Back pain: Acetaminophen no better than placebos


Yeah, I rely on ibuprofen.

Acetaminophen’s good for headaches though.


See! This is what happens when you let scientists who aren’t already bought and paid for by the pharmaceuticals companies do the research :wink:


Acetaminophen is only a pain reliever, not an anti-inflammatory, so I would not expect it to decrease the duration of the back problem. My question, as someone who has had back pain issues, is how did it effect the pain level on the days it was needed. During my last bout, back pain started at a level 9 and I was barely able to walk. If tylenol took the pain to a 5 that would be a great improvement and make me functional, even if it took the same amount of time for the pain to totally resolve. So my question would be the daily reduction in pain for tylenol vs. placebo.

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I thought it was already common knowledge that ibuprofen and aspirin were effective for muscle and joint pain, and acetaminophen for fever, but not so much the other way around.

I mean, it’s good when solid research confirms “common knowledge”, and often the research refutes it, or adds nuance to help us better apply it. I just find it surprising that acetaminophen, not aspirin or ibuprofen, is refered to as the “go-to, front-line treatment for back pain”

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No it isn’t. I’ve had chronic tension-type headaches all my life. Painkillers don’t work. Painkillers do cause rebound headaches, plus, in my experience, they also cause nausea, and intestinal pain, and they are ototoxic and may have contributed to my audiological issues.

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Surely it’s good for some headaches, if not yours?

In 1983, Pearce and coworkers studied adults with any severity of migraine, defined using the Prensky and Sommer criteria in a 2-way crossover RCT. Recruited patients attended a headache clinic as outpatients. Patients received either 400 mg of ibuprofen or 900 mg of acetaminophen. Primary outcome was any pain reduction. After scoring each attack as mild, moderate or severe, 17/23 (74%) and 17/26 (65%) found that the average severity of headaches decreased equally from baseline with ibuprofen or acetaminophen, respectively.

However, it does appear that ibuprofen is much better for specifically tension-related headaches:

Schachtel and colleagues published an RCT involving adults. Patients with a moderate to severe tension headache in an unidentified setting received either 400 mg of ibuprofen, 1000 mg of acetaminophen or a placebo. The primary outcome was not specified. Among the 613 patients enrolled, 455 were analyzed. Using a 100-mm visual analog Headache Pain Intensity Scale, pain intensity scores were significantly lower at 0.5, 1, 2, 3 and 4 hours with ibuprofen than with acetaminophen (p < 0.01). Complete pain-free status was obtained for 63% of the patients in the ibuprofen group compared with 34% in those treated with acetaminophen (p < 0.01).



Meanwhile, for high altitude headaches, acetaminophen seems to be as good as ibuprofen.

The only thing it does for me is damage my liver. It doesn’t help alleviate pain of any sort for me.


The patients in the study were aware that it was for the study of back pain, yes?

Would it not be more accurate to say that the placebo effect can be as effective as actual medication?

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Does not do much for me either. Someone should study that - is there a sub population that does not respond or responds less to acetaminophen. Maybe someone already has.


This comes as no surprise, to me either. As somebody who occasionally suffers from severe back pain, acetominophen has never done anything for me. Ibuprofen will help a little bit, but even that doesn’t really do much for me.

Yes, but my insurance plan doesn’t cover placebos.


Umm, no. That’s not what it says.

What it says under the heading “Interpretation”, in the abstract linked, is:

Our findings suggest that regular or as-needed dosing with paracetamol does not affect recovery time compared with placebo in low-back pain.

[emphasis added]

Please note the difference between “does not affect recovery time” and “is no better than.”

Shortening recovery time is not a painkiller’s only effect - patients also take painkillers to reduce pain.

Pain reduction can very, very useful even if it doesn’t dial the pain all the way down to 0 or 1 “full recovery” levels - just reducing it from, say, 9 to 4 is incredibly useful - and the abstract does NOT say what effect, if any, it had on pain levels prior to full recovery - only that that it didn’t shorten the time to full recovery.

And frankly, I wouldn’t really expect it to - it’s a painkiller, not an anti-inflammatory or a muscle relaxant.

Not really even sure why this was studied in the first place - acetaminophen may the “front line” painkiller, but only because it’s the safest thing to give someone when they first present
at the ER and the doc is uncertain of their history.

After there’s been time to fully evaluate the patient and her history, more effective painkillers and other more useful drugs are usually prescribed.

At least IME, here in the USA.


I thought the go-to, front-line treatment for back pain was drinking yourself stupid…


It doesn’t do shit for mine either. It does seem to help many people. My problem is they add it to every other medication with the excuse that it’s there to help. The real reason they add it to cough syrup, cold pills, codeine pills, and other stronger opiates is to keep people from using those drugs recreationally. It makes it too easy to take way too much acetaminophen unless you’re aware of it.


You may be onto something, we don’t seem to be alone.


Well, alcohol is a muscle relaxant, so long as it’s not a chronic condition it should help in reducing muscle spasms, and certainly you’ll be feeling no pain.

If it only works through the placebo effect, then by telling us this you get rid of the effect for those of us who benefit. Thanks a lot, Boing Boing, I say sarcastically.

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