Efficacy and Safety of Paracetamol for Spinal Pain
Efficacy and Safety of Paracetamol for Spinal Pain and Osteoarthritis: Systematic Review and Meta-Analysis of Randomised Placebo Controlled Trials
The problem of back pain has an extremely high level of relevance in modern society. Everyone experiences symptoms of back pain in different forms and with different consequences. Machado et al. (2015) claim that spinal and neck pain are considered as the primary reasons for disability. Constantly increasing expenditures for treating pain also prove this statement. While the use of drugs and especially paracetamol is the most common method of treatment, there is no unanimous opinion about its efficacy. Moreover, the authors outline that use of paracetamol can be considered as the placebo effect instead of real treatment (Machado et al., 2015). Therefore, there is a need for tests of the efficacy of this drug and its comparison to the placebo effect.
The authors of the article are concerned with significant expenditures aimed to spinal pain treatment. Such a method is used mostly for the cases of low back and neck pain. However, the use of paracetamol as a primary drug makes these expenditures ineffective. The reasons for its popularity include low cost and a small risk of complications. However, Machado et al. (2015) outline that the dosage for real therapeutic effect can be up to 4000 mg/day. Therefore, constantly increasing dose has a number of negative effects on human body. The lack of qualitative research devoted to the efficacy of paracetamol and its comparison with the placebo effect forced the authors to investigate the current state of spinal pain treatment. After a deep meta-analysis and systematic review, the authors have made a conclusion that paracetamol is ineffective for LBP treatment and it shows no significant results for people with osteoarthritis.
As a basis for research, a strong literature review is provided by the authors. Machado et al. (2015) found more than four thousand records, and after that, two reviewers evaluated about one hundred studies and thirteenth trials devoted to the use of paracetamol in spinal pain treatment. Then, the authors divided the results of their findings into spinal pain and osteoarthritis groups and compared the results according to details of participants, interventions, and outcomes. Moreover, Machado et al. (2015) provided the risk of bias for every particular trial. Such a deep literature review gives an opportunity for the use of these results as a starting point for future research.
The research provided by Machado et al. (2015) is extremely relevant today. Thus, low back pain is one of the most common causes of serious illnesses and even disability (The Lancet, 2015). It is generally believed that the reasons for back pain are musculoskeletal changes associated with stretching and excessive overload of muscles, ligaments, and joints of the spine. Back pain can signal the diseases of the spine and muscles, injuries, nervous system, pathology of the internal organs of thoracic and abdominal cavity, or even mental disorders. In addition, the causes of back pain are traumatic loads of the spine, which can be a consequence of vertebral fractures and a ruptured disc, but more often stretching of the capsule of the joints and ligaments of the spine. The microtrauma or muscle strain can be obtained in the performance of unusual movement, which subsequently supposedly can cause back pain. Neck pain is triggered by a prolonged uncomfortable position of the head or torso, the awkward posture of the hands when performing work, long sitting, and the impact of vibration. If person experiences dissatisfaction with working conditions, it also contributes to the development of back and neck pain. Despite the detailed statistics, the Governmental expenditures remain ineffective because of the use of paracetamol as a primary drug for back pain treatment. Therefore, the research by Machado et al. (2015) includes not only medical but also a financial factor.
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Since the authors cannot manipulate the subject, the type of research is non-experimental. Machado et al. (2015) analyzed and evaluated different data about spinal pain and paracetamol. However, such type of research can be easily explained by the size of the sample. Moreover, the analysis of different sources gives an opportunity to take into account different variables that a single study cannot include. The authors used two independent reviewers to extract data and a third reviewer helped to avoid any disagreement. Moreover, the researchers contacted the authors of different studies in case they lacked the needed information. In addition, all studies were evaluated according to study design, the consistency of results, and risk of bias. The system of rating of the quality of evidence provided detailed and well-grounded research.
In relation to the purpose of the study, Machado et al. (2015) have provided a systematic review of such electronic sources as Medline, Embase, AMED, CINAHL, Web of Science, LILACS, International Pharmaceutical Abstracts, and Cochrane Central Register of Controlled Trials. In order to perform a deep and relevant study the authors examined more than four thousand publications and randomized controlled trials devoted to the efficacy of paracetamol. The authors did not focus on the duration of the study, date of publication or country; they considered only the patients with non-specific back pain, osteoarthritis or their mix and excluded the cases with serious pathologies. Therefore, the size, composition, and criteria of the search made the sample for the research relevant and appropriate. Additionally, it excluded any sign of bias.
This work has a high level of practicability. Machado et al. (2015) made one of the few examples of deep and consistent analysis devoted to the back pain issue. The lack of information about this problem is a key factor for inefficient expenditures and insufficient treatment methodology. The researched problem is observed in the studies by Zhang, Jones, and Doherty (2004) and Towheed et al. (2006), but it still lacks the complex approach. The authors suggest that their research with high-quality results demonstrates the inefficacy of paracetamol as a primary pharmacological treatment for spinal pain. According to the GRADE system, the results of the research have a critical influence on the clinical decision making. I consider this study as an impetus for future changes in clinical methods and guides as well as a primary factor of decreasing popularity of paracetamol. Another important side of this study is a well-grounded basis and reliable source for all future research.
In my opinion, the research could be improved in case the authors had the possibility to implement the experimental type of research in addition to non-experimental analysis. While the non-experimental method provides an overall look at the problem, the experiment gives an opportunity to set and observe some specific causal relationships. Machado et al. (2015) outline that despite the proved inefficacy of paracetamol, its negative effects on the human body remain uncertain in clinical practice. However, the size of the sample and strong evidence base compensate for the lack of experimental research to some extent.
The language of the article varies in different parts of the text. The introduction and conclusion are written in a simple manner. Therefore, even the person without medical education can figure out the main results of the investigation. The body of the research, on the contrary, requires some medical knowledge since it describes the methodology, information analysis, and additional concepts used in this investigation. In my opinion, such deep and grounded research requires such different languages. The reader easily finds key results and, at the same time, understands that this is not an article in the entertainment magazine. While the language can change, the structure of the paper is clear and consistent. Machado et al. (2015) starts with the background information and after that, the description of methods and concepts goes. At the end of the article, the authors raise the discussion, explain strengths and weaknesses of the research, and give a start for future investigation on this topic.
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As it was previously mentioned, the article gives a variety of perspectives for the additional research. Machado et al. (2015) outline that the evidence of the inefficacy of paracetamol was founded only for a short term. However, the long-term effect remains unclear. In addition, while the previous studies by Zhang, Jones, and Doherty (2004) and Towheed et al. (2006) focused on the efficacy of paracetamol for osteoarthritis, there are no trials for this drug and neck pain treatment. Moreover, the results of the study showed that paracetamol has some negative effects on liver and this statement requires the experimental proof.
The constantly decreasing physical activities make the problem of spinal pain more and more relevant. Monotonous activity and repetitive movements contribute to the development of back pain as well as such activities as lifting weights, prolonged static loads or vibrations in the workplace. Age, sex, socio-economic status, and level of education are also considered as the risk factors for back pain. It can result from the high physical activity, especially in young adults. Over time, the spine becomes more prone to damage, even without the excessive load. One of the most popular methods of treatment of non-specific cases of spinal pain is the physiotherapy and different exercises. However, many people have no time or possibility for special courses of therapy and prefer to use paracetamol as the most popular drug. However, the article in question proved inefficacy of the use of paracetamol with the help of grounded data analysis. In such condition, it is extremely important to design an effective and low-cost drug that has a minimum of side effects.