An editorial notes that this study is the first RCT to assess paracetamol versus placebo for patients with acute low-back pain, and its results could have a substantial effect on the management of patients with low-back pain, as clinical guidelines recommend paracetamol as the first choice analgesic for this condition. These recommendations are based on indirect evidence from other pain specialties, consensus in guideline committees, and the relatively favourable safety profile of paracetamol compared with NSAIDs. The current findings require replication in further studies. Whether these findings apply to other populations should also be evaluated, as well as whether prescription of simple analgesics has additional benefit to advice and reassurance of the favourable prognosis for acute low-back pain.
The updated NICE guideline on osteoarthritis was originally intended to include recommendations based on a review of new evidence about the use of paracetamol, etoricoxib and fixed-dose combinations of NSAIDs plus gastroprotective agents. Stakeholder feedback at consultation indicated that the draft recommendations, particularly in relation to paracetamol, would be of limited clinical application without a full review of evidence on the pharmacological management of osteoarthritis. NICE was also aware of an ongoing review by the MHRA of the safety of over-the-counter analgesics. Therefore NICE intends to commission a full review of evidence on the pharmacological management of osteoarthritis, which will start once the MHRA's review is completed, to inform a further guideline update. Until that update is published, the original recommendations (from 2008) on the pharmacological management of osteoarthritis remain current advice. However, the Guideline Development Group (GDG) drew attention to the findings of the evidence review on the effectiveness of paracetamol that was presented in the consultation version of the guideline. That review identified reduced effectiveness of paracetamol in the management of osteoarthritis compared with what was previously thought. The GDG believes that this information should be taken into account in routine prescribing practice until the planned full review of evidence on the pharmacological management of osteoarthritis is published.