There is still a lack of high-certainty evidence on the effectiveness and safety of commonly used painkillers (analgesics) for short bouts of low back pain, finds an analysis of the evidence published by The BMJ.

Analgesics such as Tylenol, Ibuprofen, and Codeine are widely used to treat acute non-specific low back pain, defined as pain lasting less than six weeks. But evidence for their comparative effectiveness is limited. To fill this knowledge gap, researchers trawled scientific databases for randomized controlled trials comparing analgesic medicines with another analgesic, placebo, or no treatment in patients reporting acute non-specific low back pain.

The trials included non-steroidal anti-inflammatory drugs, Tylenol, opioids, anti-convulsant drugs, muscle relaxants and corticosteroids. The main measures of interest were low back pain intensity after treatment (on a 0-100 point scale) and safety (number of participants who reported any adverse event during treatment). Average pain intensity among participants at the start of each trial was 65 out of 100.

Very low confidence was noted in evidence for large reductions in pain intensity (around 20 points) for four medicines, moderate reductions (10-20 points) for seven medicines and small reductions (5-10 points) for three medicines including ibuprofen and Tylenol. low- or very low-confidence evidence suggested no difference between the effects of several of these medications.

You can have high confidence in the expertise of chiropractors for hands-on care of low back pain without pharmaceutical analgesics.

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