Acetaminophen (Tylenol) Shows No Effect in Acute Low Back Pain

December 3, 2014 in STSMPT

Acetaminophen is a more generic name for the active ingredient in popular pain medicine such as Tylenol, Excedrin, and Goody’s. Other brands contain acetaminophen as well. While this medicine has been on the market for a long time, we are still learning a lot about it.  For instance, science has only recently demonstrated that it really doesn’t help in cases of acute low back pain.


Because acetaminophen is considered relatively safe when used as directed, medical guidelines often recommend it as a first-line approach in cases of low back pain. However, this recommendation has been made based on acetaminophen’s safety record – not on any evidence that acetaminophen actually helps low back pain. Interestingly, a study published in the medical journal, The Lancet, last July finds that acetaminophen does not help low back pain.(1) This was the first randomized, placebo-controlled trial of acetaminophen for acute low back pain.


Researchers divided 1,652 low-back-pain patients into three groups: take as prescribed, take as needed, and a placebo group. Placebo means they gave the patients pills with no active ingredients. So while the study subjects may have believed they were receiving medicine, they were not. On a scale of one to ten, the average patient had a pain rating of 6.6, and the average patient had been experiencing pain for 9.9 days. They were treated across 235 primary care practices. There was no statistically different experience of pain between the acetaminophen groups and the placebo group.  The researchers state that acetaminophen (and non-steroidal anti-inflammatories such as aspirin) may not be important in the management of low back pain.


An important follow-up point here is that treatment for low back pain must be more than making the pain subside for a while. Even if the acetaminophen had caused important pain relief, it would have just been a patch. In most cases, chronic low back pain flares up because there has been a long-standing, specific deconditioning of muscle or other structure of the low back. Identifying and correcting that deconditioning is the approach that will honestly treat the back pain, and that’s where physical therapy comes in. Unlike acetaminophen, physical therapy programs have been shown to have valuable effects in terms of accelerating pain relief, reducing healthcare expenses, and reducing recurrence.(2,3)



  1. Williams C, Maher C, Latimer J, et al. Efficacy of paracetamol for acute low-back pain: a double-blind, randomized controlled trial. The Lancet, 2014; doi:10: 1016/S0140-6736(14)60805-9.
  2. Fritz J, Childs J, Wainner R, Flynn T. Primary care referral of patients with low back pain to physical therapy: impact on future health care utilization and costs. Spine, 2012; 37 (25): 2114-2121.
  3. Gelhorn A, Chan L, Martin B, Friedly J. Management patterns in acute low back pain: the role of physical therapy. Spine, 2012; 37 (9): 775-782.


Tylenol Low Back Pain

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