Back pain: Acetaminophen no better than placebos

I dislike BoingBoing’s headline on this. The study looks good – but doesn’t answer the main use that analgesics are for: does it reduce pain? They are NOT generally intended to reduce or improve healing, but to reduce the pain until the healing has happened.

So, I see this study as: drug doesn’t do something we don’t expect the drug to do.

And, I think BB’s headline mis-states the results, by generalizing from the specific question answered (healing time) to a general “no better”. The study does not say this in the general case.

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Well, the alternative non-opiate treatements (ibuprofen, etc) might improve healing, depending on the relative roles of inflammation vs actual damage. Personally, my back pain can go either way depending on how I irritated it; a few days of high dose ibuprofen has taken me from unable to walk to almost normal but last time it got worse while I was taking it. Some pain accelerates healing by keeping you from doing things that make the situation worse.

I am pretty sure that studies have shown that the placebo effect works even when you know it’s a placebo. I have no reference, but I probably saw it here…

I’m totally there with you guys. There is absolutely no upside to acetaminophen for me: does not mitigate any type of pain whatsoever, and it’s bad for the liver.

If its only real use is for fever, then why do medical personnel keep recommending it for various pain issues?

I’ve gone back to using aspirin as a simple, cheap solution that works great for me.


Not at all. When my kid was a baby and had a dangerous fever, the doctor had us alternate doses of Advil and Tylenol. Both are good against fever, but they don’t interfere with each other, so you can effectively double the maximum dose safely.

IANAD, but it worked.

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Is there any proof that ibuprofen is bad for your organs? I take them like candy on occasion for an old ankle break. I mean, who has had kidney failure because of ibuprofen. It’s just not proven. Kidney failure is genetic.

Also, immediate decaffeination. Plus a couple ibuprofen, if you feel like getting a head start on the pain and the hangover.

I liked your post, but then I read into the article. Pain reduction is one of the secondary outcomes they measure, and it is clear that there is no difference between acetaminophen and placebo group.

		Regular group (N=550)	As-needed group (N=546)	Placebo group (N=547)

Pain intensity
Week 1
N 517 499 504
Mean (SD) 3·7 (2·6) 3·8 (2·7) 3·6 (2·6)
Median (IQR) 3·0 (2·0–6·0) 4·0 (2·0–6·0) 3·0 (1·0–5·0)
Week 2
N 509 498 497
Mean (SD) 2·6 (2·6) 2·6 (2·5) 2·5 (2·5)
Median (IQR) 2·0 (0·0–4·0) 2·0 (0·0–4·0) 2·0 (0·0–4·0)
Week 4
N 509 507 499
Mean (SD) 1·7 (2·3) 1·8 (2·4) 1·7 (2·3)
Median (IQR) 1·0 (0·0–3·0) 1·0 (0·0–3·0) 1·0 (0·0–3·0)
Week 12
N 506 514 505
Mean (SD) 1·2 (2·2) 1·3 (2·2) 1·3 (2·3)
Median (IQR) 0·0 (0·0–1·0) 0·0 (0·0–2·0) 0·0 (0·0–2·0)


Here ya go:


I’d be more worried about potential hepatotoxicity than renal failure if you’re “popping them like candy” (or if you’re on any other meds that are either 1) mildly hepatotoxic or 2) have to be metabolized by the liver or 3) you drink alcohol a lot.


I seem to recall they can also lodge in the stomach and reduce the protective abilities of the stomach lining causing ulcers. (unlikely to happen if you have them with food, don’t lie down and several other things that reduce this risk)

Yeah, most of the cox inhibiting NSAIDS have GI ulceration as known side effects.

Not to mention cardiac issues secondary to renal impairment (primarily in people with pre-existing renal disease).

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My personal experience aligns with mathew’s. For me, para-c only works to fix headaches, and not at all on back pain.

I’ve heard that one of the few things that seems to have any positive effect for cluster headaches is shrooms/psilocybin. Have you ever tried that?

Diclofenac and its stronger friends are the ones I use when my back is whack, but I hate that all of the NSAIDs must be taken after food and will (more or less) turn me into a comatose zombie. Sometimes that release of tension is good but sometimes you have shit you need to do.

I have constant tension-type headaches, not cluster headaches. I have always had chronic tension-type headaches, though they weren’t constant growing up.

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Everyone on bbs has back pain!

Me, ibuprofen and paracetemol, alternating. Ibu gel works well - the only branded medication I buy - Nurofen gel.

But big wins from Arnica massage oil - relaxes the tension system a lot, so works well in conjunction with the NSAIDS

Also the fact that I’m training 40 years in advance to be the 80+ surfing champ. I push my docs and healers harder.

Same here. Aspirin seems to help me better than other NSAIDs for joint inflammation as well.

I’ve read that LSD, at very small doses also is effective on cluster migraines. Can’t report on experience personally.

This study was already over max recommended dosage which is being moved to 3g per day. Tylenol is a dangerous hoax.

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