Ineffective? I say misleading.
You may have recently heard in the mainstream media that there is a big question hanging over the effectiveness of Paracetamol in the management of early back pain. This was based on a very recent study by Australian team of scientists who were published in the highly reputable journal, The Lancet. The link in this post about this study is to a newspaper article written in the UK about the findings.
As a little background to all of this, it has been recently found and become an International medical guideline that with early lower back pain, the best course of treatment is to take simple and regular Paracetamol and keep moving, or stay as active as you can.
This new research challenges these guidelines and asks for further research and trials into the effectiveness of Paracetamol. However, in my opinion, this news really needs to be interpreted very carefully.
Here is why....
Firstly to this article's title and the comments from the study's authors that simple pain medication 'does not work' for lower back pain. To state that this is the case has me all but a little concerned. How very misleading. The actual study found that in those with mild to moderate lower back pain taking part in the study, there was little difference in return to pain free function between groups taking Paracetamol and those taking a placebo tablet. Both worked and had good rates of recovery. Here are the details of the main findings:
- The number of days to recovery in the Paracetamol group was 17 days, and the placebo group, 16 days.
- By 12 weeks, sustained recovery (not needing further management) had occurred in 85% of the Paracetamol group and 84% in the placebo group.
OK, so there is not much difference in the 2 groups, but
- Would you say that these results indicate that Paracetamol is NOT effective? Certainly not.
- Would you NOT consider taking the advice from your GP to take Paracetamol with an attack of back pain based on these results? Certainly not.
OK, so taking a placebo has the same effect. In my opinion, the main question (and an exciting one) to come out of these findings is this.
What is at work here when pain reduces and function increases equally in groups taking real medications and placebos?
My thoughts? As we discover more and more about the human pain response and see its complexity, explaining phenomenon like placebo effects becomes a little easier. As we are discovering, pain is a complex output system from the brain and involves brain centres of emotion, memory, movement and sensory (to name a few). There is a saying going around that translates to something like this:
'If the brain thinks that you are doing enough to help to get better, then that is often enough.'
We are increasingly seeing that other 'psychosocial factors' predict good outcomes from injury and responses to pain. These can include ethics and belief systems about pain and exercise, confidence in health practitioners, positive outlooks to injury and life generally, socioeconomic status, happiness in the workplace, relationship happiness and general health and wellbeing. The list goes on and on.
So back to the study. I personally could hypothesise that there has been a list of probable factors influencing the similar rates to recovery in both placebo and Paracetamol groups. This could start with seeing a confident well spoken doctor with a clear management course communicated for the lower back pain attack. A simple and uncomplicated message involving a simple pill and the advice to 'keep moving'. This instils confidence in the injured. Keeping as active as possible keeps the movement or motor centre in the brain functioning well and therefore feeding healthy impulses about the brain. As pain starts to ease after those first few days and movement becomes easier, 'happy hormones' and natural occurring pain endorphins kick in more, further speeding up the road to recovery.
And on it goes....
To say that Paracetamol is ineffective in managing early lower back pain is misleading. It would be fairer to ask by what means is the tablet you are taking making an effect.