Back Pain? Pick Your Pain Relievers Carefully.


If you reach for Tylenol® (acetaminophen) for an aching back, you may want to rethink your pain-management program. Recent research suggests that Tylenol and other brands of acetaminophen pain relievers, longtime family medicine cabinet staples, may not be the most effective or safest ways to manage certain conditions.

Several recent trials have evaluated acetaminophen for the management of pain in the neck and low back as well as pain in the hip or knee from osteoarthritis (arthritis that occurs when the protective cartilage on the ends of your bones wears down). The researchers were interested in how effectively acetaminophen helped manage these particular types of pain as well as whether the medicine caused any dangerous side effects.

To measure how well acetaminophen helped relieve pain, the researchers scored the participants pain on a scale of 0 to 100, with 0 representing no pain or disability and 100 representing the worst possible pain or disability. Patients in 13 clinical trials were given either acetaminophen for pain relief or a placebo. The researchers compared results between the two groups.

Based on findings from the trials, acetaminophen appeared fairly ineffective as a pain reliever for people with low back pain. People with hip or knee osteoarthritis, on the other hand, had some relief with acetaminophen, but only in the short term and to a minimal extent.

The researchers were also concerned about the safety of acetaminophen. Though the medicine didn’t appear to cause more side effects than the placebo during the trials, the researchers performed other tests that did show some potentially serious health risks with acetaminophen. Patients who took the pain reliever had almost four times the incidence of abnormal liver tests as patients who took placebo. These liver changes weren’t linked to immediate health problems, but they certainly confirmed that acetaminophen had an effect on the liver.

With unconvincing evidence that acetaminophen works as a pain reliever for low back pain and osteoarthritis of the knee and hip and a risk of side effects to the liver, you may want to ask your doctor about other ways to manage discomfort. He or she may prescribe more effective solutions, including exercise, stretching, and different medicines.


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 March 31;350:h1225. doi: 10.1136/bmj.h1225.


Understanding Back Pain