Medical guidelines around the world recommend acetaminophen as a first-line treatment for adults with lower back pain. Acetaminophen is sold under brand names including Tylenol, Panadol and Anacin.

Recently, a large trial has found that acetaminophen works no better than placebo for lower back pain.

“Our result illustrates the problems in relying on that indirect evidence when getting guidelines,” said Christopher M. Williams, a researcher at the George Institute for Global Health in Sydney, and lead author of the study, published in The Lancet.

Dr. Bart W. Koes, who wrote an editorial accompanying the paper said that while the study was large and methodologically sound, it was not necessarily the last word on the subject.

“The fact that it’s no more effective than placebo does not mean that it doesn’t work for a given patient,” said Koes, a professor of general practice at Erasmus University Medical Center in Rotterdam, Netherlands.

Dr. Williams said that acetaminophen has been shown to be effective for toothache, headache, and pain after surgery, but the mechanism of back pain is different and poorly understood. He said doctors should not initially recommend acetaminophen to patients with acute low back pain.

But, he added, “If patients already taking it feel they are getting a benefit, then it wouldn’t be wise to tell them to stop.”   7/23/14


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