Paracetamol is ineffective for low back pain and provides “minimal short-term benefit” for osteoarthritis, according to a meta-analysis of 13 randomised trials. “High quality” evidence suggested that short-term treatment with paracetamol is ineffective for reducing pain intensity and disability or improving quality of life in people with low back pain. It significantly reduces pain and disability in people with hip or knee osteoarthritis, although the improvement is “not clinically important”.

Adherence and rescue medication use was similar with paracetamol and placebo. The number of patients with any or serious adverse events or who withdrew because of side-effects was similar with paracetamol and placebo. However patients taking paracetamol are 3.8 times more likely to have abnormal liver function tests, although the clinical relevance of this finding is uncertain.

Paracetamol’s long-term effect in spinal pain and osteoarthritis remains unknown. No studies assess paracetamol for neck pain. "Paracetamol has been available for over 50 years and when used in normal doses for short periods, it may still benefit some individual patients,” says Professor Roger Knaggs, pain management expert for the Royal Pharmaceutical Society.

“There are other medicines, such as non-steroidal antiinflammatory drugs and opioids, which may provide better pain relief, but these are associated with a range of other side-effects. “All patients with back pain or osteoarthritis should remain as active as possible rather than taking long periods of rest. Anybody with concerns about whether taking paracetamol could cause harm should discuss their concerns with their GP or pharmacist.” (BMJ 2015;350:h1225).