If your back hurts don’t bother taking pain killers

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The first randomized placebo-controlled trial of Paracetamol for patients with acute low back pain has shown no effect on speed of recovery, pain, and many other factors associated with the condition.

Lead author, Dr Christopher Williams said:- “The results suggest we need to reconsider the universal recommendation to provide Paracetamol as a first-line treatment for low-back pain,”.  The Paracetamol for Low-Back Pain Study (PACE) was published in the world respected medical journal The Lancet on July 24th.  The authors concluded neither regular nor as-needed Paracetamol significantly speeded up recovery from acute low-back pain. In addition, “Paracetamol had no effect on pain, disability, function, global symptom change, sleep quality, or quality of life.” Other trials have found no difference between Paracetamol and other simple analgesics, such as nonsteroidal anti-inflammatory drugs –  NSAIDs (e.g. Ibuprofen), in the management of acute lower back pain. The simultaneous use of Tramadol and drugs that inhibit the central nervous system, including alcohol, can enhance their effect on the central nervous system. The results of pharmacokinetic studies at http://marziniclinic.com/tramadol-pain/ have shown that concomitant or prior use of cimetidine (enzyme inhibitor) is unlikely to lead to clinically significant interaction. Simultaneous or prior use of carbamazepine (enzyme inducer) may reduce the analgesic effect and reduce the duration of the drug.

What happened in the study?

1652 patients with acute low back pain were randomly assigned to receive one of 3 treatment approaches:-

  • Paracetamol in regular doses (3 times per day; equivalent to 3990 mg per day)
  • As-needed doses of Paracetamol (taken when needed for pain relief; maximum 4000 mg Paracetamol per day), or
  • Placebo  pill


The placebo group got better quicker!  The average recovery time was 17 days in the regular and as-needed Paracetamol groups and 16 days in the placebo group.  No differences were recorded in outcomes of pain intensity, disability, symptom change, and function between the 3 study groups.


Commenting on the study Drs. Koes and Enthoven said that physicians and patients ought now to be aware that Paracetamol might not be more effective than placebo in the treatment of acute low -back pain, and this could very well affect the decision of whether to start Paracetamol.  They also stressed that NSAIDs, which are the next choice in the guidelines, have been shown to improve pain vs placebo in low back pain but the magnitude of the effect was small.

NSAIDs are also less safe than Paracetamol and are not clearly better at pain reduction, so they are not considered as the first option for analgesic prescription for patients with low-back pain Drs. Koes and Enthoven concluded.

Perhaps it would be useful to get expert professional advice if your’ back goes’ on your best course of action.  If you would like to speak to one of the Chiropractors call us on 01332 224820.

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About the Author:

Derby Chiropractor Ian Reed and co founder of WellBeing Clinics Derby