Paracetamol 'ineffective for treating back pain and osteoarthritis'

Taking paracetamol may not be an effective means of offering relief for back pain and osteoarthritis, according to a new study led by the University of Sydney.

The Australian research, which was published in the British Medical Journal, has once again challenged existing UK recommendations from the National Institute for Health and Care Excellence (NICE), which suggests paracetamol as a first-line therapy for both conditions.

A systematic review and meta-analysis was carried out to examine the efficacy and safety of paracetamol for these indications, including 13 randomised controlled studies involving more than 5,000 patients that looked at the effects of paracetamol use compared with a placebo.

Results showed that paracetamol had no effect among lower back pain sufferers and did not reduce disability or improve quality of life, while for osteoarthritis, the pain and disability benefits were considered to be small and not of clinical importance.

Moreover, paracetamol use for osteoarthritis was also linked to a fourfold increase in the likelihood of having abnormal results on liver function tests, though the clinical relevance of this was not ascertained.

It was noted that the longest follow-up period of any of the studies was only six months, meaning further research is needed to determine the effects of the drug over a longer period of time.

However, the researchers concluded: "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."

In 2013, NICE warned of concern that higher doses of paracetamol could lead to multiple adverse effects, including heart, kidney and intestinal problems, and recommended GPs only prescribe the lowest effective dose for the shortest possible time.

The Medicines and Healthcare products Regulatory Agency is now carrying out a wide-ranging review of over-the-counter painkillers, including paracetamol, and until that work is completed, NICE has said it will continue to recommend paracetamol as an option.

A spokeswoman for Arthritis Research UK said: "We've known for some time that paracetamol may not work for everyone with severe pain from their arthritis, but some people find it helps them, and allows them to sleep and to exercise without discomfort.

"Exercise, keeping moving and losing weight are effective ways in which people with osteoarthritis can help themselves. In fact, physical activity is probably a better and more effective way of keeping the pain of arthritis and joint pain at bay than taking currently available painkillers.

"We recognise that there is a big, unmet need for more effective, well-tolerated painkillers for arthritis and joint pain, which we as a medical research charity and others have made a priority.

"People with arthritis who are concerned about taking paracetamol should consult their GP about alternative medications or other approaches to pain management, such as exercise and weight loss."

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