"? - Re: Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials

To criticize the efficacy and safety of paracetamol by publishing: "Objective - To investigate the efficacy and safety of paracetamol (acetaminophen) in the management of spinal pain and osteoarthritis of the hip or knee" is not reliable when to say in the end of the abstract: "Conclusions - Paracetamol is ineffective in the treatment of low back pain and provides minimal short term benefit for people with osteoarthritis. These results support the reconsideration of recommendations to use paracetamol for patients with low back pain and osteoarthritis of the hip or knee in clinical practice guidelines".

Simple "low back pain" can be caused by muscular discomfort, myogelosis, and misalignments, malposition of the spinal column, scoliosis, overstraining, improper behaviour, or inadequate exercises. A "spinal pain" will be caused by an irritation of the spinal nervous system, the spinal marrow, or neuralgia of the vertebral nerves. Orthopedic experts warn to neglect "red-flag-signs" when complicated spinal pain occurs.

The German guidelines recommend paracetamol only up to 3 grams in the treatment of "low to moderate acute non-specific low back pain". Paracetamol is possible to treat sub-acute and chronic non-specific low back pain. http://www.leitlinien.de/mdb/downloads/nvl/kreuzschmerz/kreuzschmerz-1au...

The hypothesis that paracetamol 500 mg up to 3 grams a day could be n o t efficient and safe in the treatment of acute non-specific low back pain was not subject of the investigation of G. C. Machado, PhD student, et al. They are concerned about the treatment, efficacy, and safety of paracetamol for (specific or unspecific) spinal pain and osteoarthritis.

They should reconsider that most of acute non-specific low back pain will abate after 5 to 7 days by regaining normal muscular activity with or without physiotherapy. Paracetamol will be helpful but is not urgently needed. Spinal pain and osteoarthritis are different themes.

Dr. med. Thomas G. Schaetzler (MD)
Family Medicine Unit
Public GP-medical office/Fachpraxis Allgemeinmedizin
Kleppingstr. 24 D 44135 Dortmund Germany
th.g.schaetzler@gmx.de

Competing interests: No competing interests

01 May 2015
Thomas G. Schaetzler
Family Medicine Unit
none
Public GP-medical office/Fachpraxis Allgmeinmedizin
Kleppingstr. 24 D 44135 Dortmund Germany