Paracetamol: useless for lower back and joint pain
Luise Heine has been an editor at since 2012. The qualified biologist studied in Regensburg and Brisbane (Australia) and gained experience as a journalist in television, in the Ratgeber-Verlag and in a print magazine. In addition to her work at , she also writes for children, for example for the Stuttgarter Kinderzeitung, and has her own breakfast blog, “Kuchen zum Frühstück”.
More posts by Luise Heine All content is checked by medical journalists.MunichParacetamol is hardly missing in any medicine cabinet. This is a classic way of lowering a fever, for example. However, many resort to it primarily to relieve pain. At least for some types of pain, this is not a good idea, as Australian researchers have now discovered.
The researchers led by Prof. Manuela Ferreira from the University of Sydney based their analysis on 13 placebo-controlled studies. In their meta-study, the data of over 3,500 patients with osteoarthritis of the hip or knee and around 1,800 people with back pain were compared. The scientists paid particular attention to pain relief, improving mobility and thus a possible increase in quality of life.
No relief from lower back pain
The results were sobering: compared to placebos, paracetamol did not help at all against back pain. There was no difference in the effect against pain, nor were the patients more agile again or benefit in terms of quality of life. Backache is one of the most common complaints in which the active ingredient is often used for self-medication.
It looked only a little better with joint wear. The scientists were only able to determine a very slight alleviation of the symptoms due to the active ingredient. Overall, paracetamol performed four points better than a placebo - on a 100-point scale. A difference that the researchers judged to be irrelevant. How the remedy works against other forms of pain, such as headaches, and whether other active ingredients help better with osteoarthritis and back pain, the investigation does not provide any information.
Risk of liver damage
Ferreira and her team are also concerned about a side effect of paracetamol: On average, the levels of certain liver enzymes increased fourfold when the active ingredient was taken. “We cannot yet assess to what extent this is clinically relevant,” the researchers write. Nevertheless, they see the recommendation of paracetamol in the treatment lines for back and joint problems as critical and demand that it be reviewed.
Not too much and not too often
A British study recently advised that the dose and duration of treatment of the active ingredient should be carefully selected. Because taking it too carelessly poses a risk to the heart, kidneys and gastrointestinal tract. Therefore, the recommended maximum daily dose of four grams should be exhausted as rarely as possible.
It is the world's best-selling drug for the treatment of a wide variety of acute and chronic pain, as well as fever. In the central nervous system, it inhibits the enzyme COX-3, which in turn regulates the production of an inflammatory messenger substance. It also affects two systems that also have analgesic and calming effects: the endocannabinoid and the serotonin system.
Ibuprofen, ASA and diclofenac are also available as alternative medications for the treatment of minor pain that are also available without a prescription. However, these can also have problematic side effects - such as increasing the risk of bleeding or attacking the stomach. For some underlying diseases or during pregnancy, paracetamol may be the only alternative. Basically, you shouldn't take pain medication for more than ten days a month.
Source: Gustavo C Machado et al .: Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomized placebo controlled trials; BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h1225
