Acetaminophen and Back Pain

I guess since I’m a pharmacist I should talk about drug related topics once in a while.

There is a study that was recently published about the use of acetaminophen (Tylenol) and its use in lower back pain. I don’t have access to the study other than the summary so I can’t make any conclusive remarks about what actually took place but wanted to comment on what was printed.

In this study conducted down under, 1643 people were analyzed for lower back pain and relief with acetaminophen (APAP for the rest of this post). The subjects were randomized into 3 groups; an around the clock dosing, an as needed dosing and placebo. [1]

The amounts of APAP in the first group were around 3990mg/day, the second group was 4000mg/day and then placebo which had none. They were followed for 3 months but only received 4 weeks of medication. Researchers were looking to see when patients reported relief on a pain scale of 0-1 (on a 1-10 pain scale) for 7 consecutive days.

The results were there was no difference between the 3 groups. The authors concluded that regular use of APAP,

does not affect recovery time compared with placebo in low-back pain, and question the universal endorsement of paracetamol in this patient group”

Again I don’t have access to the study itself so I can’t delve into specifics, but we can ask a few questions.

Was their a decrease in pain at all and if so how quickly did pain decrease and by how much? What kind of injury caused the back pain in the first place? Was it acute pain or chronic?

To answer the last question it does sound like it was probably more acute pain. Had it been chronic I doubt there’d been any difference in the pain levels over 4 weeks or 4 months, at least not to 0-1.

I can’t answer the first question but I suspect that the answer is the treatment probably did decrease pain, just not to a 0-1 level. I do admit that personally I don’t really respond to APAP for pain, but it does wonders if I have a fever and the opposite is true for Ibuprofen. Some people I’ve talked to respond well to APAP and others don’t.

Since I can only speculate I assume some of the patients did get pain relief while others may not have. The other question though, what caused the pain in the first place, would be relevant as well because if there is an inflammation component that is clinically significant, then APAP might not do so well as it doesn’t help inflammation.

Does that mean that APAP is worthless and shouldn’t be used for lower back pain? Not necessarily. It may be very helpful for some and the only real way to know is to try some. Be aware though that doses much higher than 625mg aren’t more effective than 1000mg.

Taking lots of APAP has the effect of decreasing glutathione in the liver which is one of the body’s main antioxidants. For a short period of time this is likely not a problem, but over weeks and months this could leave you vulnerable to oxidative damage assuming the body isn’t getting enough nutrients in the diet to replenish stores. Fresh meats, veggies like asparagus and spinach, and other foods like garlic contain sulphur compounds which are what the body uses to replenish stores. N-acetyl-cysteine is also used because it’s rapidly converted in the body to glutathione.

This is one of the major problems in the United States as far as drug overdoses are concerned. Around 150 people die every year from APAP overdose. [2] Those who survive usually end up with sever liver damage and many require transplants. That number of 150 is an average over 10 years from 2001-2010 and they are all accidental.

Yup, accidental!

From 1998-2003 The leading cause of liver failure was APAP overdose.[3]

From 1998-2007 there was an estimated 57,000 ER visits and 26,000 hospitalizations per year due to overdose.

This is pretty serious.

The max recommended dose per day is 3000mg for a healthy adult. Please be aware of medications that may have APAP in them. In other words READ THE LABEL!

Be very careful with children’s doses as well. Sometimes the bottles you get at the pharmacy for an infant will be a different strength that for a bottle you buy at the store that also says infant.

I didn’t mean to turn this into a scare post but it’s important to remember that no medications is benign. We make a big deal about things like weight loss drugs and steroids, and rightly so, but we need not forget the dangers of simple things like APAP.

If you need to use some APAP please don’t feel like I’m discouraging its use. It may be helpful. Just please remember that for something like back pain it’s probably not going to make you feel 100% and that taking more will do nothing for the pain and potentially make it worse if you keep at it for long due to liver problems. NSAIDs like naproxen or ibuprofen may be better suited to the task but talk to your doc or handy pharmacist if you have questions.


1.Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial Christopher M Williams, Christopher G Maher, Jane Latimer, Andrew J McLachlan, Mark J Hancock, Richard O Day, Chung-Wei Christine Lin
The Lancet  24 July 2014





How to Intentionally Eat

I hope everyone had a wonderful Independence Day!

In the last post I discussed a bit about some foods that are fakey when it comes to being healthy and how they aren’t really that much better than the crappy ones they copy or just straight up pretend to be healthy.


Today I want to discuss how to be intentional when it comes to eating healthy and maybe be a bit more specific on how to be intentional when taking a break and enjoying say…cherry pie or some ice cream.

When doing exercise, unless you’re straight up running for 60 min and then call it quits, you take breaks. During intense weight lifting you break in between heavy sets. During sprints you either walk or lightly jog or spin or pass out on the field until the next sprint is to begin. I don’t think your lifestyle should be much different. A break now and again is good, especially mentally.

So how do you have that ice cream without breaking your diet?

This is the first thing we need to get out of the way. You can’t be on a diet. That may sound weird but I’ve discussed this before. A diet is different from YOUR diet, meaning what you regularly put into your mouth. When people talk about A diet, they usually refer to something they will follow for a few months, maybe a year and then stop. It does not in anyway become a part of who you are.

Think about it. If you go to the gym everyday because you enjoy it, or go swimming or play tennis because you enjoy it then that is part of your lifestyle. If you go to the gym or play tennis or swim for 3 months and call it quits then it’s NOT a lifestyle. Watching a good TV show now and again or a good movie now and again doesn’t make you a couch potato. Watching those daily probably does.

If you’re going to change your diet then it has to be a lifestyle change and for that to happen it actually has to be something you want to do.

Lets say right now I’d like to cut some body fat. That’s not a bad thing. So I eat less calories but continue to eat foods I like such as steak and salmon and salads. In 4 months I lose the weight I want and want to maintain the weight I have. I eat the same foods I love, steak salmon and salad. Maybe come wintertime I want to gain some more muscle. I eat the same foods but in a larger quantity to let my muscle build up. The types of food I eat don’t really change during a weight loss, weight maintenance or weight gain, but the quantities do. Most of the time the quantities are the same because I’m not trying to gain or lose.

So if you’re trying to lose over a period of say 3-4 months how do we take a break. PLAN IT OUT!

Lets say you are really craving those Oreos. Instead of buying a pack and wolfing down the whole thing before you know what happened, set aside 2-3 cookies, sit down and enjoy them. Dont’ begin eating till you’re ready to indulge your taste buds. If you are eating them while still prepping or standing up, you aren’t going to enjoy a thing.

How much do you enjoy food when you’re in a hurry? Answer: You don’t. Hamburgers taste way better when I’m sitting down and done cooking them than when I’m trying to scarf one down while still cooking the others. Same with cherry pie, ice cream or any other treat.

Put the rest of whatever you’re going to indulge on away before you even begin eating. Enjoy your food.

Be aware that if you’re trying to lose weight that you should have your calories be part of an isocaloric day, meaning that will be a day in which you’re not actually trying to lose weight but trying to maintain what you have. Calculate how many calories of your indulgence will be and then figure what you normally eat that day. If the number is too high you can cut back on something else.

A good website to calculate total calories for a day is and there are several others.

After you’ve indulged a bit and are finished eating. Be done. Be grateful and move on. To me it’s like a mini vacation. It’s planned and not spur of the moment so you know exactly what you are doing. If you don’t plan it, the whole package of oreos will be gone before you know it, you will end up regretting ever wanting to indulge and maybe give up on everything altogether because you feel you have no self control.

Plan ahead!

Last night I had a small fudgecicle. It was tasty.I allowed for the 80 calories in my treat and sat down and enjoyed every chocolate lick I got from it. Before I sat down I did the following important action:

Put the rest away!

When I was done, I had enjoyed some chocolate and moved on. That was it. Easy peasy.

This goes with things like steaks too. Steak has a lot of nutrients and is a great source of protein. A 16 oz T-bone can have around 1100 calories and 110g protein. You’d be better off eating that thing as a 4oz-6oz cut with 275-412 calories and 27.5-41.2g protein. Your body will be able to utilize the protein and the calories won’t be too much plus you still get to have steak at more than 1 meal. It’s more cost and calorie effective. Not to mention you’re body has a hard time with much more than 50g protein at a time.

And you won’t feel like a bomb went off in your stomach when you’re done.

Have some good food. A treat now and again isn’t problematic. Be intentional with how you enjoy your food. Being unintentional will only make life happen to you rather than you happening to life.