Paracetamol and acute back pain

Karen, a 45-year-old registered nurse, presented with acute low back pain, a day after awkwardly transferring a patient.

She was otherwise well with no red flags. In an online discussion forum (GPs Down Under), I recalled reading about a new systematic review in the BMJ that claimed paracetamol was ineffective for low back pain.1 Is this true?

CLINICAL QUESTION

Is paracetamol effective at reducing pain and/or disability in acute low back pain?

What does the existing research evidence say?

Step 1: The Cochrane Library

The Cochrane Library did not have a systematic review for paracetamol. There was a review for NSAIDs that concluded “moderate evidence that NSAIDs are not more effective than paracetamol for acute low back pain, but paracetamol had fewer side effects”.2

Step 2:

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