Paracetamol (acetaminophen) is a drug we are all familiar with. It is cheap, readily available over the counter, and is common place in family medicine cabinets across the world. We rely on it in the middle of the night to settle childhood fevers, and it is usually our first choice drug for a wide range of painful musculoskeletal disorders, including osteoarthritis and spinal pain. Yet new evidence in a linked paper by Machado and colleagues (doi:10.1136/bmj.h1225) casts doubt on the efficacy and safety of paracetamol and questions its place as our first choice analgesic.1

In their systematic review and meta-analysis examining the efficacy and safety of paracetamol for spinal pain and osteoarthritis, Machado and colleagues synthesised evidence from 13 randomised controlled trials.1 They report that there is “high quality” evidence that paracetamol is ineffective for reducing pain intensity and disability in patients with low back pain and “high quality” evidence that paracetamol produces a significant but not clinically important effect on pain and disability in patients with osteoarthritis. While adverse events were reported at a similar level …