April 1, 2015
Acetaminophen Ineffective for Low Back Pain
之前聽腎臟科的老前輩開玩笑地說，醫院的腎臟科門診對面就是風濕科，左邊是骨科。每次看到這二科的病人領藥後一大包的帶回家，真是造就了許多胃腸科和腎臟科的病人啊！
而身為一位腎臟科醫師，我們所受到的訓練也是要減少NSAID止痛藥，因為它的腸胃道和腎臟方面副作用，是令人謹記在心。然而，我們洗腎病人因為年齡高下背痛的比例也不少，開acetaminophen真的效果不如NSAID來得好。有了這篇meta-analysis，我想不能再錯怪骨和風濕科同仁開的NSAID，而我們在遇到下背痛的患者，也許可以考慮開一下NSAID，因為
"Acetaminophen is not effective for relieving low back pain, according to a BMJ meta-analysis."
Researchers analyzed the results of 13 trials encompassing 5400 patients with either spinal pain or knee or hip osteoarthritis who were randomized to acetaminophen or placebo. In two studies on low back pain, acetaminophen did not appear to improve pain, disability, or quality of life. In the remaining studies on hip or knee osteoarthritis, acetaminophen appeared to provide a small — but not clinically significant — benefit in relieving pain and disability.
In addition, patients taking acetaminophen were nearly four times more likely than placebo recipients to have abnormal liver function test results.
醫師因為擔心患者腎或是胃腸副作用而開立acetaminophen，也不要忘了，這些人可能遭受肝功能的受損。
原文連結：
For Low-Back Pain, Acetaminophen Is No Better than Placebo http://shar.es/1gJAfk
Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials http://www.bmj.com/content/350/bmj.h1225
Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials http://www.bmj.com/content/350/bmj.h1225
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