Long used as a pain reliever by patents affected by arthritis, acetaminophen was recently tested for its effectiveness in management of spinal pain and osteoarthritis of the hip or knee. Researchers found that the drug underperformed, and even suggested physical treatment as a mainstay solution, according to a recent report by MedicalNewsToday.
Behind the findings is a systematic review and meta-analysis of randomized controlled trials that compared the efficacy and safety of paracetamol with a placebo in the treatment of spinal pain in the neck or low back, as well as osteoarthritis of the hip or knee.
Out of 12 reports and 13 randomized trials that were evaluated in the research, the study abstract reports there was “high-quality” evidence that paracetamol is ineffective for reducing pain intensity (weighted mean difference -0.5, 95% confidence interval -2.9 to 1.9) and disability (0.4, -1.7 to 2.5) or improving quality of life (0.4, -0.9 to 1.7) in the short term in people with low back pain.
Furthermore, for hip or knee osteoarthritis there was “high-quality” evidence that paracetamol provides a significant, although not clinically important, effect on pain (-3.7, -5.5 to -1.9) and disability (-2.9, -4.9 to -0.9) in the short term. The number of patients reporting any adverse event (risk ratio 1.0, 95% confidence interval 0.9 to 1.1), any serious adverse event (1.2, 0.7 to 2.1), or withdrawn from the study because of adverse events (1.2, 0.9 to 1.5) was similar in the paracetamol and placebo groups. Patient adherence to treatment (1.0, 0.9 to 1.1) and use of rescue medication (0.7, 0.4 to 1.3) was also similar between groups.
The researchers conclude that paracetamol is ineffective in the treatment of low back pain and provides minimal short-term benefit for people with osteoarthritis. They furthermore determined the 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.
MedicalNewsToday reports that lead author Gustavo Machado, of The George Institute for Global Health in the UK and the University of Sydney in Australia, says, “Worldwide, paracetamol is the most widely used over-the-counter medicine for musculoskeletal conditions, so it is important to reconsider treatment recommendations given this new evidence.”
Opinion leaders from the rheumatology arena posit in an editorial published in The BMJ that some of the study’s findings are not surprising. For one, the editorial endorses physical treatments, including exercise, as pain management for the conditions. The editorial further notes, “Ongoing and ever-increasing concerns about pharmacological management of musculoskeletal pain highlights the importance of nonpharmacological options, which form the cornerstone of self-management of spinal pain and osteoarthritis.”