Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials

Abstract

Objective To investigate the efficacy and safety of paracetamol (acetaminophen) in the management of spinal pain and osteoarthritis of the hip or knee. Design Systematic review and meta-analysis. Data sources Medline, Embase, AMED, CINAHL, Web of Science, LILACS, International Pharmaceutical Abstracts, and Cochrane Central Register of Controlled Trials from inception to December 2014. Eligibility criteria for selecting studies Randomised controlled trials comparing the efficacy and safety of paracetamol with placebo for spinal pain (neck or low back pain) and osteoarthritis of the hip or knee. Data extraction Two independent reviewers extracted data on pain, disability, and quality of life. Secondary outcomes were adverse effects, patient adherence, and use of rescue medication. Pain and disability scores were converted to a scale of 0 (no pain or disability) to 100 (worst possible pain or disability). We calculated weighted mean differences or risk ratios and 95% confidence intervals using a random effects model. The Cochrane Collaboration’s tool was used for assessing risk of bias, and the GRADE approach was used to evaluate the quality of evidence and summarise conclusions. Results 12 reports (13 randomised trials) were included. 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. 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any adverse event (risk ratio 1.0, 95% confidence interval 0.9 to 1.1), any serious adverse event (1.2, 0.7 to 2.1), or withdrawn from the study because of adverse events (1.2, 0.9 to 1.5) was similar in the paracetamol and placebo groups.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. “High quality” evidence showed that patients taking paracetamol are nearly four times more likely to have abnormal results on liver function tests (3.8, 1.9 to 7.4), but the clinical importance of this effect is uncertain. Conclusions Paracetamol is ineffective in the treatment of low back pain and provides minimal short term benefit for people with osteoarthritis. These 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. Systematic review registration PROSPERO registration number CRD42013006367.

Knowledge and attitude of analgesics use among Saudi population: A cross-sectional study

“…[2] There are little side effects for healthy adults taking regular doses of up to 4000 mg (e.g., gastrointestinal upset) but there is some administration cautions especially in cases of liver diseases, hypersensitivity to acetaminophen, severe renal impairment, I.V administration, chronic high dose and risk of hepatotoxicity is higher in alcoholism. [5,6] Due to paracetamol present in many OTC drugs and checking of drugs labels is significant necessity to ensure that total daily dose of paracetamol from different products does not encroach maximum daily dose. [6] NSAID is used to treat pain and reduce inflammation.…”

The Recent Trend in Diagnosis and Treatment of Chronic Low Back Pain

“…Other studies indicate that acetaminophen has a general blunting effect on individuals' emotional processing 51) and that acetaminophen is not effective in the treatment of low back pain and provides minimal short-term benefit for people with osteoarthritis 52) . There are some studies opposing the above opinions.…”

A 46-year-old man with acute low-back pain

“…Acetaminophen may be prescribed as a therapeutic trial, although recent evidence from randomized trials has shown that it is not effective for reducing pain, disability or recovery time in people with acute low-back pain. 9 Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed as a therapeutic trial, given that the evidence has shown small improvement in pain intensity. 10 However, Choosing Wisely Canada recommends against prescribing NSAIDs (including cyclo-oxygenase type 2 inhibitors) for patients with hypertension because of potential cardiovascular and renal complications (Box 1).…”