Paracetamol: is it effective and safe for musculoskeletal pain?

Christopher G Maher, Andrew J McLachlan, Christina Abdel Shaheed



Paracetamol is widely recommended as the first choice for pain relief in common musculoskeletal conditions. However, recent research challenges its effectiveness and safety in patients with low back pain or osteoarthritis.

Key Points

  • A systematic review of trials of paracetamol as an analgesic has shown it is no more effective than placebo for low back pain and has a trivially small effect for osteoarthritis.
  • There are no trials of paracetamol with long-term outcomes for either low back pain or osteoarthritis.
  • Paracetamol toxicity is responsible for the hospitalisation of 150 patients per week in Australia; most cases of paracetamol toxicity are unintentional.
  • Inadvertent paracetamol overdose is a particular risk among patients with chronic pain who may be taking modified-release formulations.
  • GPs prescribing or recommending paracetamol should educate patients about paracetamol toxicity and the need to avoid taking two or more paracetamol formulations concomitantly (e.g. paracetamol-containing cold and flu remedies plus regular paracetamol for pain).

    Picture credit: © Lisa F. Young/Dollar Photo Club. Model used for illustrative purposes only.