Shahd Al Hamadneh, Kamel Earar, Gabriel Valeriu Popa, Alina-Ramona Dimofte, Norina Consuela Forna, Doriana Agop Forna, Sara Earar
Abstract
Paracetamol (acetaminophen) is one of the most widely prescribed and self-administered analgesics worldwide, commonly recommended as a first-line treatment for musculoskeletal pain, including non-specific low back pain and osteoarthritis. Its reputation as a safe and accessible drug has contributed to its extensive use, yet accumulating evidence challenges both its efficacy and safety profile. Pharmacological research highlights that paracetamol acts mainly through central mechanisms, offering analgesic and antipyretic effects without strong anti-inflammatory action. Clinical trials and systematic reviews indicate that, although paracetamol may provide modest pain relief in osteoarthritis of the knee and hip, its benefits in spinal pain are minimal and often indistinguishable from placebo. Extended-release formulations have shown some improvement in sustaining analgesia, but overall clinical outcomes remain limited. Safety remains an important concern, particularly due to hepatotoxicity associated with high doses or long-term use, leading to regulatory efforts to minimize risks. Despite these limitations, paracetamol continues to be valued for its affordability, tolerability, and role in patient-centered treatment strategies. This review critically examines the effectiveness and safety of paracetamol in spinal pain and osteoarthritis, highlighting the need for realistic expectations and further well-designed trials to clarify its therapeutic position.
DOI : 10.62610/RJOR.2025.3.17.20
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