Paracetamol for low back pain

Saragiotto, Bruno Tirotti; Machado, Gustavo C; Ferreira, Manuela L; Pinheiro, Marina B.; Shaheed, Christina Abdel; Maher, Christopher G.

doi:10.1002/14651858.cd012230

Cited by 135 publications

(114 citation statements)

References 53 publications

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“…Previous guidelines recommended paracetamol as the first option in the management of LBP; however, it is no longer recommended in updated guidelines for either acute or chronic patients (high and low quality evidence, respectively) 7 . ‐ 10 A recent Cochrane systematic review (1825 participants) found that paracetamol does not result in better outcomes compared with placebo for patients with acute LBP, and its effect on chronic LBP is uncertain 24 . Non‐steroidal anti‐inflammatory drugs are endorsed in three of the four guidelines (moderate quality evidence), 7 , 9 , 10 which is consistent with a recent systematic review demonstrating the efficacy of this class of medicine for both acute and chronic LBP 25 .…”

Section: Treating Non‐specific Low Back Painsupporting

confidence: 54%

Primary care management of non‐specific low back pain: key messages from recent clinical guidelines

Almeida

Saragiotto

Richards

et al. 2018

Medical Journal of Australia

120

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Research in the past decade supports some major changes to the primary care management of non-specific low back pain (LBP). The present article summarises recommendations from recently published United Kingdom, Danish, Belgian and United States guidelines to alert readers to the important changes in recommendations for management, and the recommendations from previous guidelines that remain unchanged. Main recommendations: Use a clinical assessment to triage patients with LBP. Further diagnostic workup is only required for the small number of patients with suspected serious pathology. For many patients with non-specific LBP, simple first line care (advice, reassurance and self-management) and a review at 1-2 weeks is all that is required. If patients need second line care, non-pharmacological treatments (eg, physical and psychological therapies) should be tried before pharmacological therapies. If pharmacological therapies are used, they should be used at the lowest effective dose and for the shortest period of time possible. Exercise and/or cognitive behavioural therapy, with multidisciplinary treatment for more complex presentations, are recommended for patients with chronic LBP. Electrotherapy, traction, orthoses, bed rest, surgery, injections and denervation procedures are not recommended for patients with non-specific LBP. Changes in management as a result of the guidelines: The major changes include: emphasising simple first line care with early follow-up; encouraging non-pharmacological treatments over pharmacological treatments; and recommending against the use of surgery, injections and denervation procedures.

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Section: Treating Non‐specific Low Back Painsupporting

confidence: 54%

Primary care management of non‐specific low back pain: key messages from recent clinical guidelines

Almeida

Saragiotto

Richards

et al. 2018

Medical Journal of Australia

120

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“…In a systematic review, Zulman et al found that pharmacologic interventions were assessed in 68.9% of the RCTs for older adults with complex health issues, whereas our results revealed that pharmacologic agents were planned for only 27.4% of the protocols. Perhaps this difference is due to the limited effectiveness of pharmacologic interventions for LBP in the literature . More important than not showing the efficacy of pharmacologic agents, the exclusion of older adults from these CTs prevent the development of knowledge regarding adverse events …”

Section: Discussionmentioning

confidence: 99%

Exclusion of Older Adults from Ongoing Clinical Trials on Low Back Pain: A Review of the WHO Trial Registry Database

Nascimento

Ferreira

Poitras

et al. 2018

J American Geriatrics Society

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Background/Objectives The burden of low back pain (LBP) is high, especially for older adults who experience a higher number of years living with a disability. However, this population is not being well represented in clinical trials (CTs). This study analyzed the International Clinical Trial Registry Platform (ICTRP) database from the World Health Organization to verify the future trend in the participation of older adults in registered CTs on LBP. Design We performed a cross‐sectional review of the ICTRP searching for prospective protocols planning interventions for LBP with registration dates from January 2015 through November 2018. From the protocols of the eligible studies, we extracted those planning to include older adults. Results A total of 167 protocols for CTs for LBP were planning to recruit participants older than 65 years. However, only five registries (2.99%; pooled sample = 169 participants) were designed to target participants specifically older than 65 years. The exclusion of older participants was not justified and imposed through an arbitrary upper‐age limit in 93.6% of the protocols. Most of the protocols are from single‐center studies, and a greater number are planned to be carried out in developed regions. Higher interest was in pharmacologic interventions, devices/technology, and physical rehabilitation. Conclusion Older adults with LBP will continue to be underinvestigated in CTs for LBP in the near future. In general, ongoing trials are small, planned in developed regions, and proposing pharmacologic interventions to deal with LBP. J Am Geriatr Soc 67:603–608, 2019.

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“…It is now known that acetaminophen is not effective in substantially reducing chronic pain conditions such as osteoarthritis, back pain or post-operative pain [47,48]. A careful, systematic and thorough review of acetaminophen use becoming a public health and ethical concern must be gauged in depth across the globe.…”

Section: Acetaminophenmentioning

confidence: 99%

Pharmacovigilance of the Analgesic Therapy

Ussai¹

2017

Pain Relief - From Analgesics to Alternative Therapies

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Analgesics, the cornerstone for the alleviation of both acute and chronic pain, represent one of the most used classes of medications. While they are essential for the improvement of patients' quality of life, analgesic use is often associated with adverse drug reactions (ADRs) that might affect their usability in particular clinical situations. This indicates that a detailed knowledge of analgesic-derived ADRs is essential for the planning of an efficient pain relief strategy. This chapter reviews the ADRs associated with the two most commonly used analgesic classes, opioid and nonsteroidal antiinflammatory drugs (NSAID), discussing their common adverse effects and how these can influence their usability in clinical applications. With the publication in recent years of more and more long-term studies, this chapter also provides an overview of the potential risks of long-term analgesic use. This is particularly important for opioid analgesics, whose chronic use can lead to analgesic tolerance and addiction. A full description of potential problems deriving from analgesic use represents the first step in optimizing protocols for its safe application in clinical settings.

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Paracetamol for low back pain

Abstract: We found that paracetamol does not produce better outcomes than placebo for people with acute LBP, and it is uncertain if it has any effect on chronic LBP.

Cited by 135 publications

References 53 publications

Primary care management of non‐specific low back pain: key messages from recent clinical guidelines

Primary care management of non‐specific low back pain: key messages from recent clinical guidelines

Exclusion of Older Adults from Ongoing Clinical Trials on Low Back Pain: A Review of the WHO Trial Registry Database

Pharmacovigilance of the Analgesic Therapy

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