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  • Doubts About Acetaminophen for LBP, OA Lead to Discussion of Effectiveness of Exercise

    A new study that questions the effectiveness of acetaminophen for low back pain (LBP) and hip or knee osteoarthritis (OA) has also sparked a discussion about what does work: namely, movement and exercise.

    The study itself, published in the March 31 British Medical Journal (BMJ), analyzed results from 13 randomized clinical trials that evaluated short-term pain and disability outcomes for a total of 5,366 patients who received either acetaminophen or a placebo for LBP (1,825 patients) or OA (3,541 patients).

    Researchers concluded that evidence was strong that acetaminophen is "ineffective" for reducing pain intensity or improving quality of life in the short term for people with LBP, and provides "minimal short-term benefit" for individuals with hip or knee OA.

    "Overall, our research is based in 'high quality' evidence … and therefore further research is unlikely to change this evidence," authors write. "This systematic review should inform clinical practice and policy with regard to first line care of these patients."

    The study was accompanied by an editorial in BMJ titled "Physical treatments are the way forward." In that editorial, authors cite the UK's National Institute for Health Care and Excellence (NICE) recommendation that all patients with OA receive information on exercise and weight management (if appropriate) and write that "the effectiveness of exercise for both osteoarthritis and spinal pain is established."

    The editorial names physical therapists as "key professionals to offer expert advice and support in this regard," and calls for a shift in treatment away from drugs.

    "Changing behavior of doctors and their patients is notoriously difficult, but the findings [of the study] emphasize that the time has come to shift our attention away from tablets as the default option for managing chronic musculoskeletal pain," editorial authors write. "Non-pharmacological treatments work, are safe, and have benefits that reach beyond the musculoskeletal system."

    The BMJ study was reported in the media, including on websites for the Today show and US News and World Report, which posted a report on the study first published in HealthDay. Both reports mentioned physical therapy as an effective treatment.

    The HealthDay article also included a response to the study from Allyson Shrikhande, MD, a physiatrist in New York City. Like the BMJ editorial authors, Shrikhande cited the efficacy of nondrug approaches. "Strengthening exercises have been shown to decrease pain in knee osteoarthritis," Shrikhande is quoted as saying in the HealthDay article. "Physicians often prescribe [acetaminophen] or other oral medications as first-line treatment, but perhaps an individually tailored physical therapy program should be tried prior to the use of [acetaminophen] or other oral pain medications."

    The BMJ study authors themselves also acknowledge the benefits of an approach based on movement.

    "Recent evidence on lower limb [OA] shows that exercises (such as strengthening exercise) compared with no exercise control result in large treatment effects for pain reduction," authors write. "[Acetaminophen] alone therefore might not be sufficient to treat hip or knee OA and might need to be accompanied by other management strategies, such as exercises or advice/education."

    The Health Center for Low Back Pain at MoveForwardPT.com, APTA’s official consumer information website, includes numerous resources about the benefits of physical therapist treatment.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.


    • It take a paradigm shift of great lroportions tomget society to aee that magic pills are nit the answer and tha "work"/movement/exercise is. Will MDs refuse to prescribe Opiates when the mivement hets tough because it Is not an easy fix and requires a dedication kn behalf of the client.

      Posted by David A. Lehman,PT,PhD on 4/1/2015 4:51 PM

    • Thank you BMJ!

      Posted by Rita Newton PT on 4/2/2015 11:29 AM

    • Thank you John for featuring our BMJ paracetamol review and the editorial. It certainly sparked a lot of interest across the globe and the authors have been very busy with interviews. Thankfully Easter arrived and created a break for us. I certainly agree with the points you make about the value of education and movement in managing musculoskeletal (MSK) conditions and the important role physical therapists play in managing patients in a primary care (direct access) setting. I wanted to offer a different perspective from the paper that perhaps was less obvious. Physical therapists have made important contributions to MSK research and I think this research adds legitimacy to the argument that physical therapy should be a direct access profession. Our review is a great example of physical therapists doing the heavy lifting in MSK research. We had 8 authors; 6 of them were physical therapists, 1 was a rheumatologist and 1 was a pharmacist. And of course it is not just our paper; across the globe we are seeing significant numbers of physical therapy researchers having an impact in MSK primary care research. I would like to point out that the first author of our review is a physical therapist from Brazil doing his PhD with us in Sydney. When I think back to 1979 when I began my training as a physical therapist; publishing in BMJ was an impossible dream for a physical therapist. But that has all changed and there are now examples of physical therapists publishing in the big medical journals such as New England Journal of Medicine, Annals of Internal Medicine, JAMA, Lancet and BMJ. So I would definitely encourage young physical therapists to consider research as a career. You won't make a lot of money but you will make an important difference.

      Posted by Chris Maher on 4/6/2015 1:57 AM

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