Back pain: Medicine now recommends Chiropractic as the first means of treatment

Medical Doctors and Chiropractors are generally at odds with each other, until recently when the Journal of the American Medical Association (JAMA) published a study recommending Chiropractic care as the FIRST means of treatment for back pain. This recommendation comes after the medical journal ‘Spine’ published a study showing a significant increase in pain relief when back pain was treated by a Chiropractor (Goertz, 2013). 

The research found that 73% of the participants who received both standard medical care (SMC) and Chiropractic care, reported that their pain was completely gone or much better after the treatment, compared to the 17% of the participants who received only SMC (Pertzborn, 2014).  

Lower back pain (LBP) is the leading cause of disability worldwide and in Australia, utilises $4.6 billion of the national health budget (ninemsn, 2014). Paracetamol is the number one drug prescribed to patients to treat LBP and is still part of the medical guidelines, however its effectiveness is now being questioned (ninemsn, 2014).  

What high quality evidence IS out there to support the recommendation that paracetamol is the best treatment for LBP? 

 A group of Australian researchers have published a new study in Lancet, one of the most renowned research journal in the world. The first large randomised controlled trial to compare the effectiveness of paracetamol with placebo for low-back pain. (Williams, et al., 2014) They have found paracetamol to be no more effective than placebo at speeding recovery from acute episodes of lower back pain. Nor does it improving pain levels, function, sleep, or quality of life. “Paracetamol has been found to be effective for some acute pain conditions, such as tooth pain, acute post-surgical pain and headache, in this case it’s not effective for acute back pain,” Associate Professor Christine Lin said (Williams, et al., 2014). 

The Paracetamol for Low-Back Pain Study (PACE) randomly assigned 1652 individuals (average age 45 years) with acute low-back pain from 235 primary care centres in Sydney, Australia to receive up to 4 weeks of paracetamol in regular doses (three times a day; equivalent to 3990 mg per day), paracetamol as needed (maximum 4000 mg per day), or placebo. All participants received advice and reassurance and were followed-up for 3 months. 

They found no differences in the number of days to recovery between the treatment groups. Median time to recovery was 17 days in the regular paracetamol group, 17 days in the as-needed paracetamol group, and 16 days in the placebo group. Paracetamol also had no effect on short-term pain levels, disability, function, sleep quality, or quality of life. The number of participants reporting adverse events was similar between the groups. 

 Paracetamol is such a commonly used drug and considered a mild drug because most wouldn’t think twice about the negative effects before taking it.

Paracetamol had serious risks of harm that are well established. These include; fatal skin reactions, cumulative toxicity, mild repeated over-dosing leading to fatality, and more recently links to ADHD when used during pregnancy. 

“Painkillers such as paracetamol might not be of primary importance in the management of acute lower back pain”. “The results suggest we need to reconsider the universal recommendation to provide paracetamol as a first-line treatment for low-back pain.”  said lead author Dr Christopher Williams from the George Institute for Global Health at the University of Sydney in Australia. 

These findings show that paracetamol is ineffective as a treatment for low-back pain. The AMA are now recommending Chiropractic is the most evidence base choice.  

References 

1. ninemsn. (2014, July 24). New study shows paracetamol may be ‘ineffective’ in treating lower back pain. Retrieved from 9 News: http://www.9news.com.au/national/2014/07/24/21/53/new-study-shows-paracetamol-may-be-ineffective-in-treating-lower-back-pain 

2. Pertzborn, J. (2014, July 14). JAMA recommends chiropractic as first means of back pain treatment. Retrieved from Fox2now: Fox2Now 

3. Williams, C. M., Maher, C. G., Latimer, J., McLachlan, A. J., Hancock, M. J., Day, R. O., & Cung-Wei, C. (2014, July 24). Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial. Retrieved from The Lancet: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60805-9/abstract 

DC, MPH. SPINE Volume 38, Number 8, pp 627–634 Article

8. Acetaminophen Poses Risk for Rare but Fatal Skin Reactions, Robert Lowes, Aug 01, 2013 

 9. Acetaminophen: Repeated Use of Slightly Too Much Can Be Fatal, Laurie Barclay, MD, Nov 22, 2011  

10. Regular Analgesic Use May Increase Risk for Hearing Loss, Fran Lowry, March 11, 2010  

11. NICE warns against prescribing paracetamol for osteoarthritis, 15 August 2013, By Alistair Stirling