The objective of this study was to assess the efficacy of
paracetamol (
acetaminophen) in the treatment of
pain and disability in patients with non-specific
low back pain. We conducted a systematic review of randomized controlled trials to assess the efficacy of
paracetamol in the treatment of
pain and disability in patients with non-specific
low back pain. A search for randomized controlled trials was conducted using the Medline, Embase and CINAHL databases. Trials were eligible if they were randomized controlled trials comparing
paracetamol to no treatment, placebo or another treatment in patients with non-specific
low back pain. Two of the authors independently assessed trials for methodological quality on the PEDro Scale and extracted data. Continuous
pain and disability data were converted to a common 0-10 scale; ordinal data were dichotomized (e.g., no
pain,
pain). The data was analyzed using the MIX version 1.61 meta-analysis software. Out of 205 unique articles found in the searches, 7 eligible trials were identified. The trials enrolled a total of 676 participants with 5 investigating acute
low back pain, 1 investigating chronic
low back pain and 1 investigating both. No trial provided data comparing
paracetamol to placebo and only one trial compared
paracetamol to no treatment. In general the trials were small (only 1 trial had >25 subjects per group) and of low methodological quality (only 2 had a score above 6 on the quality scale). All but one of the trials provided imprecise estimates of the effects of treatment with confidence intervals spanning clinically important beneficial and also harmful effects of
paracetamol. No trial reported a statistically significant difference in favor of
paracetamol. There is insufficient evidence to assess the efficacy of
paracetamol in patients with
low back pain. There is a clear need for large, high quality randomized controlled trials evaluating
paracetamol, to provide reliable evidence of
paracetamol's effectiveness in patients with
low back pain and to establish the validity of the recommendations in clinical guidelines.