Acetaminophen (Paracetamol) Minimally Effective for Back Pain and Osteoarthritis


Am Fam Physician. 2015 Oct 1;92(7):642.

Clinical Question

Is acetaminophen (paracetamol) effective for the treatment of low back pain or osteoarthritis?

Bottom Line

Although acetaminophen was hoped to be a safer alternative to nonsteroidal anti-inflammatory drugs and opioids for the treatment of common musculoskeletal problems, on average it provides only minimal pain relief and improvement in function for patients with low back pain or osteoarthritis. Some persons may benefit with full dosages of acetaminophen but most will not. (Level of Evidence = 1a)


To identify all randomized controlled trials, the authors searched nine databases, including the Cochrane Registry. Two investigators independently selected articles for inclusion and extracted the data. Two investigators evaluated the quality of the 13 research studies, most of which were of good quality. Most of the studies used full dosages of acetaminophen (3,900 to 4,000 mg daily). There was no evidence of publication bias. For patients with low back pain, high-quality research in more than 1,000 patients found a lack of effectiveness on pain and disability in either the immediate (less than two weeks) or short-term (two weeks to three months) follow-up periods. For hip or knee osteoarthritis, acetaminophen produced a statistically significant but clinically unimportant effect on pain and disability over the immediate or short term. The research results were homogeneous except for immediate-term disability. Adverse effects were minimal. Patients receiving acetaminophen were more likely to have higher liver-function test results (greater than 1.5 times normal) than patients receiving placebo.

Study design: Meta-analysis (randomized controlled trials)

Funding source: Self-funded or unfunded

Setting: Various (meta-analysis)

Reference: Machado GC, Maher CG, Ferreira PH, et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ. 2015; 350: h1225.

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

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This series is coordinated by Sumi Sexton, MD, Associate Medical Editor.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.



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