title: A systematic review of paracetamol for non-specific low back pain.
abstract: The objective of this study was to assess the efficacy of paracetamol (acetaminophen) in the treatment of pain and disability in patients with non-specific low back pain. We conducted a systematic review of randomized controlled trials to assess the efficacy of paracetamol in the treatment of pain and disability in patients with non-specific low back pain. A search for randomized controlled trials was conducted using the Medline, Embase and CINAHL databases. Trials were eligible if they were randomized controlled trials comparing paracetamol to no treatment, placebo or another treatment in patients with non-specific low back pain. Two of the authors independently assessed trials for methodological quality on the PEDro Scale and extracted data. Continuous pain and disability data were converted to a common 0-10 scale; ordinal data were dichotomized (e.g., no pain, pain). The data was analyzed using the MIX version 1.61 meta-analysis software. Out of 205 unique articles found in the searches, 7 eligible trials were identified. The trials enrolled a total of 676 participants with 5 investigating acute low back pain, 1 investigating chronic low back pain and 1 investigating both. No trial provided data comparing paracetamol to placebo and only one trial compared paracetamol to no treatment. In general the trials were small (only 1 trial had >25 subjects per group) and of low methodological quality (only 2 had a score above 6 on the quality scale). All but one of the trials provided imprecise estimates of the effects of treatment with confidence intervals spanning clinically important beneficial and also harmful effects of paracetamol. No trial reported a statistically significant difference in favor of paracetamol. There is insufficient evidence to assess the efficacy of paracetamol in patients with low back pain. There is a clear need for large, high quality randomized controlled trials evaluating paracetamol, to provide reliable evidence of paracetamol's effectiveness in patients with low back pain and to establish the validity of the recommendations in clinical guidelines.
authors.affiliation: Back Pain Research Group, University of Sydney, Sydney, Australia.
authors.forename: Reece A
authors.initials: RA
authors.lastname: Davies
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Maher
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Hancock
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage* / Q000009:adverse effects; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage* / Q000009:adverse effects; D002908:Chronic Disease / Q000188:drug therapy; D003627:Data Interpretation, Statistical; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D018401:Sample Size; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen
references.citation: Spine (Phila Pa 1976). 2001 Nov 15;26(22):2504-13; discussion 2513-4
references.pmid: 11707719
references.citation: Health Technol Assess. 2003;7(1):1-76
references.pmid: 12583822
references.citation: JAMA. 1995 Feb 1;273(5):408-12
references.pmid: 7823387
references.citation: Am J Ther. 2005 Jan-Feb;12(1):46-55
references.pmid: 15662292
references.citation: Eur Spine J. 2006 Mar;15 Suppl 2:S169-91
references.pmid: 16550447
references.citation: Psychol Rev. 1956 Mar;63(2):81-97
references.pmid: 13310704
references.citation: N Z Med J. 1982 May 12;95(707):312-4
references.pmid: 6212783
references.citation: J Clin Epidemiol. 2005 Jul;58(7):668-73
references.pmid: 15939217
references.citation: Spine (Phila Pa 1976). 1980 Jul-Aug;5(4):324-30
references.pmid: 6450448
references.citation: Practitioner. 1988 Feb 22;232(1443):163-4
references.pmid: 2973008
references.citation: Phys Ther. 2003 Aug;83(8):713-21
references.pmid: 12882612
references.citation: BMC Med Res Methodol. 2006 Oct 13;6:50
references.pmid: 17038197
references.citation: Psychosomatics. 1996 Jan-Feb;37(1):63-70
references.pmid: 8600497
references.citation: J Spinal Disord. 1993 Jun;6(3):187-93
references.pmid: 8347966
references.citation: Spine (Phila Pa 1976). 2003 Jun 15;28(12):1290-9
references.pmid: 12811274
references.citation: Spine (Phila Pa 1976). 2002 May 15;27(10):1012-7
references.pmid: 12004166