Using paracetamol for low back pain does more harm than good 98



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Manuela L Ferreira, George Institute for Global Health

Around a quarter of the world’s population is affected by low back pain, one of the ten leading causes of disability globally. But the painkiller routinely prescribed to most of these people may not only be unhelpful, it may actually be causing harm.

Apart from the obvious discomfort it causes, low back pain is among the main reasons for work absenteeism. According to the World Health Organization, it’s responsible for more than 100 million workdays lost per year in the United Kingdom and the loss of 149 million workdays or US$200 billion a year in the United States. In Australia, it’s the main medical condition keeping older people away from the workforce, and it’s associated with treatment costs of almost A$5 billion every year.


On the wrong track

Approximately nine out of ten people visiting a doctor because of low back pain don’t have a serious problem with their spine, such as a fracture, for instance, or any involvement of nerve tissue. For these patients, back pain is likely the result of strain or stress to lumbar spinal structures, including the muscles, ligaments or discs or a combination of all three.

Although it’s not possible to pinpoint the exact cause of low back pain in most people, we do know that the pain will resolve within six weeks for more than six out of ten. Clinical practice guidelines, which doctors use to help treat their patients, recommend that people suffering from low back pain should, in the first instance, be given a prescription for painkillers, such as paracetamol.

But research my colleagues and I published today in the BMJ shows paracetamol in particular is not only ineffective for treating low back pain, it may actually lead to toxicity in the liver when used. Not surprisingly, we think it’s time to review current recommendations for managing low back pain.

The study we published was a review of 13 trials published around the world, and reported on the effects of paracetamol based on more than 5,000 patients.

Significantly, the research highlights that a greater proportion of people being treated with paracetamol will have abnormal liver function tests, which might indicate liver toxicity. We also found paracetamol was neither effective nor safe for the treatment of osteoarthritis.


Better ways

Our findings are published weeks after another study confirmed an association between paracetamol use and increased risk of premature death, and cardiovascular, gastrointestinal and kidney disease. This link became apparent after four weeks of using the painkiller, and after 22 days of use, the risk of hypertension doubled.

This research also suggests reviewing the recommendations about prescribing paracetamol.

We do have other treatments for low back pain that are safe and effective. We know, for instance, that reassuring people with a new episode of low back pain of the benign nature of their condition, and impressing the importance of keeping up with normal daily activities will speed their recovery.

People with low back pain should discuss safer, more effective non-pharmacological options, such as physiotherapy, with their doctors. For those who fail to recover within six weeks, treatment options might need to include long-term lifestyle changes, including exercise and weight loss. They may also consider changing how they deal with the pain they’re feeling by focusing more on what they can do, rather than on what they can’t.

So while there might not be a quick fix for low back pain, there are ways to help people get better. Being more active and keeping your weight in a healthy range are two things that will help and they are also recommended for other chronic non-communicable diseases. These measures have excellent impacts on general well-being as well.

The Conversation

This article was originally published on The Conversation.
Read the original article.


Share your thoughts below: do you take paracetamol for back pain? Do you think that it works for you?

Manuela L Ferreira

Associate Professor in Medicine, The University of Sydney, Sydney Medical Foundation Fellow & Senior Research Fellow at George Institute for Global Health

  1. I thought we had a long, drawn out column about this a couple of days ago. The report from a man who recommended “reassurance” for back pain!! The man who’s obviously never had back pain of any kind.

  2. Agree with you absolutely Judy. That man should try struggling to get out of a chair when his back is killing him

  3. I have liver damage through taking prescribed Panadol Osteo for arthritis in my knee. I stopped taking them some time ago now and even though my LFT has improved it is still not normal and not sure if it ever will be. Only time will tell I guess. I rarely drink alcohol.

  4. They are aiming at lower back pain surely they mean pain anywhere , paracetamol would be just as harmful taken for instance neck pain etc .

  5. So what about the people, like me, that have chronic low back pain? I take paracetamol osteo, twice daily, 3 times when it is bad, and I have pain nearly every day. If i don’t have the paracetamol, I would be either chair or bed bound.

    3 REPLY
    • Unfortunately the warning on Panadol Osteo is not to take them for more than a few days at a time without medical supervision. That is something my doctor didn’t tell me when she told me I could take them. Now I only take a couple when I absolutely have to but never on a regular basis.

    • I thought Panadol osteo was a continuos tablet, rather than just a pain killer! I’ve been taking two in the morning and two at night every day for the past two years! Gulp!!!

    • The warning is on the packet. I just checked it again before my previous comment. I took 4 daily for quite a few months before I read it. Now I just take a couple when I really feel I need them. I’m not really totally convinced they do any good – maybe it’s just psychological!

  6. I read a report few years ago that the elderly are more prone to liver toxicity of Paracetamol due to the obvious reason that the body is much slower at this stage to process things. I work in a hospital ward that caters for the elderly and guess what? Just about everyone is on 4x a day regular Paracetamol!! Are research results just for info?

    3 REPLY
    • It’s all about the money as always. My mother has been in care for two years, finally I have her off 8 paracetamol a day. She says it didn’t make if she took it or not. It has been 8 weeks since took them and the problems in her gut have settled down and she’s so much better. She has an anti inflammatory cream she uses for her arthritis on her joints, still some pain there but not with her gut which is so much better. Elderly people need someone to go into bat for them and that will never be a pharmacist or a drug company.

    • Raylene I am on paracetamols 8…per day and have bad digestive problems….burning and feel nauseous…tonight I will not take them and tomorrow …longer…they do not kill the pain I guess I just hope they will…cannot exercise…need double hip replacement…..Thankyou..xx

    • Sometimes I wonder about research and just how right they really do get it and how many people were involved in the studies.????

  7. I find it frustrating when the dr says walk exercise . My feet have arthritis and iv arthritis of the spine hips knees hand . But I’m asked to exercise . I use to walk round the oval . But don’t feel safe any more . And my feet hurt me then for the rest of the day . I tell people I hurt all over some day quite bad but because they see no injury they got no idea .

    5 REPLY
    • Has your doctor checked you for lupus or fibromyalgia. If not, ask him to check for them. Your symptoms sound vwry similar to one or the other of these diseases.

    • I went gluten free for another reason but found that a lot of my joint pain eased as well, so I am thinking a lot of my inflammation in my joints was being caused by the gluten

    • Christine can you access a headed pool? If so just walking in the water is very helpful and because the water supports your body it’s not painful. Maybe your gp can refer you to a physio who also does water therapy, sometimes these are in local hospitals. I know how much water can help as I learned to walk again into the water n like you my body is full of arthritis so when I can I get to a heated pool.

      1 REPLY
      • I totally agree with your comments as long as the pool is warmer than 30 degrees. I have had four vertibrea fused in my lumber area and suffer from chronic pain in that area. The pool is about the only relief that I get from this pain, but, it is only temporally relieved until I leave the pool. I am on a large amount of pain medication and I believe that they are only masking some of the pain. Movement is wracked with pain as is standing and sitting.

    • It’s not as easy as that…If your bones are wearing down and joints are inflamed. Swimming does help or just lifting legs etc while sitting in ocean water. Helps keep weight off which enhances pain.

  8. I tend to agree with all comments thus far. When in chronic pain it is impossible to move freely let alone exercise. If Paracetamol causes so much damage why is it prescribed for children??? Another medication used for chronic arthritis is Voltaren which is a leading cause of stomach ulcers. When will these so called experts wake up and realise the cure is not always “in the mind”. I was married to a pharmacist and he often told of drugs being pushed by large pharmaceutical companies despite knowing the harm they caused when there were other alternatives that worked so much better with fewer side effects and at a lower cost to the consumer. Back pain is often associated with inflammation and can be relieved with a combination of anti-inflammatory and analgesic, with minimal side effects when managed properly.

    1 REPLY
    • No way will i take anti inflammatories.So many of them have dangerous side effects.I fractured my L3 and herniated a disc as well as sustaining a full thickness hip muscle tear.My doctor gave me all sorts of painkiller prescriptions and was annoyed when i would not have them filled.The pain has gradually eased but i am still aware of it after 24 weeks.I am trying to keep active as i seem to stiffen up if i sit around for long.No paracetamol or other pain killers for me thank you.

  9. I rather liked Adam Hills comment on the recent Melbourne Comedy Festival “My doctor said I could take as many Panadol Osteo as I liked because they did nothing – so I decided to take Panadaol Rapid to do nothing faster….”

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