To Your Health
April, 2015 (Vol. 09, Issue 04)
A Poor Choice for Relieving Your Low Back Pain
By Editorial Staff
Acetaminophen is the most popular pain reliever in the U.S., accounting for an estimated 27 billion annual doses as of 2009. With 100,000-plus hospital visits a year by users, it's also the most likely to be taken inappropriately.
In fact, improper use, coupled with the drug's narrow safety margin, means "a large fraction of users [are] close to a toxic dose in the ordinary course of use," according to the Food and Drug Administration.
But for the sake of discussion, let's ignore the safety issues for a moment. Is acetaminophen an effective pain reliever in the first place? Not for low back pain and pain attributable to knee / hip osteoarthritis, conclude the authors of a recent meta-analysis. The just-published review of 13 randomized trials has yielded "high-quality evidence" that paracetamol (acetaminophen) does not reduce pain intensity or disability, and does not improve quality of life, in the short term for people experiencing LBP; and provides only "minimal, short-term benefit" for people suffering from hip or knee pain caused by OA, stating that "the small effects ... are not likely to be meaningful for clinicians or patients."
Back to the safety issues surrounding acetaminophen, which the meta-analysis did little to dilute. According to the review researchers, "high-quality" evidence suggests paracetamol use results in a fourfold risk of an abnormal liver function test. Not surprising, since acetaminophen misuse (overdose) is now the most common cause of acute liver failure (exceeding all other medications combined) and the second most common cause of liver failure requiring transplantation.
In fact, the FDA has mandated that all acetaminophen-containing prescription products feature a "black box" warning (the administration's strongest safety statement) noting an overdose can cause liver failure and even death; and have been urged to place similar language on OTC acetaminophen products.
How often do you use acetaminophen-containing over-the-counter and/or prescription medications for you LBP and OA pain, even as you pursue relief through chiropractic care? How often do you take these drugs for your spinal / OA pain instead of visiting a chiropractor? As this meta-analysis suggests, acetaminophen is ineffective for these types of pain. So give chiropractic a try – a proven natural pain reliever.
- Machado GC, et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised, placebo-controlled trials. Brit Med J, 2015;350. Full text available online.
- Dal Pan GJ. "Acetaminophen: Background and Overview." FDA Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, June 29, 2009.
- Greenlaw E. "Your Guide to Over-the Counter Pain Relief. OTC Pain Relief: Understanding Acetaminophen." WebMD.com.
- Healy M. "Acetaminophen in Rx Drugs: For Liver's Sake, Lower the Dose." Los Angeles Times, April 28, 2014.
- Gerth J, Miller TC. "Use Only as Directed." ProPublica, Sept. 20, 2013.