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Paracetamol: Liver Failure and Useless for Back Pain

Panadol: Associated with Hepatitis and Ineffective for Back and Neck Pain

The most commonly used medication for back and neck pain – Paracetamol, has been proven to be useless. No better than placebo or a sugar pill. Despite being ‘the‘ recommended front line treatment for back pain in the ‘scientific’ community for over 50 years – no one has really bothered to check it. Until now.

Amazingly, previous studies on the efficiency of Panadol and other Paracetamol containing products were self reported trials of less than 25 people; usually run by the drug manufacturers. Yet they were adopted as ‘Evidenced Based Medicine’ for the treatment of back pain, for more than half a century. One has to question, is it evidence based medicine or selective evidence based medicine?

Prior to that, patients were recommended products like Bex containing phenacetin which according to the NSW Cancer Council killed many patients by causing kidney cancer. Incidentally Bex was banned in 1977 when they were finally linked with high rates of kidney disease. Since then we have seen a significant reduction of kidney and pelvic cancers. I have written about Paracetamol in the past, as it causes extensive damage to the liver and the kidneys. Indeed Paracetamol, has surpassed hepatitis and alcohol to become the most common cause of liver failure in Australia. Patients should always avoid or be very judicious in the use of Paracetamol, as accidental overdose can easily occur when you are struggling with pain resulting in liver failure and avoidable death.

Paracetamol

Background

Low back pain is the leading cause of disability world wide. It is the second most common reason for patients to visit a GP. This study was published by the Lancet, which is a very prestigious medical journal.  The large double-blind randomised controlled trial test more than 1600 patients and was carried out by researchers from the University of Sydney, University of New South Wales and University of Newcastle, all in Australia.

According to the authors of the study, although paracetamol is the recommended first-line analgesic for acute low-back pain – No high quality evidence supports this recommendation. All seven of the included trials had substantial methodological flaws, and only one trial included more than 25 participants per group. The authors aimed to assess the efficacy of paracetamol taken regularly or as-needed to improve time to recovery from pain, compared with placebo, in patients with low back pain. The trial was funded by, in part, by GlaxoSmithKline Australia – the makers of Panadol, so as you can imagine, they really wanted it to work. Indeed, they gave some patients some very serious doses. Up to 4000 mg per day! If you stayed on this dose for an extended time, you would most certainly develop liver dysfunction and perhaps liver cirrhosis.

One group received a placebo, another was told to take paracetamol as needed (maximum 4000 mg per day) and a third received up to four weeks of paracetamol in regular doses (three times a day; equivalent to 4000 mg per day).

“The study concluded that Paracetamol had no effect on short-term pain levels, disability, function, sleep quality, or quality of life, and the number of patients reporting negative side effects was similar in all groups.”

Not a good outcome for the sponsoring drug company – what a shame.

 

Evidence Based Medicine (EBM) or Selective Evidence Based Medicine (SEBM)?

As a Chiropractor, we have always copped endless flak about not being scientific. No matter what research we provide. Without getting on a soap box, I find the elephant in the room a little too much to ignore. So I apologise, but I have to comment here. The number one reason for patients to visit a medical practitioner in Australia is for a cold. An upper respiratory tract infection (URTI). The second most common reason for patients of our taxpayer funded medical system to visit a GP, is back pain.

For colds, the overwhelming majority of patients receive antibiotics even though nearly all URTI’s are caused by viruses. Patients have no business taking an anti-microbial for a virus. They simply do not work, are not clinically indicated, with no evidence supporting the use of antibiotics for a virus. Indeed recent evidence out of the University of London suggests that the use of antibiotics should be avoided, except for life threatening conditions. And they consider that pneumonia is not life threatening. Studies now show that your gastro-intestinal system will take up to 4 years to recover from a course of antibiotics – with appropriate re-culturing by specific probiotic strains. It is a bit like spraying your back yard with Roundup and wondering why things don’t grow back as they should.

With regard to back pain, we see that there never was any evidence to support the accepted treatment paradigm for decades. The trials for Paracetamol were ridiculously small and of poor quality. On the other hand, there is quite good evidence for the treatment of back pain with spinal manipulative therapy. And the pioneers, developers and custodians of this art over the last few centuries are without doubt Chiropractors. More recently Physiotherapists, Medical Practitioners and Surgeons have been producing very nice work in this area.

The question is, why does it take so long to stop recommending drugs that either don’t work for colds and back pain, or cause further damage to the patient?

 

So, What are the Findings of the Trial?

PARACETAMOL is the pill universally recommended worldwide to treat back pain but it doesn’t speed recovery or reduce the pain a startling new study has found.

The first ever placebo controlled study of the drug’s use in lower back pain conducted by Australian researchers is likely to prompt the rewriting of official medical guidelines.

Associate Professor Christine Lin of the George Institute and Sydney University tested more than 1,600 patients and found the median recovery time from lower back pain was 16-17 days whether patients used paracetamol or not.

In her study published in The Lancet medical journal today some patients in the trial were given regular paracetamol; some were given the drug as required while others were given a placebo.

“We have demonstrated that taking paracetamol does not speed recovery or reduce pain compared to placebo,” she said.

Professor Lin said she was “very surprised” by the results especially as the medicine was universally recommended.

“Every set of guidelines in the world recommend you commence paracetamol as the first line of treatment,” she said.  Professor Lin says the most important option for treating back pain was to remain as active as possible and avoid bed rest.

Patients could try heat packs to relieve discomfort. There was evidence that a course of spinal manipulation can help control pain.

Professor Lin said there should be a rethink of official guidelines on treating back pain in the light of her study’s results.

These guidelines all recommend the use of paracetamol despite the fact no previous studies have provided convincing evidence it effective in low back pain.

The authors of the study did recommend three things. Mobility, Heat, Spinal Manipulation.

Sounds like the world is catching up with Chiropractic Care.

Further Reading

For a full copy of the report – Efficacy of paracetamol for acute low-back pain.

 

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