SubEx

Comparison

Back pain: Tylenol or an anti-inflammatory?

For low back pain, paracetamol, the drug in Tylenol, came half a point ahead of placebo out of 100. Anti-inflammatories helped a sudden bad back a little; reviews split on how sure that is.

Acetaminophen (Paracetamol)NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

Many people assume Tylenol will ease a bad back. Across 13 trials, on evidence graded high quality, paracetamol came half a point ahead of placebo on a 100-point pain scale, with disability no different, over up to twelve weeks. For a sudden bad back, anti-inflammatories beat placebo, but the benefit was small, and another review rated every painkiller's evidence low or very low. On the familiar pill the answer is a confident near-zero; on anti-inflammatories, a small benefit still argued over.

The findings behind this

1–
PainParacetamol beat placebo by half a point out of 100 for back pain

Across 13 trials on a 0-to-100 pain scale, paracetamol came half a point ahead of placebo, and did not change disability or quality of life. The evidence was graded high quality.

★★★Well replicated — this finding’s sources average out to meta-analyses, systematic reviews or high-powered trials.Short-term outcomes only, out to twelve weeks, so this says nothing about months of use. A group average does not rule out individuals who feel better on it. A separate network of 98 trials covering 69 medicines for the same condition rated confidence in every analgesic tested as low or very low, which is a different verdict from a confident null and worth holding alongside it. Four authors, lead and senior among them, had GlaxoSmithKline support for one of the pooled trials, a conflict that runs against the finding rather than towards it.Click to keep this openRelieve painAcetaminophen (Paracetamol)
2↓
PainFor a sudden bad back, the benefit is small and the reviews disagree

Cochrane pooled 32 trials and found these drugs better than placebo for acute low back pain. A network of 98 trials rated every painkiller it tested at low or very low confidence.

★☆☆Contested — the evidence disagrees with itself, or the finding carries a caution. A caution or conflict always shows one star, however strong the sources are.Conflicting evidenceBoth reviews agree any benefit is small, and the Cochrane authors call the size probably not clinically relevant. Low confidence means the evidence cannot settle the question, not that the drugs were shown not to work. Only 7 of the 32 trials in the Cochrane review were judged at low risk of bias, almost half were industry-funded, and most were never registered. Neither review followed anyone long enough to speak to repeated use.Click to keep this openRelieve painNSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

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