Medicines Management for Musculoskeletal Conditions in CantaCore
Paracetamol has been one of the 'go-to' prescription medicines for the treatment of people with non-specific low back pain (LBP) for many years*. Recommended by NICE (National Institute for Health and Care Excellence) for the treatment of low back pain and osteoarthritis, paracetamol or paracetamol/opioid combinations are the most commonly used medicines for the treatment of neuropathic pain, including low back pain with a neuropathic component.
However, in recent years, the efficacy and safety of paracetamol as an analgesic in a range of pain conditions has been controversial.
* Non-specific low back pain is low back pain without an identified disease or condition.
#1 - No efficacy in Paracetamol for low back pain
“there is strong evidence that paracetamol is not effective for reducing acute low back pain.” —— Abdel Shaheed, C. et. al., (2021). The efficacy and safety of paracetamol for pain relief: an overview of systematic reviews. Medical Journal of Australia, 214(7).
According to the experimental results, evidence regarding the effectiveness of paracetamol is insufficient in acute and chronic low back pain. Also, in other chronic pain conditions, paracetamol was not effective. These include, among others, osteoarthritis, chronic neuropathic pain, cancer pain, as well as acute postoperative pain and migraine, with which paracetamol is ineffective.
#2 - The safety of paracetamol is controversial
Emerging evidence provides food for thought. The safety of paracetamol showed similar adverse event rates in some randomised studies in recent months. The cases are associated with:
increased mortality
cardiovascular adverse events (fatl or non-fatal myocardial infarction, stamp stroke or fatal coronary heart disease)
gasrointestinal adverse events ( complications such as ulcers and upper gastrointesinal bleeding)
impaired renal function
acute liver pain
chronic pain
arthritis
Medicines Management for Musculoskeletal Conditions in CantaCore
Since 2005, physiotherapists have been allowed to prescribe alongside GPs or consultants within the NHS. The highly trained physiotherapist Nyle Stewart was actively involved with the Chartered Society of Physiotherapy (CSP) and registered with the Health and Care Professions Council (HCPC). At the same time, In CantaCore, we place a high priority on the patient's medical history and medication use.
The following is a case study that illustrates how a physiotherapist can manage, assess and finally provide an individualised treatment plan in conjunction with a history of medication use, enabling the patient to receive rapid and effective care.
Case
Mr M had a 4-week history of low back pain radiating down to his tailbone and numbness like pins and needles in his lower back. He has been off work for 1 week and has been taking maximum doses of paracetamol and ibuprofen.
Based on a thorough assessment and contacting his GP to double-check his past medical history and potential contraindications, an exercise programme was developed for the patient through a combination of his original pain relief and physiotherapy at the GP hospital. He was also able to exercise, rehabilitate and was assessed all within a week, with results showing a 50% reduction in pain and plans in place for his return to work.