Clinical guidelines recommend paracetamol as the first-line analgesic drug for both spinal pain and osteoarthritis of the hip and knee. This guidance has recently been called into question, and a meta-analysis published in The
(2015;350:h1225) casts further doubt on the use of paracetamol in these conditions.
An analysis of 13 randomised trials yielded evidence that paracetamol is ineffective for reducing pain and disability in people with lower back pain. Patients taking paracetamol were also around four times more likely to have abnormal results on liver function tests. For osteoarthritis, paracetamol was found to provide small, short-term benefit on pain and disability.
The results support the reconsideration of recommendations to use paracetamol in these patients, the researchers conclude.
 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. The BMJ 2015;350:h1225. doi:10.1136/bmj.h1225.