Tylenol and other products containing acetaminophen do little or nothing to help lower back pain or arthritis, a new report finds.
Patients might do better with stretching and exercise, the Australian researchers report. They don’t recommend that people move on to stronger drugs such as opioids.
It’s sure to be a controversial finding. Most expert groups advise that people try acetaminophen first — even though the pills can cause liver damage, if people take too much. They’re also far safer than drugs such as ibuprofen or naproxen, known as non-steroidal anti-inflammatory drugs or NSAIDS. NSAIDS can sometimes cause deadly gastric bleeding.
And the dangers of opioids are even worse — dependence, addiction and overdose.
For the study, Gustavo Machado from The George Institute for Global Health at the University of Sydney in Australia and colleagues reviewed 13 different studies that looked directly at which treatments helped lower back pain and arthritis.
Ten of the trials included 3,541 patients with osteoarthritis of the hip or knee, and three trials included 1,825 patients with lower back pain.
“There was ‘high quality’ evidence that (acetaminophen) is ineffective for reducing pain intensity and disability or improving quality of life in the short term in people with low back pain,” they wrote in the online version of the British Medical Journal, called The BMJ.
“For hip or knee osteoarthritis there was ‘high quality’ evidence that (acetaminophen) provides a significant, although not clinically important, effect on pain in the short term,” they added.
“(Acetaminophen) is ineffective in the treatment of low back pain and provides minimal short term benefit for people with osteoarthritis.”
It might be better to tell people to manage pain with exercise and stretching, the team recommended.
That’s what Susan Fox of Cambridge, Massachusetts, will do from now on.
Fox, who is 59, takes acetaminophen for back pain that followed back surgery.
“If I kind of have acute back pain, then I will be taking it every day, extra strength as a way to not make it any worse because I’m worried about permanently injuring my back and not being able to make it better,” she told NBC News. “And that’s pretty much what I have been told to do.”
But Fox says she also exercises five days a week. “I go to the gym,” she said. “I go running,” she added. Stretching is important.
“It helps in an enormous amount, because not only has it made me a lot stronger (but it helps) in all kinds of ways.”
Fox, a computer programmer, was disappointed by the study’s findings.
“I was really surprised to hear that it really didn’t have any effect on acute back pain, because that’s what’s really offered to you,” she said.
“Tylenol is supposed to be the thing you do to relieve it.”
Dr. Allyson Shrikhande, who specializes in physical rehabilitation and pain at New York Bone and Joint Specialists, says it’s unlikely doctors will change their recommendations just yet.
“The study does make me question the use of acetaminophen,” she told NBC News.
“My experience is the Tylenol is just controlling symptoms while not fixing the problem,” she added.
“However, given other options it will remain the first-line treatment as oral pain medication.”
The makers of Tylenol didn't directly challenge the study.
"The safety and efficacy profile of acetaminophen is supported by more than 150 studies over the past 50 years," McNeil Consumer Healthcare said in a statement.
Jane Derenowski and Judy Silverman contributed to this report.
This article was originally published Mar. 31, 2015 at 6:30 p.m. ET.