Efficacy and safety of paracetamol for spinal pain and osteoarthritis

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Efficacy and safety of paracetamol for spinal pain and osteoarthritis
Key Take-Away: 

Paracetamol (acetaminophen) is the most common approach of general practitioners for the treatment of pain in spinal & osteoarthritis; however there is a controversy about the use of paracetamol in these conditions. This particular study has tried to evaluate the efficacy and safety of paracetamol in the management of spinal pain and osteoarthritis of the hip or knee.

To investigate the efficacy and safety of paracetamol (acetaminophen) in the management of spinal pain and osteoarthritis of the hip or knee.

ABSTRACT: 
Background: 

To investigate the efficacy and safety of paracetamol (acetaminophen) in the management of spinal pain and osteoarthritis of the hip or knee.

Methods: 

In this systematic review and meta-analysis, we used various 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. 

We selected patients through randomised controlled trials and comparing the efficacy and safety of paracetamol with placebo for spinal pain (neck or low back pain) and osteoarthritis of the hip or knee. 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 summarize conclusions.

Results: 

Twelve 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 studybecause of adverse events (1.2, 0.9 to 1.5) was similar in the paracetamol and placebo groups. Patientadherence to treatment (1.0, 0.9 to 1.1) and use ofrescue medication (0.7, 0.4 to 1.3) was also similarbetween groups. “High quality” evidence showed that patients taking paracetamol are nearly four times morelikely to have abnormal results on liver function tests(3.8, 1.9 to 7.4), but the clinical importance of thiseffect is uncertain.

Conclusion: 

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.

BMJ 2015; 350:h1225
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