brand logo

Am Fam Physician. 2015;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: MachadoGCMaherCGFerreiraPHet alEfficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ2015; 350: h1225.

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to

This series is coordinated by Natasha Pyzocha, DO, contributing editor.

A collection of POEMs published in AFP is available at

Continue Reading

More in AFP

More in Pubmed

Copyright © 2015 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.