Low back and neck pain (spinal pain) affects slightly more than nine percent of the world’s population, while osteoarthritis affects nearly four percent. For years, acetaminophen (Tylenol and other brands) has been the go-to drug recommended to ease these pains. Now, a group of Australian researchers are saying, Not good enough. Acetaminophen is ineffective when treating low back pain, their new research study finds, and can provide only minimal, short term benefit to sufferers of osteoarthritis.

Drugs cost money, money no one wants to spend, but extreme pain usually outweighs financial considerations. Pain in the lower back can make both standing and sitting impossible, while neck pain sometimes rules out even bed rest. Another type of pain, osteoarthritis, occurs whenever cartilage, the tough but flexible tissue that covers the ends of your bones at a joint, wears down. Any joint in your body may be damaged by osteoarthritis, but the disorder usually affects the hands, knees, hips, and spine. Since this pain generally worsens with each passing year, sufferers wanting relief are highly likely to reach for the nearest drug. But what works?

Some previous studies comparing acetaminophen with placebo reported only small beneficial effects in combating osteoarthritis pain. Plus, the guidelines were published back in 2007 and might be outdated. For this reason, the researchers of the current study decided to test how effectively this “first line analgesic” treated both spinal pain and osteoarthritis pain. After gathering 12 reports, including 13 randomized trials, the researchers performed extensive calculations and analysis of all the data.

The researchers found acetaminophen to be ineffective for reducing pain intensity and disability or improving quality of life in the short term in people with low back pain. For hip or knee osteoarthritis acetaminophen provided a small effect on pain and disability in the short term.

“These results support the reconsideration of recommendations to use [acetaminophen] for patients with low back pain and osteoarthritis of the hip or knee in clinical practice guidelines,” concluded the authors.

Advocates of natural cures for pain relief often suggest exercise, massage, acupuncture, and ice and heat therapies. In cases of osteoarthritis that affect knees and hips, it’s usually important to keep your weight under control as well. Sadly, pain management may be difficult or even impossible for some patients.

Source: Machado GC, Maher CG, Ferreira PH, et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ. 2015.