acetaminophen – useless for lower back pain

Lower back pain is one of the most common and costly ailments. Sedentary lifestyles leave the stabilizing muscles of abs and lower back (which would otherwise keep the vertabrae safe from injury) weak, and simple motions can strain them or cause disc problems. A new study from Britain shows acetaminophen (known as paracetamol in Britain) is no more helpful than placebo in alleviating lower back pain.

From NINDS – Neuroscience Center:

If you have lower back pain, you are not alone. Nearly everyone at some point has back pain that interferes with work, routine daily activities, or recreation. Americans spend at least $50 billion each year on low back pain, the most common cause of job-related disability and a leading contributor to missed work. Back pain is the second most common neurological ailment in the United States — only headache is more common. Fortunately, most occurrences of low back pain go away within a few days. Others take much longer to resolve or lead to more serious conditions.

The study, published in The Lancet, is written up in Science Daily:

Paracetamol [acetaminophen] is no better than placebo at speeding recovery from acute episodes of lower back pain or improving pain levels, function, sleep, or quality of life, according to the first large randomised trial to compare the effectiveness of paracetamol with placebo for low-back pain. The findings, published in The Lancet, question the universal endorsement of paracetamol as the first choice painkiller for low-back pain, say the authors.

Low-back pain is the leading cause of disability worldwide. National clinical guidelines universally recommend paracetamol as the first choice analgesic for acute low-back pain, despite the fact that no previous studies have provided robust evidence that it is effective in people with low-back pain.

The Paracetamol for Low-Back Pain Study (PACE) randomly assigned 1652 individuals (average age 45 years) with acute low-back pain from 235 primary care centres in Sydney, Australia to receive up to 4 weeks of paracetamol in regular doses (three times a day; equivalent to 3990 mg per day), paracetamol as needed (maximum 4000 mg per day), or placebo. All participants received advice and reassurance and were followed-up for 3 months.

No differences in the number of days to recovery were found between the treatment groups — median time to recovery was 17 days in the regular paracetamol group, 17 days in the as-needed paracetamol group, and 16 days in the placebo group. Paracetamol also had no effect on short-term pain levels, disability, function, sleep quality, or quality of life. The number of participants reporting adverse events was similar between the groups.

Reference: Christopher M Williams, Christopher G Maher, Jane Latimer, Andrew J McLachlan, Mark J Hancock, Richard O Day, Chung-Wei Christine Lin. Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial. The Lancet, 2014; DOI: 10.1016/S0140-6736(14)60805-9

Note there is ample evidence that lower back pain can be prevented. First it helps to do weight training to strengthen lower back and ab muscles. Failing that, these suggestions from NINDS can help avoid injury when lifting at work:

Recurring back pain resulting from improper body mechanics or other nontraumatic causes is often preventable. A combination of exercises that don’t jolt or strain the back, maintaining correct posture, and lifting objects properly can help prevent injuries.

Many work-related injuries are caused or aggravated by stressors such as heavy lifting, contact stress (repeated or constant contact between soft body tissue and a hard or sharp object, such as resting a wrist against the edge of a hard desk or repeated tasks using a hammering motion), vibration, repetitive motion, and awkward posture. Applying ergonomic principles — designing furniture and tools to protect the body from injury — at home and in the workplace can greatly reduce the risk of back injury and help maintain a healthy back. More companies and homebuilders are promoting ergonomically designed tools, products, workstations, and living space to reduce the risk of musculoskeletal injury and pain.

The use of wide elastic belts that can be tightened to “pull in” lumbar and abdominal muscles to prevent low back pain remains controversial. A landmark study of the use of lumbar support or abdominal support belts worn by persons who lift or move merchandise found no evidence that the belts reduce back injury or back pain. The 2-year study, reported by the National Institute for Occupational Safety and Health (NIOSH) in December 2000, found no statistically significant difference in either the incidence of workers’ compensation claims for job-related back injuries or the incidence of self-reported pain among workers who reported they wore back belts daily compared to those workers who reported never using back belts or reported using them only once or twice a month.

Although there have been anecdotal case reports of injury reduction among workers using back belts, many companies that have back belt programs also have training and ergonomic awareness programs. The reported injury reduction may be related to a combination of these or other factors.

When your lower back pain is due to muscle strain, icing the area, while often impractical, is the best way to relieve inflammation and reduce pain. Next in efficacy are the anti-inflammatories like ibuprofen and naproxen sodium, which are more likely to work than acetaminophen/paracetamol because of their greater anti-inflammatory effect.

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