A recent research paper out of Australia on the effect of paracetamol for back pain has suggested it has no measurable effect on duration of back pain. It had more than 500 subjects so it has quite a bit of statistical significance. It was reported in Pulse (a web site dedicated to GPs in the UK) with a certain amount of surprise, particularly because the NICE guidelines for the treatment of back pain recommends paracetamol as the first line treatment. As the paper says, until the finding is reproduced by another paper this can only be a provisional discovery.
However, it is congruent with other papers I haves seen on the effectiveness or more the ineffectiveness of non-steroidal anti-inflammtories in treating back pain. Despite the ineffectiveness for back pain and relatively common side effects NICE recommends these too.
There is a problem here. Opioids are effective at controlling pain, however there are significant risks prescription medication abuse that is associated with opioids. This isn’t just malingerers looking for a fix, use of more effective opioids leads to addiction in a small but significant sub-population, so use of opioids is out of the question for a first line treatment option in primary care. The same goes with benzodiazepines (Diazepam and Temazepam) which are very effective in the short term at controlling muscle spasm, but carry significant risks of dependency even in the medium term.
So for the primary care doctor there is a pharmacological choice between ineffective and effective but disastrous for some.
The solution is within the NICE guidelines. Refer for manual therapy.